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138 Cards in this Set
- Front
- Back
Toes Special - sesamoids
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Foot dorsiflexed
15 - 20 degree angle Shows sesamoids free of superimposition |
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Foot Special - AP & lateral weight bearing
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Plantar surface perpendicular to IR
Entire foot should be shown |
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Ankle Special - AP oblique medial rotation
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Leg extended and medially rotated 15 - 20 degrees
Foot rotated medially to 45 degrees |
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Ankle Special - AP stress
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Patient supine with leg extended
Foot rotated both medially and laterally by second provider - protective gloves required Utmost care with injured patient |
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Knee Special - AP or PA weight bearing
Rosenberg method For distal femur, proximal tibia, fibula, knee joint space |
Patient standing, knee partially flexed to 45 degrees
Use Bucky device for support Knees touching Bucky device CR angled 10 degrees caudad CR centered mid-point between knee joints |
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Knee Special - Intercondyloid fossa
Camp-Coventry method |
Patient PA recumbent (prone)
Knee flexed so that tibia is 40 degrees to tabletop Foot rested on support CR 40 degree caudad (perpendicular to tibial long axis) |
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Knee Special - Intercondylar fossa, articular facets, knee joint space
Holmblad method |
Kneeling position, with 60 - 70 flexion
CR perpendicular to IR & lower leg at mid-popliteal crease |
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Knee Special -Intercondylar fossa, tibial plateau
Beclere method |
Knee flexed 40 - 45 degrees
Rest knee on supported IR CR 45 degrees cephalic, aimed at patella |
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How many Phalanges are there in the foot?
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14
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How many Metatarsals are there in the foot?
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5
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How many Tarsals are there in the foot?
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7
3 cuneiforms, cuboid, navicular, talus, calcaneus |
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Which tuberosity of the foot is palable and a common site of foot trauma?
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Tuberosity of base of fifth metatarsal
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Where are the sesamoid bones of the foot most commonly located?
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The plantar surface of the foot
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What is the largest and strongest tarsal bone?
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Calcaneus
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What is the smallest cuneiform?
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Intermediate
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For a oblique foot radiograph what is the degree of the angle of the foot?
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45 degrees
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For a AP mortise foot radiograph what is the degree of the angle of the foot?
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15 - 20 degree medial rotation
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The extreme distal end of the fibula forms which malleolus?
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Lateral malleolus
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Why must the CR be angled 5 to 7 degrees cephalad for a lateral knee position?
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because the medial condyle extends lower than the lateral condyle.
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What are the two palpable bony landmarks found on the distal femur?
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Medial and lateral epicondyle
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When you extend the ankle or point the foot and toes downwards is called what?
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Plantar flexion
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Decreasing the angle between the dorsum pedis and anterior lower leg is called?
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Dorisflexion
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Why is the central ray angled 10 to 15 degrees toward the calcaneus for an AP projection of the toes?
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It opens up the interphalangeal and metarsophalangeal joints
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Where is the CR centered for an AP oblique projection of the foot?
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At the base of the third metatarsal
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Why should the CR ray be perpendicular to the metatarsals for an AP projection of the foot?
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Opens up metarsophalangeal and certain intertarsal joints
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Which oblique projection of the foot best demonstrates the majority of the tarsal bones?
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AP oblique with medial rotation
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Which oblique projection of the foot demonstrates the navicular and the first and second cuneiforms with minimal superimposition?
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AP Oblique with lateral rotation
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How should the CR be angled from the long axis of the foot for the plantodorsal axial projection of the calcaneus?
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40 degree cephalad
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Where is the CR placed for a lateral projection fo the calcaneus?
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1 1/2 inch inferior to the medial malleolus
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Why should AP, 45 degree, oblique, and lateral ankle radiographs include the proximal metatarsals?
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To demonstrate a possible fracture of the 5th metarsar tuberosity (common fracture site)
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Which projection of the ankle best demonstrates a possible fracture of the lateral malleolus?
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45 degree AP oblique with medial rotation
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How many views are used for a Tibia and Fibula and what are they?
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2 views, AP and Lateral projection
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What is the recommended CR angulation for an AP projection of the knee for a patient with thick thighs and buttocks measuring greater than 24 cm?
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3 to 5 degree cephalad
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Where is the CR centered for an AP projection of the knee?
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1/2 inch (1.25cm) distal to apex of patella
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Which basic projection of a knee best demonstrates the proximal fibula free of superimposition?
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AP oblique, 45 degree
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The AP oblique medial rotation projection of the knee best vizualizes?
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The lateral condyle of the tibia and the head and neck of the fibula.
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How much flexion is reccommended for a lateral projection of the knee?
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20 to 30 degree
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Which special projections of the knee best demonstrates the intercondylar fossa?
