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Proc and Posi Exam 4
| Question | Answer |
|---|---|
| What is the tibia? | 2nd largest bone in the body, medial side of the bone and bears the weight of the leg |
| The superior/proximal tibia consist of what? | Condyles: medial, lateral, articulates with the femoral condyle and superior surface is called tibial plateau |
| What does the tibial plateau articulate with | The femur |
| What is the Fibula? | Lateral bone, slender, and consist of the shaft (body) and and two articular extremities. |
| What does the proximal fibula articulate with | The head articulates with the lateral condyle of tibia apex |
| What does the distal fibular articulate with? | The lateral malleolus 15-20% posterior than medial malleolus |
| What is the femur? | Longest, strongest, heaviest bone, and slopes medially as it goes inferiorly |
| Parts of the proximal femur | head, neck and trochanter (greater and lesser). intertrochanteric crest is located on the posterior and intertrochaneric line is on the anterior side |
| Parts of the distal femur | Medial condyle, lateral condyle, medial epicondyle, lateral epicondyle, patellar surface, intercondylar fossa, shaft |
| Medial condyle is larger | |
| The anterior surface of the femur articulate with what? | patella |
| The medial condyle is how many degrees lower than the lateral condyle | 5-7 |
| Parts of the knee | femur, medial condyle, lateral condyle, tibia, tibial plateau, tibial spine, medial condyle, lateral condyle |
| Routine projections of the lower leg | AP and lateral |
| Why may you use an SID of 48 instead of 40 | to decrease the divergence of the beam and demo more of the leg |
| AP lower leg | IR: 14 x 17 SID: 40 or 48 CR: perpendicular to center of the leg Patient Positioning: Collimate 1/2 inch beyond ankle and knee and supine with foot dorsal flexed |
| Structures Shown and Evaluation Criteria for AP Lower leg | tib/fib adjacent jts, no rotation, proximal and distal articulations of tib/fib moderately overlapped, fibular midshaft free of tibial superimposition |
| Lateral lower leg | IR: 14 X 17 SID: 40 or 48 CR: perpendicular to center of the leg Patient Position: turn to affected side, collimate 1/2 inch beyond knee and ankle |
| Structures Shown and Evaluation Criteria for Lateral lower leg | tib/fib jts, distal fib over posterior half of tibia, slight overlap of tib on proximal fibular head, ankle and knee jt not rotated, femoral condyle not superimposed, moderate separation of tib and fib bodies |
| Routine projections for femur | AP proximal, AP distal, lateral proximal, lateral distal |
| AP Femur | IR: 14 x 17 SID: 40 IR Placement:For proximal place top of IR at level of ASIS and rotate limb 15-20 degrees internally. For distal place limb in true anatomic position, epicondyle parallel with IR, bottom of the IR is 2 inches below the knee joint |
| Structures shown for AP femur | Lesser trochanter not seen beyond medial border of femur, femoral neck not foreshortened |
| What happens if the lower limb is externally rotated too much? | The epicondyle are not demonstrated in profile, medial condyle is larger than the lateral, tibia has more than 1/2 inch superimposition on fibular head |
| What happens if the lower limb is internally rotated too much? | lateral femoral condyles larger than medial condyle and superimposition of fibular head and tibia less than 1/4 inch |
| Lateral lower leg | IR: 14 x 17 SID: 40 IR placement: Proximal place top of IR at ASIS level, adjust pelvis so it is rolled posteriorly 10 to 15 degress from lateral. Distal adjust pelvis to be in true lateral, flex affected 45 degrees, bottom 2 inches beyond knee |
| Structures shown and evaluation criteria for lateral lower leg | Superimposed anterior surface of the femoral condyles, patella in profile, open patellofemoral space, inferior surface of condyle not superimposed because of divergent rays, opposite thigh not over area of interest |
| Pelvis consists of 4 bones that are what? | 2 hip bones or innominate bones, sacrum and coccyx |
| hip bone are called what? | Ilium, Ishcium and Pubis |
