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clinical comp final
chest, abdomen, upper limb
| Question | Answer |
|---|---|
| What body habitus generally requires the IR to be placed crosswise or transverse in the upright wall stand for a chest exam? | Hypersthenic |
| Which direction does the diaphragm move on inspiration? | Downward |
| Why does it matter which way the diaphragm moves for chest radiography? | Making the exposure on deep inspiration allows the diaphragm to move to the lowest point and better visualization of the thoracic cavity |
| What are the proper breathing instructions for chest radiography? | Expose on patient's second full inspiration |
| When evaluating a chest radiograph, how can you determine if the patient sucessfully followed your breathing instructions? | You should be able to count a minimum of 10 pairs of posterior ribs above the diaphragm |
| Before positioning a patient for a chest exam, what is something the technologist must do? | Make sure to remove all radiopaque objects from the chest region (also adjust the position of the oxygen tubing, heart monitor leads, etc. to be removed from the lung field. |
| Please list a reason why a chest exam might be performed on expiration as well as inspiration. | Small pneumothorax, fixation or abnormal movement of diaphragm, presence of foreign body, or to distinguish the difference in density located around a rib or in the lung (foreign body) |
| Why should all chest exams be performed upright when possible? | Alows the diaphragm to move to the lowest position, utilizes a horizontal beam which demonstrates air/fluid levels, prevents engorgement of pulmonary vessels |
| Why should chest exams be performed at a SID of 72"? | Less magnification of the heart because of less beam divergence |
| Why should chest exams be performed PA rather than AP? | Places the heart and great vessels closer to the IR (because they are located in the anterior portion of the thorax) thereby reducing magnification |
| How do you evaluate a PA chest radiograph for rotation? | The SC joints should be symmetrical or equal distances to the midline of the spine to ensure no rotation |
| If the SC joints are not symmetrical and the right one is closer to the spine, what positioning error has occured? | The patient was rotated toward their right side (RAO) |
| Why do you ask patients to elevate their chin before taking a PA chest radiograph? | So the chin/mandible will not superimpose over the apices of the lungs |
| Why do you ask patients to roll their shoulders forward before exposing a PA chest radiograph? | To remove the scapulae from the lung field as much as possible |
| How do you evaluate a lateral chest radiograph for rotation? | Verify that the posterior rib margins and costophrenic angles are superimposed. The right costophrenic angle will be higher than the left, due to the presence of the liver |
| When should you repeat a lateral chest film for rotation? | If the distance between the posterior rib margins measures more than one cm. |
| Why should the patient raise their arms above their heads before taking a lateral chest exam? | To prevent the upper arms from superimposing upper areas of the chest |
| What is the CR location for either a PA or AP chest exam? | T7 |
| How should you locate T7 for a PA chest radiograph? | Use the finger spread method; 7" below vertebra prominens for females, 8" for males |
| How should you locate T7 for a AP chest radiograph? | Locate the jugular notch and center 3" inferior (3-4 finger widths) |
| When performing a chest exam portable, the patient is usually positioned as close to upright as possible by raising the bed. What is the goal of angling the CR for this portable AP chest projection? | To place the CR perpendicular to the sternum of the patient so that the clavicles will not obscure the apices. |
| If a patient is unable to sit or stand for a PA upright chest radiograph, what specific position will also demonstrate air/fluid levels in the chest? | Either a right or left lateral decubitus |
| If you need to evaluate a pneumothorax in a patient's left lung, which decub position would be best? | Right lateral decub |
| If you need to evaluate pleural effusion in a patient's left lung, which decub position will be best? | Left lateral decub |
| What projection of the chest will demonstrate the apices with the clavicles demonstrated above? | AP or apical lordotic projection |
| If an order was written to perform an anterior oblique chest exam to demonstrate the right lung, what specific position would you place your patient? | LAO ( if the patient is in the anterior oblique position, it will best demonstrate the lung farthest away from the IR; opposite if the patient is placed in a posterior oblique position) |
| The vertebra prominens is the spinous process of ____ and lies at the level of ____. | C7, T1 |
| The jugular notch (manubrial, suprasternal) lies at the level of ____. | T2-3 |
| The xiphoid tip or process lies at the level of _____. | T9-10 |
| The common passageway for food, fluid, and air is the _______. | Pharynx |
| The trachea is _______ to the esophagus. | Anterior |
| The trachea bifurcates into right and left bronchi at the ______. | Carina (T5) |
| The right bronchi is _____ in diameter and more _____, therefore objects aspirated are more likely to travel down the passage vs the left. | Wider, Vertical |
