Procedures Written Practice Questions
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| Bony thorax consists of what three main parts | sternum, thoracic, 12 pairs of ribs
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| What projection would demonstrate the spine but would show the sternum minimally? | AP or PA
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| Thin, flat narrow bone with three divisions composed of vascular cancellous tissue covered by compact bone | sternum
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| Total length of adult sternum | 7 inches
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| Upper portion of the sternum and measures 2 in. | manubrium
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| Longest part of the bony thorax, whose 4 segments combine at puberty and completely at 25 | body of sternum
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| Most inferior portion of the sternum, composed of cartilage during infancy and youth and ossifies at 40yrs. | xyphoid tip
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| The palpable landmark that is in the uppermost border of the manubrium, located at upper border of the sternum at the junction of the two clavicles. | jugular notch (suprasternal, manubrial notch)
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| At the level of T4-T5 on an average adult and at the end of the manubrium | sternal angle
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| Palpable landmark that is part of the sternum and corresponds to level of T9-T10 | xyphoid tip
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| What corresponds to the level of L2-L3 | Inferior costal angle
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| What joints articulates with each side of manubrium laterally, forming a notch on each side | sternoclavicular joint
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| What is the connection called between each shoulder girdle and bony thorax | sc joint
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| What two structures connect directly to the sternum | clavicles and 1st seven pairs of ribs
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| Depression that is below each clavicular notch and sternoclavicular joint | facets for articulation with cartilage of 1st rib
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| Anterior ribs do not directly unite with sternum with what short piece of cartilage | Costocartilage
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| The 2nd costocartilage connects to the sternum at what level | at the sternal angle
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| Which ribs that have costocartilages connect directly to the body of sternum | 3rd-7th ribs
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| Which ribs connect at the 7th rib costocartilages, which then connects to sternum | 8-10th ribs
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| What are the 1st-7th pairs of ribs considered as | true ribs
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| Each true rib attaches directly to what structure by its own costocartilage | sternum
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| What structures make up the false ribs | 8-10th ribs attached with 7th rib costocartilage
11-12th ribs do not have costocartilage
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| What lies lateral to the neck of the rib, what it articulate with and its purpose | tubercle- articulates with the transverse process, and allows attachment of ligaments
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| In the posterior view of a rib what is demonstrated at the vertebral end | head, neck, and tubercles
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| The area part of the bony thorax with forward angulation | angle of the rib
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| What is the typical measurement of the posterior(vertebral end) of a rib | 3-5in. HIGHER than anterior(sternal) end
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| Which part of the rib is most superior when looking at a chest radiograph | posterior rib is more superior, whereas the anterior ribs are inferior - up and downward
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| Name and purpose of the lower inside margin of each rib and can cause pain during trauma when hemorrhages in that are are involved | Costal groove- protects arteries,veins, and nerves (closer to the heart anteriorly)
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| What are the differences in the ribs if any | 1st ribs are short,broad and mostly vertical of all ribs, elongating downward up to the 7th-12th ribs where it then becomes short.