| What is the acetabulum? | Deep, cup shaped cavity that accepts the femoral head and is a ball and socket joint |
| What is the illum? | crest of the ilium, upper margin of the ala, extends from ASIS to PSIS |
| what does ASIS and AIIS stand for? | Anterior superior iliac spine, and Anterior inferior iliac spine |
| what does PSIS and PIIS stand for? | posterior superior iliac spine, and posterior inferior iliac spine |
| What is the greater sciatic notch? | located between the PSIS and ischial spine and this is where the sciatic nerve passes through |
| what is the ischium? | inferior and posterior to acetabulum and includes 2/5 of the posterior acetabulum |
| What does the Ischial Tuberosity bear most of? | body weight when sitting |
| Where is the ischial spine? | directly posterior to the body |
| What is the body of the pubis? | anterior and inferior to acetabulum and includes anteroinferior 1/5 of acetabulum |
| What is the superior pubic rami? | superior pubic ramus extends anterior and medial to the body of each pubi |
| What is the inferior pubic rami? | inferior pubic ramus passes down and posterior from symphysis pubis where it joins the inferior ramus of ischium |
| What is the obturator foramen? | larger opening, formed by rami of ischium and pubis, largest foramen in the body |
| What is the sacrum? | consists of 5 fused segments, shaped like a shovel |
| what is the coccyx? | also called the tailbone and consists of 3-5 fused segments |
| What is the difference between female and male pelvis? | female's pelvis is more broader and more flared, shallower, larger and inlet is oval. male's pelvis is narrower and less flared and inlet in round |
| What are the SI joints in the pelvis? | wide, flat joints, located obliquely between the sacrum and each ilium. |
| What is the pubis symphysis? | LImited expansion during late pregnancy and child birth and separates |
| What type of joints are hip joints? | ball and socket joints |
| The highest point of the greater trochanter is the same plane as what? | hip joint |
| Most prominent point of the greater trochanter is in the same plane as what? | symphysis |
| Routine projections for pelvis | AP |
| AP Pelvis | IR: 4 x 17 SID: 40 CR/IR placement: center midway between ASIS and symphysis, 2 inch inferior to ASIS and 2 inch superior to pubis symphysis Patient position: 15-20 degrees of medial rotation of the lower limbs |
| Structures shown and Evaluation criteria for AP Pelvis | see entire pelvis, femoral head, neck and trochanters. 1/4 to 1/3 of femoral shafts, lesser trochanter on medial border, greater trochanter in profile, hip bones and obturator foramen are symmetric |
| Routine projections of the hip | if no recent images do AP pelvis, AP hip, lateral or axiolateral. if there are recent film do AP hip, lateral or axiolateral |
| AP Hip | IR: 10 x 12 SID: 40 CR: perpendicular to femoral neck, 2.5 inch distal on the line perpendicular to mid point of line between ASIS and pubic Patient: Medially rotate affected limb 15-20 degree |
| Structures show and evaluation criteria for AP HIP | Greater trochanter in profile, femoral neck not foreshortened, show orthopedic appliance in entirely |
| Lateral Hip, Lauenstein Method | IR: 10 x 12 SID:40 CR: perpendicular to hip joint midway between ASIS and pubic Patient: oblique the patient towards the affected side, the angle of oblique depends on how much the patient can abduct the leg, flex the knee almost to a right angle |
| Lateral Hip Hickey method | IR: 10 x 12 SID: 40 CR: angel 20 - 25 degrees cephalic to hip point midway between ASIS and pubic Patient: Oblique the patient toward the affected side, the angle of oblique depends much they can abduct their leg, flex the affected knee to right angle |
| Structures show and evaluation criteria for Lateral Hip | include acetabulum and proximal femur, the femoral neck free of superimposition in the hickey, hip jt centered, femoral neck superimposed on greater trochanter is important |
| Axiolateral Hip | IR: 10 x 12 SID: 40 CR/IR: dependent on pt Patient postion: supine |
