Term 3 mock exam Flashcards
- A patient arrives for a CXR.
a. Name TWO (2) ways to ensure full inspiration is achieved on a CXR.
Discuss the instructions with the patient first, letting them know it is important
- Practice the breath in with the patient
- Watch the patient so you expose at the correct time
Identify TWO (2) ways to check whether a patient is rotated on a PA CXR image.
- The ribs should appear symmetrical
- The medial end of the clavicles should be equidistant from the midline
- The distance from the lateral border of the vertebral column to the costal margin should be equal
The request form states ‘CXR – PA AND LATERAL VIEWs please’. Provide a clinical indication that would be expected to be written on the request form (.5) and explain the reason why a lateral view is justified to be performed
Oncology reasons – see mets. behind the lungs
Mass on a particular lung (R/L)– close to ID
. You are looking at a lateral chest image. List THREE (3) ways to judge whether the positioning of the lateral was acceptable:
For a true lateral projection the ribs should appear superimposed posteriorly
- The apices and bases should be included (lean the patient forward to include posterior bases) - The humeri should be elevated so that there is no soft tissue overlap from the arms. - the midsagittal plane should parallel to the IR, no cupping seen of the thoracic vertebra
What is COAD?
Chronic obstructive airways disease
What is LVF?
Left ventricular failure
What is PE?
Pulmonary embolism or pleural effusion
What is CABG?
Coronary artery bypass graft
On a patient’s request form the Doctor has requested an Abdomen X-ray.
a. State TWO (2) clinical reasons which justify this projection
? Obstruction
Pain ? cause
Suggest an average adult exposure for a KUB X-ray, a kVp (.5) and a mAs (.5) value.
70 - 85 kV, and 20 - 35 mAs
Your next patient has arrived on a bed for a knee X-ray after their surgery. On the referral form the clinical indications states ‘Post op TKR’
a. Define the abbreviation TKR
Total Knee replacement
When positioning the patient for an AP Knee projection, suggest ONE (1) positioning consideration you will apply when you are manoeuvring the man’s leg to ensure that the knee is in a true AP position?
The condyles of the knee should be equidistant from the table top.
The patella should be centralised.
You are working in the Orthopaedic department and your next patient is an adult for an Elbow X-ray. The clinical indications states the following ‘Fell onto R elbow. Pain over olecranon’
a. Justify your choice of which X-ray projection would you perform first
Lateral first. More comfortable for patient to begin with as painful over the olecranon
Describe the key points of positioning for an elbow lateral view, including the centre point (.5) and central ray (.5)
Sit the patient alongside the table, with the table raised so that the elbow is level with the shoulder (.5) and the elbow is flexed 90deg (.5). Position the film under the elbow and turn the wrist true lateral (if patient able to) and ensure the epicondyles of the humerus are superimposed (.5). CR should be perpendicular centred to the elbow joint (.5) which is 4cm medial to the olecranon process (.5)
Briefly discuss why is it important to include both the ankle and knee joints when the request card suggests ?# tibia.
With some fractures of the distal tibia there may also be a fracture of the proximal fibula as these bones articulate in a ring formation
You are imaging the tibia and fibula of a tall patient. Suggest two methods that would increase your chances of including both joints on one image.
Increase the FFD
Turn the cassette on a diagonal
You are working in ED when an 80 year old male arrives in the department. The request form states “Fall. Valgus deformity L Hip ?# NOF”
Name TWO (2) views you would take on this patient (2 x .5) and how will a valgus deformity affect your positioning?
AP Pelvis ASIS down
Cross table lateral hip
This means you will not alter the position of the affected leg to risk further damaging the hip and blood vessels (.5). This is of particular importance for the AP pelvis as you will not medially rotate the leg (.5)
What is valgus deformity (.5) and write in full what the pathology is likely to be demonstrated on the images
Valgus deformity: The hip and foot will be turn out laterally.
This is a classic sign of hip fracture - Neck of Femur #
Suggest ONE (1) method you would use to check that the correct exposure was used for producing diagnostic images of a hip fracture.
EI – within range
Cortical outline of femoral shaft and soft tissue
Bony trabecular pattern
A 18 year old female presents to the Radiology Department with an injury to base of thumb. Her GP has requested for her to have routine thumb X-rays with the clinical indications stating ‘Injured thumb yesterday. ++++ swelling ? Base of thumb #’.
a. Name a pathology that involves a fracture at the base of the thumb that would be likely to be demonstrated on the images taken
Bennett’s fracture
. As well as checking the patient’s name, DOB and that the correct anatomy has been requested to be X-rayed, what should you also check with the patient?
Pregnancy check / LMP
With the swelling around base of thumb, name the views that you take to complete the examination (2 x .5) and justify why you would chose to perform these to complete the examination answering the clinical indications
PA and lateral views (1 mark)
PA and too sore for AP (plus swelling – hard on patient to bring dorsal aspect of hand on ID)
Lateral – to show base of thumb in 2 planes – more information of base of thumb fracture if present
A young man arrives in the Radiology department for imaging of his left shoulder from a sporting injury with querying a dislocation.
a. Explain the differences in positioning and image appearance of an AP Shoulder to the Grashey’s method.
The most commonly employed AP method requires a 15 degree rotation towards the affected side so that the body of the scapula is parallel to the cassette and there is a 1/3rd overlap of humeral head on the glenoid fossa
The Grashey’s method, however, uses a 45 degree posterior oblique rotation so that the Glenohumeral joint is open (glenoid rim in profile)
Will accept true AP description with half overlap of humeral head on glenoid.
Describe the key points of positioning for a shoulder Lateral Y view, including the patient positioning technique (2 x .5), central ray (.5) and centre point (.5)
Erect in an anterior oblique position in front of the upright bucky
MSP 45-60degrees in relation to the IR- medial border of scapula and acromion process should align
CR perpendicular to the midpoint of the medial scapula