The 1st rib is the most sharply curved
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| Name of joint between costocartilage and sternal ends are called and its significance | costochondral union -(1-10ribs) cartilage and bone are bound by periosteum of the bone itself
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| What type of joint classification would the costochondral junctions (1-10 ribs) be | synarthrodial
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| State classification of sternoclavicular joints and their location | Synovial-diarthrodial, between clavial and sternum,
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| Sternocostal joint(1st) attaches directly to what structure and what is their joint classification | manubrium, synarthrodial-diarthrodial
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| Continuous borders between the costal cartilages of 6-9th ribs | interchondral joints
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| State interchondral joint classification | synovial,diarthrodial
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| Joints between head of ribs and the thoracic vertebral column | costovertebral joints (1-12th)
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| Joints between ribs and transverse processes of the thoracic vertebrae | costotransverse joints (1-10)
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| Why is it difficult to radiograph the sternum in a true AP/PA | Thin cortex, within thorax and it's anterior midline structure is in the same plane along t-spine
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| What position is best to visualize sternum and the amount of rotation, if any. | RAO, 15-20 degrees to shift sternum to the left into the homogenous heart shadow
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| What determines the degree of obliquity in an RAO position for the sternum | Size of patient, 15 for barrel chested, 20 for thin-chested
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| Exposure factors required for sternum | analog:40"SID, 65-72kv, low mA, long exposure time 2-3s to compensate for motions,orthostatic breathing
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| To minimize pt dose, patient's skin should be at what measurement below the surface of the collimator | 15"(38cm)
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| What determines if you perform an AP/PA on a rib study | location of pain, extent of pain,cause,stability
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| Which ribs represents the minimum number of ribs shown above the dome of the diaphragm on full inspiration | upper 9 posterior ribs
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| What is the minimum SID for rib studies and what is the exception | 40"SID for unilateral, 72"SID for bilateral
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| Routine for doing ribs ABOVE the diaphragm | erect, expose at inspiration,use low kv(65-70)
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| Why do we do erect for ABOVE the diaphragm | Gravity pulls down the diaphragm, better inspiration,patient comfort and avoid movement
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| Why do we use inspiration as breathing technique when doing ribs ABOVE diaphragm | When taking a deep breath in, diaphragm is pushed down fully to the 9th rib
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| Why do we lower kV when doing ribs ABOVE diaphragm | To better visualize the ribs through the lung tissue and contrast in analog. If site of injury is near the heart, we increase technique to go through the heart shadow as well as lungs
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| When doing ribs BELOW diaphragm | recumbant,expose at expiration, med kV(70-80)analog
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| Wy do we do recumbant for ribs BELOW the diaphragm | to flatten abdomen and better visualization of lower ribs through abdominal structures
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| We use expiration breathing for ribs BELOW the diaphragm because | lifts diaphragm up to the 7th posterior rib, uniform density
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| Medium kV for ribs BELOW diaphragm to | ensure proper penetration,going through muscle, denser area
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| When doing ribs study, which side is touching the IR | site of interest close to IR, rotate spine away to prevent superimposition
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| If patient has trauma to the left posterior ribs, what are the preferred projections | AP,LPO(elongate the left ribs, PO pulls spinous process away from area of interest)
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| When doing the LPO how are the spinous processes in relation to the left side of injury | spinous process are away
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| What determines if you do a AP/PA for ribs | pain anterior(AP), pain posterior (PA) (inpractice: most will do AP)
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| Patient has trauma to the right anterior ribs, what is the preferred projection | PA,LAO(elongate the right ribs, pull spinous process away from area of interest)
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| Why do department protocols order routine PA/Lateral chest? | Rule out pneuomothorax,hemothorax,pulmonary edema and other pathologies
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| Modality to evaluate skeletal detail and soft tissues with sternum/sc joints | CT
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| Evaluating skeletal pathologies such as mestases,bone scans | Nuclear Medicine
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| Fractures of the 1st ribs are associated with | injuries to the arteries, veins
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| Fractures of the lower ribs are associated with | injuries to the lower organs, kidneyes, spleens,liver
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| Fracture adjacent to the ribs in two or more places by blunt trauma causing pulmonary injury and collapses chest wall, linear lucency | flail chest, routine
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| Fractures in this structure caused by blunt trauma and associated with cardiac injury (hint: near heart) | sternum fracture,sternum/CT
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| Congenital defect characterized by anterior protrusion of lower sternum and xyphoid process | pectus carinatum(pigeon chest), routine chest/lateral sternum
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| Known as funnel chest, deformity of depressed sternum interfering with respiration | pectus excavatum
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| Distructive lesions with IRREGULAR margins | osteolytic
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| Proliferative bony lesions of INCREASED density | osteoblastic
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| Moth-eaten appearance of bone resulting of mixed destructive and blastic lesions | osteo-lytic/blastic , NucMed
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| Localized/generalized bacterial infection of bone and marrow due to postoperative complications of open heart surgery and causes sternum to split | osteomyelitis
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| Routine exam procedures for ribs | PA/AP(site of injury)/bilateral, obliques,chest (inpractice: one below diaphragm shot at AP)
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| Routine exam procedures for sternum | RAO, Lateral
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