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FBHS/MID 2123/AUGUST2009 FINAL EXAMINATION AUGUST 2009 SEMESTER EXAMINATION 1/2009/2010 SESSION SUBJECT SUBJECT CODE DURATION FACULTY : : : : PROGRAMME LECTURER : : RADIOGRAPHIC ANATOMY MID 2123 2 HOURS BIOMEDICAL AND HEALTH SCIENCES DIPLOMA IN MEDICAL IMAGING HJ. SILAHUDIN JARJIS BIN MAT JIRI INSTRUCTION TO CANDIDATES This question paper consists of THREE (3) Parts. Part A : Part B : Part C : 30 Objective questions 8 Short essay questions 5 Essay questions - Answer ALL questions - Answer ALL questions - Answer THREE (3) questions only Part A must be answered in the OMR objective paper provided. Part B and C must be answered in the answer booklet provided. Do Not Open The Question Paper Until Instructed This Question Paper Consists of THIRTEEN (13) Printed Pages CONFIDENTIAL 1 CONFIDENTIAL/ FBHS/MID 2123/AUGUST2009 PART A – OBJECTIVE QUESTIONS (30 Marks) Choose the best option to answer the questions. 1. In Medical Imaging, the term position includes A. B. C. D. 2. In Medical Imaging, the term projection includes A. B. C. D. 3. tangential decubitus Fowler Sim The term stating the curvature of the spine includes A. B. C. D. 5. supine prone lithotomy postero-anterior (PA) Additional special use projection term includes A. B. C. D. 4. medio-lateral trendelenberg AP oblique antero-posterior (AP) varus valgus scoliosis meiosis Longitudinal plane of the human body includes A. B. C. D. coronal occlusal transthoracic infero-superior CONFIDENTIAL/ 2 FBHS/MID 2123/AUGUST2009 6. The term body surface includes A. B. C. D. 7. The following bony landmarks correspond correctly to the following vertebral levels A. B. C. D. 8. : T4 – T5 : C3 – C4 : T2 – T3 : S1 – S2 muscular persons 10% of the population obese persons slender and tall persons The radiographic appearance of a normal adult postero-anterior erect chest radiograph should demonstrate A. B. C. D. 10. sternal angle vertebra prominens xiphod process iliac crest Hypersthenic body habitus represents A. B. C. D. 9. sagittal palmar supination pronation oesophagus visualized centrally vascular markings symmetrical on both sides ribs unevenly spaced both lung fields of unequal density The lateral projection of the chest is taken to A. B. C. D. show the lateral and medial borders of the heart localize the depth of the mediastinum show the posterior costophrenic recesses demonstrate scoliosis CONFIDENTIAL/ 3 FBHS/MID 2123/AUGUST2009 11. Occasionally, PA chest radiography is taken on arrested deep expiration because of A. B. C. D. 12. Diagnostic medical procedures that DO NOT involve the use of ionizing radiation include A. B. C. D. 13. kidneys oesophagus gall bladder liver When an abdominal X-ray is taken in the erect position, the event that occurs include A. B. C. D. 15. ultrasonography (US) computerized tomography (CT) angiography nuclear medicine (NM) Barium sulphate examination demonstrates the A. B. C. D. 14. greater lung volume can be seen abnormalities of the heart is more obvious to show diaphragmatic excursion lung fields are less radio-opaque diaphragm ascends fluid rises upper abdomen bulges air rises Splenomegaly can be demonstrated in a plain abdominal radiograph by the A. B. C. D. elevation of the left hemidiaphragm lateral displacement of the stomach superior displacement of the colon a soft tissue mass extending upwards and laterally CONFIDENTIAL/ 4 FBHS/MID 2123/AUGUST2009 16. Radiological sign to look for in appendicitis include A. B. C. D. 17. An important cause of acute abdomen which may be identified in the plain AP erect and supine abdomen radiographs includes A. B. C. D. 18. 20. myocardial infarction basal pneumonia pulmonary embolism intestinal obstruction Plain film radiography A. B. C. D. 19. free gas in the fundus of the stomach loss of the left psoas margin clarity of right peritoneal fat stripe in the flank scoliosis to the affected side solely produced by differential x-ray beam absorption of body organs resorts to the use of radionuclide imaging resorts to the use of magnetic resonance imaging resorts to the use of ultrasound The following anatomical structures can be demonstrated by the related projection A. B. lumbar spine intervertebral foraminae frontal bone C. right sacro-iliac joint D. 3rd metartarsal – oblique lumbar projection – submento vertical (SMV) projection – AP projection of the whole pelvis – lateral projection of the foot Radiographic features of tension pneumothorax include A. B. C. D. deflated lung elevated diaphragm shift of mediastinum and heart to left side overexpanded lung CONFIDENTIAL/ 5 FBHS/MID 2123/AUGUST2009 21. Radiographic features to