Question 1

An optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates all of the following except
A) the scaphoid fat stripe.
B) open scaphotrapezium and scaphotrapezoidal joint spaces.
C) a closed radioscaphoid joint space.
D) alignment of the long axis of the first metacarpal and radius.

Accepted Answer

An optimal ulnar-deviated PA axial (scaphoid) wrist projection should demonstrate the scaphoid fat stripe, open scaphotrapezium and scaphotrapezoidal joint spaces, and alignment of the long axis of the first metacarpal and radius. However, a closed radioscaphoid joint space is not necessary to demonstrate the scaphoid bone and surrounding structures.

Question 2

Where are the soft tissue structures that can be used to indicate joint effusion located on the ulnar-deviated PA axial wrist projection?
A) Anteriorly
B) Medially
C) Laterally
D) Posteriorly

Accepted Answer

The soft tissue structures that indicate joint effusion on the ulnar-deviated PA axial wrist projection are located laterally.

Question 3

A less than optimal PA wrist projection demonstrates an elongated scaphoid and the second through fourth metacarpals superimposing the CM joint spaces. Which of the following is true about this projection?
A) The wrist was in ulnar flexion.
B) The wrist was flexed.
C) The hand was overflexed.
D) The wrist was externally rotated.

Accepted Answer

The answer of A less than optimal PA wrist projection...

Question 4

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a proximal scaphoid fracture is suspected, and the patient is unable to ulnar-deviate the wrist?
A) 15 degrees
B) 20 degrees
C) 5 to 10 degrees
D) 20 to 25 degrees

Accepted Answer

The central ray angulation used for the PA axial, ulnar-deviated wrist projection is 5 to 10 degrees. This angulation is used to visualize the proximal scaphoid, which is located in the proximal row of carpal bones. When the wrist is ulnar-deviated, the proximal scaphoid is brought into better view.

Question 5

An optimally positioned PA wrist projection demonstrates all of the following except
A) an open radioulnar articulation.
B) open second through fifth MC joint spaces.
C) alignment of the long axis of the third metacarpal and midforearm.
D) the pronator fat stripe.

Accepted Answer

An optimally positioned PA wrist projection demonstrates an open radioulnar articulation, open second through fifth MC joint spaces, and alignment of the long axis of the third metacarpal and midforearm. However, it does not demonstrate the pronator fat stripe.

Question 6

A less than optimal lateral wrist projection demonstrating the distal scaphoid anterior to the pisiform
A) will also demonstrate the distal scaphoid proximal to the pisiform.
B) will also demonstrate the ulna anterior to the radius.
C) was obtained with the wrist in ulnar flexion.
D) was obtained with the wrist internally rotated.

Accepted Answer

The distal scaphoid appearing anterior to the pisiform indicates internal rotation of the wrist in the lateral projection.

Question 7

An optimal AP elbow projection is obtained when
A) an imaginary line connecting the humeral epicondyles is aligned perpendicular with the IR.
B) the radial tuberosity is demonstrated in profile laterally.
C) the radial head articulating surface is demonstrated.
D) the radial head superimposes the lateral aspect of the proximal ulna by 0.25 inch (0.6 cm).

Accepted Answer

The answer of An optimal AP elbow projection is obtained...

Question 8

A less than optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates closed scaphotrapezium, scaphotrapezoidal, and CM joint spaces. How should the positioning setup be adjusted to obtain an optimal projection?
A) Externally rotate the wrist until it is at a 25-degree angle with the IR.
B) Extend the hand, positioning it flat against the IR.
C) Increase the degree of hand flexion.
D) Increase the degree of ulnar deviation until the first metacarpal and ulna are aligned.

Accepted Answer

The answer of A less than optimal ulnar-deviated PA axial...

Question 9

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a distal scaphoid fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned?
A) 15 degrees
B) 20 degrees
C) 5 to 10 degrees
D) 20 to 25 degrees

Accepted Answer

The answer of What is the central ray angulation used...

Question 10

Where are the soft tissue structures that can be used to indicate joint effusion located on the PA wrist projection?
A) Anteriorly
B) Medially
C) Laterally
D) Posteriorly

Accepted Answer

On a PA wrist projection, joint effusion is typically indicated by soft tissue structures located laterally, such as the scaphoid fat pad.

Question 11

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned?
A) 15 degrees
B) 20 degrees
C) 5 to 10 degrees
D) 20 to 25 degrees

Accepted Answer

The answer of What is the central ray angulation used...

Question 12

A less than optimal lateral hand projection demonstrating the longest of the second through fifth metacarpal midshafts situated anterior to the others
A) was obtained with the hand internally rotated.
B) may result if the central ray was centered too anteriorly.
C) will also demonstrate closed IP joints.
D) will also demonstrate the distal scaphoid posterior to the pisiform.

Accepted Answer

This occurs because internal rotation of the hand positions the metacarpals so that they overlap each other more than when the hand is in a true lateral position, making the one furthest from the source of the X-ray (usually the second or third metacarpal) appear the longest.

Question 13

Which side of the arm is positioned against the IR for the lateral fourth finger projection?
A) Ulnar
B) Radial

Accepted Answer

For a lateral fourth finger projection, the ulnar side of the arm should be positioned against the IR so that the fourth finger and the ulnar side of the hand are parallel to the IR.

