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Normal Rad I Final Exam
1.
Order of radiologic density from radiolucent to radiopaque:
Air, Fat, Water, Bone, Metal
2.
If we were to visualize the Right IVF in the cervical spine and we know that image is the result of the
x-ray beam passing A to P through the IVF, what image was taken?
A. RAO
B. LAO
C. RPO
D. LPO*
3.
Which of the following is not a border of the cervical spine IVF?
A. Inferior surface of the cephalad pedicle
B. Posterior body and uncinate process
C. Superior surface of the caudal pedicle
D. Superior facet of the caudal segment
E. All of the above are boundaries of the cervical IVF*
4.
The posterior longitudinal ligament is found on the anterior aspect of the spinal cord.
A. True*
B. False
5.
The ADI is normally no greater than 3mm in adults and 5mm in children.
A. True*
B. False
6.
According to class notes, which is not one of the 5 lines for evaluation of the LCN?
A. Anterior Body Line
B. “George’s Line” = Posterior Body Line
C. Spinolaminar Junction Line
D. Posterior Spinous Line
E. Anterior Soft Tissue Line
AB. Articular Pillar Line*
7.
The Retrotracheal soft tissue space should be no more than 7 mm in adult.
A. True
B. False* (22 mm)
8.
On APLC projection, osseous structures are superimposed on top of each other. From A to P, what is
their order in a typical cervical vertebra?
A. Vertebral Body, Pedicle, Pillar, Lamina, Spinous Process*
B. Spinous Process, Lamina, Pedicle, Vertebral Body
C. Vertebral Body, Pillar, Pedicle, Lamina, Spinous Process
D. Spinous Proces, Pedicle, Lamina, Vertebral Body
9.
The orientation of the Superior Articular Facets in the cervical spine is:
A. Anterior and Cephalic
B. Anterior and Caudal
C. Posterior and Cephalic/B.U.M.*
D. Posterior and Caudal
10. Flexion and Extension views of the cervical spine are contraindicated in all of the following except:
Normal Radiology I
January M. Mierzejewski
Revised Spring 2001
A.
B.
C.
D.
E.
Occipitalization* (Transverse ligament stability)
Fractures
Infections
Dislocations
Malignancy
11. Sella Turcica size measurements are:
A. 12mm maximum horizontal, 16mm maximum verticle
B. 16mm maximum horizontal, 12mm maximum verticle*
C. 11 mm maximum horizontal, 17mm maximum verticle
D. 17mm maximum horizontal, 11mm maximum verticle
12. The four lines of mensuration below are used to determine if basilar imperfections are present. Three
of the following are visualized on the lateral spine projection, which one is not?
A. McGregor’s Line
B. Chamberlain’s Line
C. McRae’s Line
D. Digastric Line*
13. When SBO is referred to as Spondyloschisis it is located at C1 and C1 only.
A. True*
B. False
14. Cervical Spondylolisthesis has a number of clinical and radiographic findings, which is not one of
them?
A. Most commonly found at level of C6
B. SBO
C. Bilateral absence of pedicles
D. Dysplasia of the articular processes
E. All of the above are true*
15. Only seen in 52% of the cases of Klippel-Feil Syndrome. Which is not part of the classic clinical triad?
A. Low posterior hairline
B. Short webbed neck
C. Decreased cervical range of motion
D. Congenital heart defects*
16. Congenital Block Vertebra (a.k.a. Failure of segmentation) has a number of features, which is not one
of them?
A. Wasp waist
B. Joints above and below develop premature degenerative changes
C. Apophyseal joint fusion accompanies 50%
D. SP fusion occurs
E. All of the above are true*
17. Congenital Block Vertebra is most common at:
A. C2/C3
B. C6/C7
C. T4/T5
D. T12/L1
E. None of the above* (C5/C6)
18. Which one of the following is correct for Ruth Jackson’s cervical stress line?
A. Flexion b/w C5/6 and Extension at C4/5*
B. Flexion b/w C4/5 and Extension at C5/6
C. Flexion b/w C4/5 and Extension at C6/7
Normal Radiology I
January M. Mierzejewski
Revised Spring 2001
D. Flexion b/w C6/7 and Extension at C4/5
19. Normal Lordosis of the cervical spine is between 30-45 degrees, a hypolordosis would be greater than
45 degrees.
A. True
B. False* (hypolordosis < 30, hyperlordosis > 45)
20. Which of these is not a part of the Extended Series for the cervical spine?
A. LCN
B. APLC
C. APOM
D. R & L Oblique
E. Lateral Cervical Flexion and Extension*
21. In Cervical Oblique radiographs osseous structures are superimposed, which of these is not one of the
superimposed structures?