confirm coarctation of aorta include A. B. C. D. 22. Radiographic features to confirm tetralogy of Fallot include A. B. C. D. 23. pneumocystic carinii pneumonia (PCP) silicosis pneumothorax legionnaire’s disease Radiographic features of Legionairres’ disease as manisfested on chest radiograph include A. B. C. D. 25. cyanosis for 3 months episodic loss of consciousness squatting when fatigued boot-shaped heart AIDS related pathology manisfested image on chest radiograph include A. B. C. D. 24. aortic figure-4 configuration notching of the inferior ribs reverse 5 sign of barium sulphate -filled oesophagus prominent right cardiac border unilateral lung affected slow progression pleural effusions < 50% upper lobe involvement Radiographic features of pleural effusions include A. B. C. D. all cardiophrenic angles are obliterated mediastinal structures remain unshifted depressed diaphragm costophrenic angles not blunted CONFIDENTIAL/ 6 FBHS/MID 2123/AUGUST2009 26. The following cervical spine injuries can be demonstrated in plain lateral projection of the cervical vertebrae A. B. C. D. 27. Radiographic features of spondylolysis is manifested in lumbar spine radiographs as A. B. C. D. 28. lateral projection occlusal projection Towne’s projection Water’s projection Radiographic features of Colles fracture is manifested as follows A. B. C. D. 30. separation of pars interarticularis (neck of ‘Scotty’ dog) oblique projection is normally non-diagnostic AP projection is normally diagnostic If patient looks to the right, the left pars interaticularis is not visualized by xray Anterior nasal fracture is best evaluated by A. B. C. D. 29. Fracture of the odontoid peg of axis Simple wedge fracture Posterior subluxation Avulsion fracture of C1 posterior arch Non-articular fracture Distal radius is dorsally displaced Ulnar styloid fracture, 5% Elongation of radius Radiographic features of osteoarthritis (OA) include A. B. C. D. narrowing of joint space, usually assymetric presence of osteoporosis absence of osteophytes absence of subchondral cysts CONFIDENTIAL/ 7 FBHS/MID 2123/AUGUST2009 PART B:SHORT ESSAY QUESTIONS (40 Marks) Answer ALL questions. 1. With reference to the radiographic criteria for an erect postero-anterior projection of the chest, state reasons why: 2. 3. a. The median sagittal plane must be perpendicular to the film? (3 marks) b. The x-ray beam must be collimated? (2 marks) Define the following terms: a. trendelenberg; b. decubitus; c. lithotomy; d. radiograph; e. projection. (5 marks) State the vertebral levels that correspond with the following anatomical surface landmarks: 4. a. jugular notch; b. sternal angle; c. anterior superior iliac spine (A.S.I.S.); d. subcostal margin; e. iliac crest. (5 marks) State FOUR (4) types of human body habitus and the percentage of each type. (5 marks) CONFIDENTIAL/ 8 FBHS/MID 2123/AUGUST2009 5. a. State THREE (3) reasons why a minimum of two (2) projection (90o to each other) are required in medical imaging. (3 marks) b. State how the following radiographic images are being displayed on the viewing box for reporting by Radiologist: i) hand; ii) erect PA chest. 6. (2 marks) State FIVE (5) roles of transvaginal sonography imaging(TVS) in the 3rd (5 marks) Trimester. 7. State FIVE (5) secondary mammographic signs of malignancy. (5 marks) 8. State FIVE (5) sonographic locations of ectopic pregnancy. (5 marks) CONFIDENTIAL/ 9 FBHS/MID 2123/AUGUST2009 PART C : ESSAY QUESTIONS (30 Marks) Answer THREE (3) questions only. Question 1 a) Label parts A to G on the PA chest radiograph. (7 marks) b) State THREE (3) reasons why the taking of chest radiography is preferred in the erect position. (3 marks) (7 marks) CONFIDENTIAL/ 10 FBHS/MID 2123/AUGUST2009 Question 2 a) State SEVEN (7) surface landmarks of the abdomen referred by Diagnostic Radiographers when positioning patient. b) (7 marks) State the method of application of gonad shielding for male patients for (3 marks) abdominal radiography. Question 3 a) State a good criterion to evaluate a true lateral position of the elbow joint, when it is flexed 90o. b) Label fully parts A to I of the lateral elbow joint radiograph. (1 mark) (9 marks) CONFIDENTIAL/ 11 FBHS/MID 2123/AUGUST2009 Question 4 Label fully parts A to J of the cross section computerized tomographic axial scan at the mid-level of both kidneys. (10 marks) CONFIDENTIAL/ 12 FBHS/MID 2123/AUGUST2009 Question 5 a) State FOUR (4) radiographic features that demonstrate lumbar vertebrae (4 marks) fractures. b) Label fully parts A to F of the oblique lumbar spine displays the parts of the ‘SCOTTY DOG’. radiograph that (6 marks) END OF QUESTIONS CONFIDENTIAL/ 13