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Camp-Coventry Method, Holmblad Method, and Beclere Method
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How much flexion of the lower leg is required for the Camp-Conventry projection.
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40 degree flexion
Centeral ray is angled 40 degrees caudad |
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How much knee flexion is required for a Holmblad method?
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60 -70 degrees
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How much part flexion is recommended for a lateral projection of the patella?
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5 to 10 degrees
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Situation: A geriatric patient comes to the radiology department for a study of the knee. The patient is unsteady and unsure of himself. Which intercondylar fossa projection would provide the best results without risk of injury to the patient?
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Camp-Coventry method / trash can view
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A patient enters the ER with a possible transverse fracture of the patella. Which of the following routines would safely provide the best images of the patella?
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AP and horizontal beam lateral, no flexion
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How much part flexion is required for the Hughston method?
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45 - 55 degrees
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How much part flexion is required for the Setegast method?
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90 degrees
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How much foot rotation is required for the AP oblique, medial rotation projection of the foot?
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30 - 40 degrees
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What CR angle is generally required for the AP projection of the foot?
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10 degrees posterior
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Which projection of the foot best demonstrates the cubiod?
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AP oblique medial rotation
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The upper or superior portion of the patella is called the what?
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Base of the batells
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What are 2 differences in the phalanges of the foot as compared with the phalanges of the hand?
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They are smaller and the joint movements are more limited (in the phalanges of the foot)
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What is the name of the joint found between the talus and calcaneus?
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Subtalar or talocalcaneal
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T/F: the cuboid articulates with the four bones of the foot
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True
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The calcaneus articulates with the talus and the ____
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Cuboid
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What are the two arches of the foot?
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Longitudinal and transverse arches
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What 3 bones make up the ankle joint?
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Talus, tibia, fibula
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The _____ is the weight bearing bone of the lower leg
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Tibia
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The ankle joint is classified as a synovial joint with ______ type of movement
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Sellar
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The metatarsophalangeal joints are of what type?
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Modified ellipsoidal or condyloid
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The interphalangeal joints are of what type?
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Ginglymus or hinge
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The tarsometatarsall joints are of what type?
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Plane or gliding
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The intertarsal joints are of what type?
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Plane or gliding
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The femorotibial joints are of what type?
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Bicondylar
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Patellofemoral joint is of what type
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Sellar or sadle
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Proximal tibiofibular joint is or what type
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Plane or gliding
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What is the largest sesamoid bone in the body/
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Patella
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The most posterior-inferior part of the calcaneus is a process called the _____
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Tuberosity
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The talus articulates with_____(4 bones)
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Tibia, fibula, calcaneus, navicular
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The inferior portions of the tibia and the fibula form a deep socket or 3-sided opening called a _________.
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Mortise
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What are the 4 views for the ankle?
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AP, AP mortise, 45 degree oblique, lateral
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Should the patient dorsiflex for an AP ankle projection?
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Yes
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In a true AP projection of the ankle are the malleoli on the same plane?
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No
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In an AP ankle projection which malleoli is more anterior?
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Medial
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A fracture at the base of the 5th metatarsal is called ______
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Jones fracture
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If the patient does not dorsiflex the foot in an ankle mortise projection what happens to the lateral mortise?
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the calcaneus superimposes the lateral mortise
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If you are doing an ankle mortise projection and can visualize the sinus tarsi then what is the positioning error?
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too much oblique
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Where do you center for a lateral ankle?
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Medial malleolus
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T/F: stress views are done by the lead technologist
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False (physician or resident)
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What is the rule about imaging long bones?
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Include both joints
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What size cassette is used for tib/fib projections?
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14x17
diagonal |
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What SID is used for tib/fib projections?
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44 - 48 inches
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Would you use grid on knee projections
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yes
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Where do you center for a calcaneus projection?
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1 inch below medial maleolus
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T/F: the distal end of the 5th metatarsal is a common injury site.
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False, proximal end
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Where is a common site for bone spurs in the foot?
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Calcaneal tuberosity
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T/F: the navicular articulates with all 3 cuneiforms.
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True
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T/F: the lateral malleolus is the distal end of the tibia
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False
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What is the injury to the ligament that spans across the articulation of the medial cuneiform and the 1st and 2nd metatarsal base called? What kind of study would be done to confirm this injury?
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Lisfranc injury, weight-bearing study
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What is the major disadvantage of the settegast method?
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Requires overflexion of the knee
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When performing an AP oblique projection of the toes how much do you angle the tube, if any?
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None
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What are the 3 divisions of the hip bone?
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Ilium, ischium, pubis
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The ASIS, PSIS, iliac crest, and anterior inferior iliac spine are all part of what hip division? (ilium, ischium, or pubis?)
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Ileum
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Where is the fovea capitis located?