A. Same side pedicle
B. Same side TVP
C. Opposite side Lamina
D. Same side Lamina*
22. Bifurcation in the cervical spine goes from C2—C6
A. True*
B. False
23. Uncovertebral joints:
A. AKA: Joints of Von Luschka
B. Best seen in APLC
C. Located between C2/3—C7/T1
D. All of the above are true*
24. On viewing a cervical RPO two structures you will be looking down longitudinally/on end, a column of
bone rather than across are:
A. L pedicle and L lamina
B. R pedicle and R lamina
C. L pedicle and R lamina
D. R pedicle and L lamina*
25. Which of the following is not true of thoracic ribs?
A. 1st rib articulates only with T1
B. Ant. Ribs are oriented inferior lateral*
C. The 10th - 12th ribs are articulate only with their corresponding level
D. All of the above are true.
26. The orientation of the IVF’s are coronally oriented in Lumbar and Thoracic regions.
A. True*
B. False
27. On the AP thoracic view the medial 1/3 of the lung fields are dark due to over penetration. However
we are responsible for close inspection and viewing structures within the region can be easily
accomplished using intense light.
A. True*
B. False
28. Which is not part of the general description of scoliosis:
Normal Radiology I
Revised Spring 2001
January M. Mierzejewski
A.
B.
C.
D.
E.
Abnormal side to side deviation of spine from central saggital line
Scoliosis is designated according to the apex and convexity
There is usually a degree of rotation
Generally a lateral deviation
All of the above are true*
29. Which of the following is not a subcategory of Structural Scoliosis?
A. Idiopathic
B. Congenital
C. Developmental
D. Neuromuscular
E. All of the above are true of structural scoliosis*
30. Structural Scoliosis is a lateral curvature that is fixated and fails to correct with lateral bending.
A. True*
B. False
31. Idiopathic Scoliosis is the most common form and comprises approximately 80% of the cases.
A. True*
B. False
32. There are 3 types of idiopathic scoliosis which of the following is not?
A. Infantile - birth to 3 yr.; left thoracic predominant; more common in boys
B. Juvenile - 3-9 yr.; right thoracic predominant; Female 4:1
C. Adolescent - most common; Female 9:1
D. All of the above are true*
33. Which of the following subcategories of idiopathic scoliosis is most common?
A. Infantile
B. Adolescent*
C. Juvenile
34. Congenital scoliosis is the result of congenital abnormality of osseous or neural structures. Which of
the following is not a subcategory?
A. Failure of formation - Hemivertebrae
B. Failure of segmentation - Block vertebrae
C. Mixed Congenital syndromes - Klippel-Feil, Sprengels, etc.
D. Abnormal bony or neural development - Tethered cord etc.
E. All of the above are true of congenital scoliosis*
35. Which of the following is not applicable to Non-structural Scoliosis?
A. Generally progressive*
B. Usually no rotation
C. Minor curve
D. All true
E. All false
36. Which of the following is not true with regards to Structural scoliosis
A. Generally progressive
B. Rotational deformity is common
C. Major curve
D. All of the above are true*
37. Which of the following is not a factor in the progression of scoliosis in the adult life?
A. Those with a strong genetic dose of scoliosis
Normal Radiology I
January M. Mierzejewski
Revised Spring 2001
B.
C.
D.
E.
Curve which throws the trunk out of balance
Poor musculature
Women with several pregnancies (multiparous)
All of the above are true*
38. Which of the following is not part of the description on drawing using Cobb’s method as the
determining measure of scoliosis?
A. Line drawn tangent to the superior endplate to the most superiorly involved vertebral segment.
B. Line drawn tangent to the inferior endplate to the most inferiorly involved vertebral segment.
C. Line drawn at right angles as the line described in A and B on the convexity*
D. Measurements are in degrees of the intersected lines.
39. Several methods of determining maturation relative as scoliosis are used. Which of the following are
not one of the methods discussed in the notes?
A. Left hand and wrist
B. Right hand and wrist*
C. Vertebral Ring Epiphysis
D. Iliac Epiphysis
40. Which of the following is not true of chest projections?
A. Taken P-A to reduce magnification
B. FFD of 6-10 feet
C. The projections are normally taken on full exhalation*
D. On the lateral chest projection the left side is the closest to the film
41. Which of the following is not one of the cardiovascular borders?
A. Right Atrium-Right border is not visible on the lateral view
B. Left Atrium-Upper 1/3 left on the PA and upper 1/3 of the posterior on the lateral
C. Right Ventricle-Not visible on the lateral projection, however it is the Anterior border on the
PA projection*
D. Left Ventricle-Lower 2/3 of the left heart border on the PA view and the lower 2/3 of the
posterior heart border on the lateral
42. Which of the following is not true of chest projections relative to the diagnostic view of the chest
radiograph?