| Smallest structures where oxygen and carbon dioxide are exchanged in the lungs are known as _________. | Alveoli |
| Right lung has ____ lobes and the left lung has ____ lobes | 3, 2 |
| Mediastinum is the area of the thoracic cavity located between the lungs that include the ______, ______, _______, and ______. | trachea, esophagus, heart/great vessels, thymus gland |
| TRUE/FALSE: The thymus gland reaches its largest size at puberty and then begins to decrease and is almost unidentifiable in an adult. | True |
| What is the name of the muscle that divides the thoracic and abdominal cavities? | Diaphragm |
| What are the names of the muscles located on either side of the lumbar spine which will be seen on a properly exposed abdomen radiograph? | Psoas major muscles |
| Another name for the AP supine abdomen radiograph is the KUB. What does KUB stand for? | Kidneys, ureters, and bladder |
| What conditions would exist in which an acute abdominal series would be performed instead of only an AP supine abdominal radiograph? | Bowel obstruction, perforations that involve free-air, excessive fluid (ascites), or possible mass |
| Name the accessory organs to digestion. | Liver, gallbladder, pancreas |
| What are the organs of digestion that lie within the abdominopelvic cavity? | Stomach, small intestine, large intestine |
| Name the three portions of the small intestine. | Duodenum, jejunum, ileum |
| Name the portions of the large intestine in anagrade fashion (direction of normal flow): | Ileocecal valve, cecum, ascending colon, right colic (hepatic) flexure, transverse colon, left colic (splenic) flexure, descending colon, sigmoid colon, rectum, anus |
| What organ classified as part of the lymphatic system is located in the left upper quadrant of the abdomen? | Spleen |
| Which quadrant of the abdomen houses the liver? | Primarily right upper |
| Which quadrant is the cecum located? | Right lower |
| What are the structures of the urinary systen located within the abdominopelvic cavity? | Kidneys, ureters, bladder, urethraEndocrine |
| The adrenal or suprarenal glands are part of what body system? | Endocrine |
| Where are the adrenal glands located? | Upper poles of each kidney |
| What major structures of the abdomen are considered to be retroperitoneal? | kidneys, most of the ureters, pancreas, duodenum |
| The inferior rib margin is located at the vertebral level of _____. | L2-3 |
| The iliac crest is located at the vertebral level of _______. | L4-5 |
| The symphisis pubis is considered to represent the ____ level or the ____ margin of the abdominal cavity. | lowest, inferior |
| Make abdominal exposures on _______ to allow the diaphragm to rise to its highest point and demonstrate the abdominal cavity better. | Expiration |
| Can use a contact gonadal shield for male abdomen procedures by placing the _____ margin of the shield at the _____ margin of the symphysis. | Superior, Inferior |
| Where is the CR location for an AP supine abdomen (KUB) radiograph? | Level of the iliac crest and to the midsagittal plane |
| What size IR should be used for most adult abdomen radiographs? | 14X17 lengthwise unless the patients body habitus requires two IRs used crosswise to demonstrate the diaphragm and symphysis |
| When positioning for a KUB, what can the tech do to ensure the patient is not rotated? | Place thumbs on each ASIS to make sure they are equal distances to the tabletop. |
| How do you verify by analyzing the image whether the patient was rotated for a KUB readiograph? | By looking at the size and shape of the iliac wings. If a wing is elongated or widened, the patient was rotated in that direction; if a wing is foreshortened, that side of the patient was farther from the tabletop. |
| If an acute abdominal series is ordered, what projections are most routinely performed? | 2 way: AP supine and AP upright abdomen radiographs; 3 way: same as 2 way but also include an upright PA chest projection |
| What specific anatomy must be demonstrated on upright abdominal radiographs and decubs? | Diaphragm |
| What projection should be performed if a patient is unable to be positioned for an upright abdominal radiograph? | Left lateral decub |
| Why should the left lateral decu projection be performed as described? | It places the patient's right side up and allows free air (if present) to rise and be better visualized in the shadow of the liver instead of competing with the air in the fundus of the stomach if pt were placed in a right lateral decub |
| When positioning for the upright abdomen or left lateral decub abdomen projections, where is the CR location? | 2" above the iliac crest |
| Why should the patient be postioned a minimum of 5 minutes erect before any upright abdominal radiographs are performed? | To allow abnormal air to rise and fluid to settle |
| Why would a cross-table lateal or dorsal decub position be performed on an abdomen? | To demonstrate aneurysms, calcification of aorta, or umbilical hernias. |
| How many and what specific bones comprise a hand and wrist? | 14 phalanges, 5 metacarpals, 8 carpals; 27 total |
| Which portion of the metacarpal is more distal? | Head |
| Which carpal is most commonly fractured? | Scaphoid |
| Which carpal bone is the largest? | Capitate or os magnum |