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Center of the femoral head
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The greater pelvis is also called the _____ pelvis
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false
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The ______ pelvis forms the actual birth canal.
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True
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Is the male or female pelvis more wider with the ilia more flared and more shallow from front to back?
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Female
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The sacroiliac and hip joints are what classification of joints?
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Synovial
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The symphysis pubis and the union of acetabulum are what classification of joints?
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Cartilagenous
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By ______ rotating the entire lower limb, the proximal femur and the hip are positioned in a true AP projection
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Internally
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When the femur and hip are in a true AP projection, what structure should not be seen, or is seen minimally?
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Lesser trochanter
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T/F: when performing an AP pelvis projection (bilateral hips) the CR is perpendicular to IR, directed midway between the level of ASISs and symphysis pubis
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True
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When the lower leg is not internally rotated it causes _____ of the femoral neck. (elongation, foreshortening)
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Foreshotrtening
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The greater and lesser trochanter are connected by the _____
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Intertrochanteric ridge
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Name the facets of the sub talor joint.
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Anterior, middle anterior
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Where are the interphalangeal joints located?
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Between phalanges
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Where is the intercondylar sulcus AKS trochlear groove l
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Patellar surface of the femur
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What attaches to the tibial tuberosity, which can be seen on the AP and l
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Patellar tendon
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Describe osteogenic sarcome
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Highly malignant primary bone tumor seen in late childhood and young adults. Tib
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Describe bone cysts
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Benign, neoplastic lesions, filled with fluid that often occur near the knee joint in children and adolescents. These are not usually detected on X-rays until a pathologic fracture occurs.
If detected, they appear as lucent areas with thin cortex. |
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Describe osteochonromas
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Most frequently encountered neoplasm of the skeleton. Made of both cartilage and bone commonly co
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Can torn ligaments be seen on X-ray
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No, MRI required for visualiz
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Do you angle for AP of toes?
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Yes, 10 degrees.
Opens up joint spaces. CR to metatarsal of 2nd toe AP medial oblique |
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Which projection would best demonstrate the medial and intermediate cunierform bones?
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??
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Describe projections needed for imaging
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2 projections needed:
AP axial (40 degrees angjulation) Lateral (centered at maleolus |
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In an AP ankle, which joints are open?
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Medial and
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Ankle mortise opens
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Opens up lateral joints.
Medial rotation of 15 - 20 degrees may help. |
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Why are ankle stress images done?
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For joint and ligament tears
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What does the AP of the knee demonstrate?
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Distal femur, proximal tibia and fibula.
Femoral-tibial joint space should be open. |
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Do you angle the CR on a lateral knee?
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Yes.
Short/wide person - 7 - 10 degrees Narrow/tall person - 5 degrees |
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How is the leg flexed for a lateral knee projection?
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20 degrees
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Describe Rosenberg method
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Skier's position, 45 degree knee flexion
Weight bearing Views interdondylar fossa and joint degenera |
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Why is the bilateral Merchant method used?
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To detect abnormalities of the patella and femeropatellar joint
Merchant method - patient at edge of table knees flexed to 40 degrees, CR 30 degrees |
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What technique is used to image the patella
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Hobbs method
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??
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Superoinferior sitting tangential method
SID 48 inches 90 degree flexion |
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Which joints are open in AP ankle?
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??
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How do you modify technique when patient
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Use AP, not PA and cros
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Describe Osgood -Schlatter disease
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Inflammation of the anterior proximal tibia, usually seen in adolescent boys.
Patella tendon detaches part of the tibial tuberosity Visualize with AP and Lateral knee. |
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What is the angle for weight bearing
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Patient standing, no angle
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Describe differences between Houston and Settagast.
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Hughston - 55 degree flexion
Settagast - 90 degree flexion |
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Differences between male and female pelvis
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1) Males - narrower, deeper and less flared
2) Males - acute pubic angle less than 90 degrees 3) Males - oval shaped (females-round) |
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What do you do if you are unable to adequately shield the gonads?
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Increase KV, lower
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Describe frogleg
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Legs abducted 45 - 50 degrees
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??
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Views bilateral pubis for pelvic trauma
Patient supine with support under knees CR angled 20 - 35 for males CR angled 30 - 45 for females |
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What is the Teufel method?
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Views acetabulum
Patient semiprone (35 - 40 degree anterior oblique), affected side down CR - 12 degrees cephalad |
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What is the Judet method?
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Views acetabulum
Semi supine, patient 45 degree oblique Anatomy of interest is the downside |
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Describe the Clements-Nakayama method
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Views hip fracture
Patient supine |
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Modified Cleaves
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Views hip joint and proximal femur
Used in nontrauma situations Unilateral frogleg position |
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How can your
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Look for equal ala and foramen
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What image should be first taken in pa
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AP pelvis
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