A. The entire chest should be visualized including apices superiorly and lateral costophrenic
gutters inferiorly
B. IVD space should be faintly visible through the cardiac soft tissue
C. We would see many shades of gray which allows differentiation
D. Should determine if rotation exists using clavicles
E. All of the above are true*
43. Which of the following rules relative to structures viewed is incorrect?
A. PLO-opposite side structures
B. ALO-same side structures
C. PCO-same side structures
D. ACO-opposite side structures
E. All correct
AB. All of the above are incorrect*
44. Lumbar oblique projections, as in the cervical spine RAO and LPO visualize the same structures as do
RPO and LAO.
Normal Radiology I
January M. Mierzejewski
Revised Spring 2001
A. True*
B. False
45. In reference to AP lumbopelvic, which of the following is not true?
A. L5 disc space cannot be adequately assessed
B. Pedicles may appear round, oval or slightly triangular
C. Facet articulation will be visible in the upper lumbar region
D. TVP of L3 is generally the longest
E. All of the above are true*
46. The anterior aspect of the SI joint is lateral to the Posterior SI joint.
A. True*
B. False
47. True statements about SBO:
 Seen in 3.1 - 15.3% of the population
 3% occurs off midline
 M/C occurs in males at L5/S1 (9:1)
 If at C1 it is referred to as spondyloschisis
 Can be multiple
48. True statements about Hahn’s Venous Clefts:
 M/C seen in the lower thoracic segments
 May be single or multiple
 Horizontally oriented, linear radiolucent line in the midportion of the vertebral body
49. What is a Schmorl’s Node?
 Focal herniation of the nucleus pulposus through the vertebral endplate
 Generally found near the posterior end plate
50. True statements about notochordal impression:
 AKA Cupid’s Bow
 AKA Nuclear impression
 Appears as a double hump
 May involve both superior and inferior endplates
 Will appear as Owl’s Eyes on an axial CT section
51. True statements about butterfly vertebra:
 Cleft formation within the center of vertebral body
 Hour glass shaped
 M/C found in the thoracic and lumbar spine
 Multiple levels may be involved and may be associated with cord and/or meningeal anomalies
52. True statements about limbus bones:
 M/C involves the anterior portion of body
 Posterior limbus could result in cord compression
 Felt to be related to herniation of disc material
 Caused by an obliquely oriented Schmorl’s Node
53. True statements about hemivertebra:
 One of the lateral ossification centers fails to grow
 Creates a wedge effect
 Generally multiple, but can be single
 Multiple hemis in conjunction with block vertebra result in a “scrambled” spine
Normal Radiology I
Revised Spring 2001
January M. Mierzejewski
54. True statements about Knife-Clasp:
 SBO of the first sacral segment
 Vertically oriented
 Elongated spinous process of L5
 M/C in males
55. True statements about transitional vertebra:
 Cervical ribs are considered one
 Anywhere there are extra characteristics of the segment above or below
 M/C at L5/S1 level
56. What are some x-ray characteristics of a transitional vertebra?
 Cervicals – cervical ribs or C7 TVP elongation
 Thoracics – single rib at T11 or T12, bilateral absence of ribs at T12, or bilateral ribs at L1
 Lumbars – spatulated TVP at L5 (pseudoarticulation or fusion w/sacrum; uni or bilateral)
57. True statements about congenital absence of a pedicle:
 Absence of pedicle on AP projection
 If congenital there will sclerotic changes to opposite side pedicle
 Same side IVF will also increase in size
58. What are Oppenheimer’s Ossicles?
 Non-union of the secondary ossification centers at the inferior articular process
 M/C in lumbar spine
 May be unilateral or bilateral
 Persistent non-union of articular process
59. What is the orientation of the facets throughout the spine?
 Cervicals – superior facets: back, up, and medial
 Thoracics – superior facets: back, up, and lateral
 Lumbars – superior facets: sagittally oriented (L5/S1 = coronal)
60. True statements about paraglenoid sulci:
 Characteristic of female pelvis (rarely found in male)
 Occasionally unilateral but mostly bilateral
 AKA preauricular sulcus
61. Do secondary ossification centers have a potential for non-union resulting in accessory ossicles?
A. Yes*
B. No
62. Ferguson’s Lumbosacral Angle:
 Upright lateral L5/S1 spot
 Line across the sacral base
 Horizontal line parallel with the bottom of the film to intersect line 1
 Normal angle~26-57 degrees (avg. 41 degrees)
63. Ferguson’s Gravitational Line:
 Center of L3 by lines connecting the opposite corners of the vertebral endplates superior to
