NYCC Spring 2010 Dr. Jarrett-Pulliam Final exam
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| what are the standard radiographs for the cervical spine | APOM, AP cervical, lateral cervical neutral projections
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| What are the standard views for the thoracic spine? | AP thoracic, lateral thoracic neutral
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| What are the standard views for the lumbar spine? | AP lumbar, Lateral lumbar neutral
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| What is the tube setup for RAO and LAO cervical oblique projections? | RAO/LAO cervical tube tilt is 15deg. caudad/tail (shoot them from above and behind!)
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| What is the tube setup for RPO and LPO cervical oblique projections? | 15 deg. cephalad (kneel and aim the bow and arrow UP if they come face on - pin their shoulder to the bucky!)
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| What do lumbar obliques visualize? | SCOTTY DOG!
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| describe the parts of the Scotty dog! | nose: transverse process, ears: superior articular process/facet, eye: pedicle, neck: pars interarticularis (a "collar" indicates a fracture), front feet: inferior articular process/facet, body: lamina
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| spondylolytic spondylolisthesis? | a fracture at the "collar" or neck of the Scotty dog - the pars interarticularis - with an anterior displacement
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| What lines can be used to see spondylolisthesis at L5/S1? | Ulmann's line, Meyerding's grading method, and George's line can be used on L5/S1
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| What lines can be used to see spondylolisthesis at L4/L5? | Meyerding's grading method and Georges line can be used L4/L5 (NO Ulmann's - that is just for sacral base to L5 relationship)
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| What term would be synonymous with spondylolisthesis? | ANTEROlisthesis
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| What line demonstrates joint laxity? | George's line, Van Akkerveeken's measurement can be used
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| What conditions can cause joint laxity? | Compression fractures, DJD, Declining disc spaces
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| Which side of the diaphragm comes up higher? | the Right because the heart presses down on the left
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| What is the minimal normal limit for the sagittal dimension of the spinal canal in the cervical spine? | 12 mm. minimum for cervical sagittal
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| What is the minimum normal limit for the sagittal dimension of the spinal canal in the thoracic spine? | 12 mm. minimum for thoracic sagittal
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| What is the minimum normal limit for the sagittal dimension of the spinal canal in the LUMBAR spine? | 15 mm. minimum for the LUMBAR sagittal
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| What is the minimum normal limit for a coronal dimension of the spinal canal/interpediculate distance for the Cervical spine? | minimum 24 mm. cervical interpediculate/coronal
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| Numbers for minimums of Coronal/INterpediculate Cervical, Thoracic, Lumbar? | 24,14,21 mm. (C,T,L)
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| Minimum normal interpediculate/Coronal distance for thoracic spine? | 14 mm.
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| Minimum normal interpediculate/Coronal for Lumbar spine? | 21 mm. 21 mm. 21 mm. 21 mm. 21 mm. 21 mm.
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| 21 mm. | the minimum interpediculate/coronal dimension of the lumbar spine
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| 14 mm. | the minimum interpediculate/coronal dimension for the thoracic spine
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| 24 mm. | the minimum interpediculate/coronal dimension for the cervical spine
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| Best projection to visualize the odontoid space? | APOM (A - P Open Mouth)
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| What radiographs can visualize the atlantodental interspace? (ADI) | Lateral cervical neutral, flexion, extension
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| ADI | AtlantoDental Interspace
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| What view best illustrates an ADI problem? | lateral cervical FLEXION for ADI
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| What can cause a problem with the ADI? | Down's syndrome, rheumatoid arthritis, trauma, etc.