| Which carpal bone has only one name? | Pisiform |
| Which carpal bone articulates with the 1st metacarpal? | Trapezium or greater multangular |
| Which bone of the forearm is located laterally? | Radius |
| Where is the radial head located? | Proximal |
| Where is the ulnar head located? | Distal |
| What is the name of the beak-like process that projects anteriorly on the ulna at its proximal end? | Coronoid |
| What is the name of the large process located on the proximal, posterior aspect of the ulna? | Olecranon |
| What is the name of the two processes located on both the distal radius and ulna? | Styloid |
| Which specific condyle of the distal humerus is located medially? | Trochlea |
| Which specific condyle of the distal humerus is located laterally? | Capitulum |
| The radial fossa is located where? | Lateral side of the anterior, distal humerus |
| Name the deep depression located on the distal, posterior surface of the humerus? | Olecranon fossa |
| The radius pivots or rotates around the ulna during what motion? | Supination to pronation |
| In order to display open joint spaces in the fingers, hands, and wrists, the parts must be kept ______ to the IR; sometimes there will be an increase in OID, but this is acceptable when keeping the part ______. | Parallel |
| Which direction should the hand and wrist be rotated when performing a routine oblique procedure? | Laterally or externally from a pronated postion |
| What are the two basic projections for a forearm exam? | AP and lateral |
| Why should a forearm be performed AP instead of PA? | The AP projection allows the radius and ulna to be positioned beside one another with minimal superimposition. |
| When performing a lateral forearm and/or elbow, what 3 things must be achieved? | Elbow should be flexed 90 degrees, hand and wrist positioned in a true lateral , and humerus should be in the same plane as the forearm. |
| How will the hand be positioned for an oblique projection of the thumb? | Pronated |
| What is the best way to provide a frontal image of the thumb? | AP |
| When performing a lateral radiograph of teh hand and looking for foreign bodies, which type of lateral is best? | Extension lateral |
| Why should an oblique hand not be positioned with fingers in contact with the IR when looking at injuries to the digits? | The joint spaces will not be open on the radiograph due to the part not being kept parallel to the IR |
| What should be done if an AP elbow is ordered and the patient cannot straighten or extend their arm? | Take two AP projections; one with the forarm parallel to IR and the other with the humerus parallel to IR |
| Where is the CR location for a PA hand projection? | 3rd metacarpophalangeal joint (base of 3rd metacarpal) |
| Which projection of the elbow will best demonstrate the coronoid process of the ulna? | Medial oblique |
| Which projection will best demonstrate the olecranon process? | Lateral elbow |
| Which projection will best demonstrate the radial neck, head, and tuberosity with minimal superimposition of other structures? | Lateral oblique |
| Which tubercle of the humerus is profiled laterally in the anatomic position? | Greater tubercle |
| What is the most common site for fractures of the proximal humerus? | Surgical neck |
| Name the area of the scapula where the humeral head articulates to form the shoulder joint. | Glenoid fossa |
| To provide an AP view of the proximal humerus: | *Hand supinated until humeral epicondyles are parallel with IR *Considered an AP external rotation projection *Greater tubercle will be profiled laterally on radiograph and lesser will be seen anterior |
| To provide a lateral view of the proximal humerus: | *Hand pronated until humeral epicondyles are perpendicular to IR *Considered an AP internal projection *Lesser tubercle will be profiled medially and greater is seen anterior |
| What routine shoulder projections should be performed if a patientis suspected of having a fracture or dislocation? | AP with neutral rotation, and either a transthoracic lateral or scapular Y view |
| Where is the CR location for a transthroacic lateral projection? | Level of the surgical neck |
| What is the name of the projection that may be performed on a non-trauma shoulder that has the patient's arm abducted 90 degrees from the body? | Inferosuperior axial or transaxillary lateral |
| What special breathing instructions can be given to the patient when performing a transthoracic lateral and AP scapula exams? | Breathing technique to blur the ribs/lungs so area of interest remains in focus and better visualized |
| In order to perform a lateral scapula or scapular Y view projection, how will the patient's body be positioned in relation to the IR? | 45 to 60 degree oblique |
| Name the two routine projections for a clavicle exam. | AP and AP with 15-30 degree cephalic angle |
| What SID should be utilized for AC joints? | 72 inches |
| Are AC joints considered a bilateral study? | Yes, both sides are examined for comparison I |
| When performing lateral scapula projections, if the patient is placed in an RAO position, which scapula will be best demonstrated? In an LPO? | Right in both sessions |
| What are the routine projections for AC joints? | AP with weights and AP without weights |
Created by:
danielle89
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