inferior
 Vertical line perpendicular to the bottom of film drawn from L3
 Normal line will fall on anterior 1/3 of sacral base
Normal Radiology I
Revised Spring 2001
January M. Mierzejewski
64. McNabb’s Line should not intersect the tip of the superior articular facet of the level below.
A. True*
B. False
65. True statements about Ullman’s Line:
 AKA Garland-Thomas Line
 Used on lateral L5/S1 spot
66. Meyerding’s Classification of Spondylolisthesis:
 Sacral base divided into 4 equal quadrants
 Graded by what quadrant the posterior aspect of the anteriorly displaced segment resides
 Grade 5 is when the segment is completely off the base (anterior and inferior)
 Grade 5 is spondyloptopsis
67. True statements about the Interpediculate Distance:
 Distance between the most medial aspect of pedicles
 AP projection
 Cervicals - 28-29mm
 Thoracics - decreased T1-T7 then gradually increases
 Lumbars - gradually increases caudally
68. True statements about Eisenstein’s Method of Sagittal Canal Measurement:
 Line connecting most superior point of the superior articular process to the most inferior point
of the inferior articular process
 Perpendicular line to line 1 to the midpoint of the vertebral body
 Anything less than 15 mm may indicate stenosis/narrowing of canal
69. Definitions of spondylolysis and spondylolisthesis:
 Spondylolysis - an interruption of the pars interarticularis, can be uni or bilateral
 Spondylolisthesis - anterior displacement of a vertebral body in relationship to the segment
immediately below
70. What is true about the prevalence of spondylolysis and spondylolisthesis?
A. Found in 5-7% of the white population (higher in athletes)
B. Found in 40% of the Alaskan Eskimo population
C. 90% of all spondylolysis occur at L5
D. 5% at L4; 3% at L1, L2, and L3; 2% at C5, C6, and C7
71. Wiltse Classification of Spondylolisthesis: 6 Types
 Dysplastic
 Isthmic
 Degenerative
 Traumatic
 Pathological
 Iatrogenic
72. What is true about the dysplastic type?
 Congenital abnormality in the upper sacrum or neural arch of L5
 Bony architecture is inadequate to withstand the forward vectors of forces
 Pars interarticularis is still intact
Normal Radiology I
Revised Spring 2001
January M. Mierzejewski
73. What is true about the isthmic type?
 Lytic or fatigue in the pars (most commonly seen in the lower lumbar spine)
 Elongation but intact pars (due to initial and repeated stress fracture)
 Acute fracture of the pars (rare)
74. What is true about the traumatic type (spondylolisthesis)?
 Secondary to fractures in the area of the neural arch other than the pars interarticularis
 Common at C2
 AKA traumatic spondylolisthesis - (Hangman’s Fracture at C2)
75. What is true about the degenerative type?
 Secondary to long standing arthrosis of the zygapophyseal joints and discovertebral
articulation
 No pars disruption
 No more than 25% anterior displacement
 10 times M/C at L4 than L3 or L5
76. What is true about the pathological type?
 In conjunction with generalized or localized bone disease
 Paget’s disease, metastatic bone disease, and osteoporosis
77. Clinical findings associated with spondylos:
 Approximately 50% never develop back pain
 Progression seldom occurs after the age of 18
 2-3% w/listhesis show progression
 SBO associated w/increased risk of anterior displacement
78. What may you find during a physical examination of a person that has one of the spondylos?
 Heart shaped buttocks, hyperlordosis of lumbar spine, palpable step defect, transverse skin
furrow above iliac crests, hypertrichosis (hairy patch)
 May also have a spinal rattle (clicking w/SLR) or a pelvic waddle
79. Muscle tightening of the quadriceps muscles may be associated with spondylolisthesis.
A. True
B. False*
80. Many athletes with a spondylolisthesis compete without any reduction in performance or any greater
prevalence of back pain. Participation in sports should be discouraged unless biomechanical
instability, spinal stenosis, or neurological deficit is present.
A. True
B. False*
81. Grades 3, 4, 5 of spondylolisthesis can look like an inverted Napoleon’s hat or the Gendarme’s cap,
AKA Bowline of Brailford.
A. True*
B. False
82. Pars defect is most commonly bilateral and 50% are associated with SBO.
 Combination of unilateral pars defect and contralateral sclerosing = Wilkinson syndrome
83. Know all there is to know about spondys!!
Normal Radiology I
Revised Spring 2001
January M. Mierzejewski
All of the above*
84. A Single Photon Emission Computer Tomography (S.P.E.C.T.):
 Shows areas of osteoblastic activity
 Looks like a focal dark area on the film
85. What sort of treatment should a patient with spondylolisthesis consider?
 Stop causative activity for 6 to 8 weeks
 Bed rest
 Stretching hamstrings and strengthening abdominal and back muscles can bring relief
along with adjustments (Psoas mm.)
 Use of non narcotic analgesics
 Use Boston (antilordotic) overlapping brace (only 32% heal w/use)
 Conservative treatment and management is the best means of treatment, however, surgery
may become necessary when all conservative measures are exhausted. Especially true in
the relief of back pain in unstable patients and elimination of neurocompressive
radiculopathy.
Normal Radiology I
Revised Spring 2001
January M. Mierzejewski