| Structures shown and evaluation criteria for axiolateral hip | acetabulum, head, neck and trochanter, hip jt demonstrated withough soft tissue superimposition, orthopedic appliance inlcuded, ischial tuberosity below femoral neck, small amount lesser and greater trochanter |
| What is tomography? | predetermined plane of the body is demonstrated in focus while structures above and below are eliminated by a controlled blur |
| Different names for tomography | planiography, startiography, laminography, body section, |
| What is tomographic amplitude | total distance tube travels, amplitude and blurring are directionally proportionaly |
| Exposure amplitude | total distance tube travels during exposure, is always equal or less than tomographic amplitude |
| Fulcrum | pivot point, can be fixed so the patient would be moved up and down to change section level, more commonly it is adjustable so that it moves up and down while the patient is still |
| Focal plane | section or region in focus |
| section level | layer height |
| object plane | depth of focus |
| section of thickness | width of focal plane and is controlled by the exposure angle, exposure angle is inversely proportional to the section thickness |
| Exposure factors: time | critical that time is set first, exposure time must match the length of time required for the x-ray tube to complete the tomographic amplitude, if time is short blurring will not be complete, time too long, end position of tube will increase record detail |
| Exposure factor:mA | have fixed time setting because of the length of the exposure, 30% more mAs is required |
| Exposure factor: kVp | all the exposure adjustments are accomplished by variations of kVp, since the mA and time limits are present |
| Type of Motion: Linear | when movement of the tube and IR are along a straight line, first form, amplitude up to 48 degrees, tube and grid go opposite direction, best for blurring objects perp, to motion of tube |
| Type of Motion: Circular | all elements are equally blurred regardless of there orientation, not used much because most units capable of achieving this most are capable of achieving more complex motions |
| Type of motion: Elliptical | has both linear and circular aspects, eliminates some of the edge phantoms of circular motions, especially when the long axis of the ellipse is perpendicular to the long axis of the object |
| Type of motion: Hypocycloidal | Provides maximum tomographic amplitude, thus producing the thinnest possible section, about 1mm thickness |
| Type of motion: spiral | AKA trispiral, provides maximum tomo amplitude this producing the thinnest section possible, about 1mm thickness |
| Digital tomosynthesis | digital radiographic tomography, time to be set first, |
| general description of lumbar spine | forms central axis of the skeleton, midsagittal plane, purpose is to protect spinal cord, support skull, attachment for muscles and ribs |
| Divisions | Cervical(7), Thoracic(12), Lumbar(5), Sacrum(5), Coccyx(3-5) |
| Curvatures | Cervical and lumbar is lordotic curve, Thoracic and pelvic is kyphotic curve, Primary curve is thoracic and pelvic, Secondary forms in early childhood development |
| Lordosis | butt more out |
| Kyhposis | hunch over |
| Scolosis | lateral |
| Typical vertebrae | Consists of 2 parts that are the body and vertebral arch that are the pedicles and lamina |
| Process of the typical vertebra | transverse process, spinous process, and four articular process |
| Vertebral notch | inferior, superior, intervertebral foramina |
| Joints of lumbar | zygapophyseal joints, intervertebral joints or disk space |
| Intervertebral disks | functions as a cushion, consists of annulus fibrosis layer and nucleus pulpous layer, |
| Spondylolistheis | slipping of the vertebrae |
| Spina bifida | failure of lamina to meet or form |
| Radiographic landmarks for lumbar | Thoracic: 2 inch above manubrial notch(T1), manubrial notch (T2-3), Sternal angle(T4-5), xiphoid tip(T9-10). |
| Lumbosacral spine (LSS) | AP, oblique, left lateral, left lateral (L5-S1, spot) |
| AP Lumbosacral | IR: 14 x 17 SID: 40 or 48 Patient: recumbent, hip and knee flexed CR: vertical midsagittal, horizontal is crest |