Question 14

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is unable to ulnar-deviate the wrist?
A) 15 degrees
B) 20 degrees
C) 5 to 10 degrees
D) 20 to 25 degrees

Accepted Answer

The central ray angulation for a PA axial projection of the wrist when a scaphoid fracture is suspected and the patient cannot ulnar-deviate is typically 20 degrees.

Question 15

What is the degree of central ray angulation that should be used for an ulnar-deviated PA axial (scaphoid) wrist projection being obtained to demonstrate a proximal scaphoid fracture?
A) Use a 10-degree angle if the first metacarpal and ulna are aligned.
B) Use a 25-degree angle if the first metacarpal and ulna are not aligned.
C) Use a 15-degree angle if the first metacarpal and ulna are aligned.
D) Use a 20-degree angle if the first metacarpal and ulna are not aligned.

Accepted Answer

The central ray is angled 10 degrees toward the ulna if the first metacarpal and ulna are aligned.

Question 16

A poorly positioned PA oblique wrist projection demonstrates superimposition of the trapezoid and trapezium, and the capitate is superimposed by the trapezoid. How should the positioning setup be adjusted to obtain an optimal projection?
A) Align the third metacarpal and midforearm, decreasing radial flexion.
B) Increase the degree of medial wrist rotation.
C) Decrease the degree of medial wrist rotation.
D) Increase hand extension.

Accepted Answer

To correct the superimposition seen in a poorly positioned PA oblique wrist projection, decreasing the degree of medial wrist rotation will help in achieving better separation of the trapezoid and trapezium, and prevent the capitate from being superimposed by the trapezoid. This adjustment aligns the bones more accurately for optimal imaging.

Question 17

What is the projection for the PA oblique finger?
A) Phalanges demonstrate equal concavity.
B) Phalanges demonstrate more concavity on one side than on the other.
C) Phalanges demonstrate concavity on one side and convexity on the other.

Accepted Answer

In the PA oblique projection of the finger, the phalanges will demonstrate more concavity on one side than on the other due to the angled view of the bones. This oblique angle allows for better visualization of certain structures and can help in identifying fractures or dislocations.

Question 18

Where are the soft tissue structures that can be used to indicate joint effusion located on the lateral wrist projection?
A) Anteriorly
B) Medially
C) Laterally
D) Posteriorly

Accepted Answer

The soft tissue structures that indicate joint effusion on a lateral wrist projection are located anteriorly, where the joint capsule and associated soft tissues can be visualized.

Question 19

A less than optimal PA finger projection demonstrates unequal soft tissue width and midshaft concavity on each side of the phalanges. The side of the phalanges with the greatest midshaft concavity is facing the shortest finger metacarpal. All of the following are true about this projection except that the
A) finger was internally rotated.
B) projection will demonstrate more soft tissue width on the lateral surface.
C) projection will demonstrate open IP and MP joints as long as the digit remains parallel with the IR.
D) projection will demonstrate less phalangeal concavity on the lateral surface.

Accepted Answer

A less than optimal PA finger projection with unequal soft tissue width and midshaft concavity on each side of the phalanges would actually demonstrate less soft tissue width on the lateral surface, not more. Options A, C, and D could all be true for a less than optimal PA finger projection.

Question 20

Which side of the arm is positioned against the IR for the lateral second finger projection?
A) Ulnar
B) Radial

Accepted Answer

The answer of Which side of the arm is positioned...

Quiz 4: Image Analysis of the Upper Extremity

An optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates all of the following except

Where are the soft tissue structures that can be used to indicate joint effusion located on the ulnar-deviated PA axial wrist projection?

A less than optimal PA wrist projection demonstrates an elongated scaphoid and the second through fourth metacarpals superimposing the CM joint spaces. Which of the following is true about this projection?

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a proximal scaphoid fracture is suspected, and the patient is unable to ulnar-deviate the wrist?

An optimally positioned PA wrist projection demonstrates all of the following except

A less than optimal lateral wrist projection demonstrating the distal scaphoid anterior to the pisiform

An optimal AP elbow projection is obtained when

A less than optimal ulnar-deviated PA axial (scaphoid) wrist projection demonstrates closed scaphotrapezium, scaphotrapezoidal, and CM joint spaces. How should the positioning setup be adjusted to obtain an optimal projection?

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a distal scaphoid fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned?

Where are the soft tissue structures that can be used to indicate joint effusion located on the PA wrist projection?

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is able to ulnar-deviate until the first metacarpal and radius are aligned?

A less than optimal lateral hand projection demonstrating the longest of the second through fifth metacarpal midshafts situated anterior to the others

Which side of the arm is positioned against the IR for the lateral fourth finger projection?

What is the central ray angulation used for the PA axial, ulnar-deviated wrist projection: a scaphoid wrist fracture is suspected, and the patient is unable to ulnar-deviate the wrist?

What is the degree of central ray angulation that should be used for an ulnar-deviated PA axial (scaphoid) wrist projection being obtained to demonstrate a proximal scaphoid fracture?

A poorly positioned PA oblique wrist projection demonstrates superimposition of the trapezoid and trapezium, and the capitate is superimposed by the trapezoid. How should the positioning setup be adjusted to obtain an optimal projection?

What is the projection for the PA oblique finger?

Where are the soft tissue structures that can be used to indicate joint effusion located on the lateral wrist projection?

Which side of the arm is positioned against the IR for the lateral second finger projection?