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| Ossiculum terminale? | Tip of dens/odontoid process does not fuse with remainder of body. Some cartilage remains (should fuse by 10-12 yrs. of age)
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| Odontoideum? | odontoid process does not join C2 vertebral body. (should fuse between 5-7 yrs. old)
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| 4 indications of congenital Block vertebrae? | anterior concavity (wasp waist), rudimentary disc space (faint calcification), fused facets 50%, malformed spinous process
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| triad of radiographic findings for a Schmorl's node? | anterosuperior endplate placement, reduced supradjacent disc space, increase in A-P diameter for vertebral body
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| does a Schmorl's node involve the entire endplate? | no
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| do nuclear impressions involve the entire endplate? | no
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| what causes nuclear impressions? | notochord persistence
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| what can the wavy gravy appearance of the endplates be described as | cupid's bow
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| What can McNab's line or Hadley's S Curve help determine? | facet imbrication (subluxation)
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| normal range for lumbosacral angle | 26-57 degrees (30-60)
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| normal adult ADI (atlantodental interspace) | 1-3 mm.
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| normal child ADI | 1-5 mm.
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| 1-3 mm. | normal adult ADI
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| 1-5 mm. | normal child ADI
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| spondyloptosis | L5 slips off sacral base
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| At which segments do we use Eisenstein's method for sagittal canal measurement? | L1-L4 because the spinolaminar line is not visualized at those segments
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| "eyes of the spine" | pedicles (Scotty Dog eye)
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| How can you determine right from left in AP thoracic if there is no marker? | Heart shadow on left, right side of diaphragm higher due to heart on left, arch of descending aorta on left, Gastric/Fundus air bubble (Meganblasse) on left, splenic flexure on left, sigmoid colon on left
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| Offset limit for George's line? | 2 mm. (because the 2 of us are moving into George's house;-)
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| Can spina bifida be visualized on AP lateral projections? | yes, by the absence of spinolaminar lines.
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| Can spina bifida be visualized on AP projections? | yes.
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| what is missing on an AP lateral projection to indicate the presence of spina bifida? | the absence of spinolaminar lines
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| 4 clinical indications for taking plain film radiographs: | rule out child abuse, whiplash from MVA, person over 30 with unremitting back pain, aparent scoliosis or trauma if possible fracture present
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| Lumbar gravity line measurement | From midpoint of L3 vertebral body, drop a line straight down. Line should pass in under 10mm. of sacrum
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| How do you measure lumbar IVD angles and what are the norms for each of the 5 lumbar spaces? | on Lateral projection, lines are drawn on superior and inferior vertebral endplates posteriorly to intersection. Angles in degrees should be: 8.10.12.14.14 for L1-5 respectively
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| 8.10.12.14.14 | lumbar IVD angle norms.
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| How do you visualize the right IVF's of the cervical spine? | RAO or LPO
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| How do you visualize the left IVF's of the cervical spine? | LAO or RPO
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| What is another name for lateral flexion and extension radiographs? | stress views
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| Why is the disc space of L5/S1 not visualized in AP lumbar projections? | the sacral tilt/lumbosacral lordosis
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| how do we get a radiograph of the L5/S1 disc space? | angulated AP lumbosacral SPOT projection
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| SPOT projection | tilt for L5/S1 disc space due to lumbosacral angle
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| normal measurement for retropharyngeal soft tissue space? | 0-7mm.
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| 0-7 mm. | retropharyngeal
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| retrotracheal soft tissue space normal measurement? | 0-21 mm.
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| 0-21 mm. | retrotracheal ("t" for "twenty-one")
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| what clinical conditions might reduce the retropharyngeal (0-7 mm) or the retrotracheal (0-21 mm) spaces? | inflammation from an infection, swelling from trauma, cancerous growth impinging on the space
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| best projection for cervico-thoracic junction? | AP cervical
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| best projection for cervical rib? | AP cervical
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| best projection for clasp-knife deformity? | AP lumbar, AP lumbopelvic
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| What are a bunch of non-standard cervical views? | R and L anterior obliques, R and L posterior obliques, swimmer's view (C/T junction), R and L lateral flexion APOM, R and L lateral flexion and extension lateral cervical projections, articular pillar projections
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