| Structures Shown and Evaluation criteria for AP l-spine | all vertebrae body, see T12 and S1, no rotation, joint spave, |
| AP Oblique L-spine: RPO and LPO | IR: 14 x 17 SID:40 Patient position: supone or erect, turn 45 degrees toward left or right side CR: 1/2 inch above crest for horizontal, 2 inch medial from elevated ASIS |
| AP oblique L-spine: LPO and RPO | all 5 vertebrae, zygopophyseal joint open, see scotty dog, if too rotated pedicle is posterior, if under rotated pedicle is anterior |
| Parts of the Scotty Dog | Ear: superior articular process, Leg: Inferior articular process, Nose:transverse process, Eye: pedicle, Neck: pars inerarticularis, Body: lamina |
| Lateral L-spine | IR: 14 x17 SID: 40 Patient: turn to left side CR: midcoronal, angle 5 degree caudad for men and 8 degree caudad for women, center at iliac crest |
| Structures shown and evaluation criteria for lateral L-spine | vertebra body lateral, open joint space, spinous process, nearly superimposed crest |
| L5-S1 the spot | IR: 8 x 10 SID: 40 Patient postion: on left side, knee flexed CR: 1/2 inch inferior to the crest, 2 inch posterior to ASIS Angle 5 degree for men and 8 degree for women caudad |
| Structures shown and evaluation criteria for L5-S1 the spot | open lumbar sacral joint, all of L5 and S1 |
| For what projection of the foot | plantar surface is perpendicular and metatarsals are nearly superimposed |
| For Becelere method the CR is directed | perpendicular to long axis of the leg |
| Pharmacology | the study of drug actions on and interactions with living organisms |
| Drug Name | Chemical: 7- cholor-1 Generic: given by original manufacture, diazepam Trade: given by pharmaceutical company, Valum |
| Medication Orders | must have physician, date, drug, dose, route, frequency |
| 6 right of safe administration | right patient (3 times: when you pull med, prepare med, and administer), right drug, right dose, right time, right route, with the right documentation |
| Rules for safe administration | aseptic technique, right to refuse, check name strength, an expiration date, administer what you have prepared, correct patient, record immediately, report medical error, be prepared for reaction |
| Factors affecting drug administration | age, gender and weight, nutritional state, emotional state, time of day(evening better), routes of administration, drug tolerance and resistance, metabolism, and absorption |
| Routes of Administration | Topically and transdermal: on top of skin, eye drops Inhalation: o2, high absorption rate Orally: mouth, ibuprofen Buccal: between teeth and cheek Sublingually: under the tongue Rectally: butt Parenterally: IV, injection, IM |
| Oral Administration | safest, most desirable when can be used, don't use if bad taste, potential to be destroyed by stomach acid, risk to aspirate, pt uncooperative, need for immediate effect, vomiting |
| Parenteral Administration | Subcutaneous: SQ usually 1-2 mL, TB, under skin, 45 degrees, small amount Intramuscular: IM, into muscle, prompt absorption, larger amount than SQ, 1-5mL, flu shot Intradermal: between layer of skin, small amounts, absorption slow, 1 mL |
| Parenteral Administration continue | Intravenous: IV, fast effect,most hazardous, monitor pt, heparin lock, piggy back, butterfly, angiocatheter, contrast use large vein and inject fast, skin prep is clean with alcohol, iv stand 18-24 inch abover vein, 10-20 drops per min, intravenous pump |
| Needles | disposable, parts, length and gauge of needle, contaminated and don't recap, stick pt bevel up |
| Parts of needle | Hub, cannula or shaft and bevel |
| Syringes | Disposable, parts, sizes, leur-loc, eccentric tip syringe |
| Parts of syringe | plunger, barrel, tip |
| Preparing Medication | aseptic techniques, universal precautions, maintain sterility, check MD order, read label 3 time, check expiration date, check patient ID, keep medication container, disposal of needle and syringe |
| Container | Vial: prepare medication Ampule: prepare medication |
Created by:
bbesler
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