CONFIDENTIAL HS/OCT 2009/MRD400

UNIVERSITI TEKNOLOGI MARA

FINAL EXAMINATION

COURSE MEDICAL IMAGING 1

COURSE CODE MRD400
EXAMINATION OCTOBER 2009
TIME 2 HOURS

INSTRUCTIONS TO CANDIDATES

1. This question paper consists of two (2) parts: PART A (50 Questions)
PART B (4 Questions}

2. Answer ALL questions from all two (2) parts:

i) Answer PART A in the OMR multiple Choice Answer Sheet.

ii) Answer PART B in the Answer Booklet. Start each answer on a new page.

3. Do not bring any material into the examination room unless permission is given by the
invigilator.

4. Please check to make sure that this examination pack consists of:

i) the Question Paper

ii) an Answer Booklet - provided by the Faculty
iii) an OMR Multiple Answer Sheet - provided by the Faculty

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO

This examination paper consists of 14 printed pages
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CONFIDENTIAL 2 HS/OCT 2009/MRD400

PART A (50 marks)

Answer ALL questions.

Choose the MOST appropriate answer for each question.

1. Chest examination should be performed with a 180-cm focus-film-distance (FFD)

to^ .

A. blur involuntary heart motion

B. minimize magnification of the heart
C. maximize magnification of the heart
D. project clavicles above the apices

2. Which evaluation criterion pertains to the anteroposterior (AP) axial projection (lordotic
position) radiograph of the chest?

A. The ribs should be distorted.

B. The clavicles should lie below the apices.
C. The sternum should be lateral, not rotated.
D. The thoracic intervertebral disk spaces should be open.

3. To ensure the scapulae are removed from the lungs field during postero-anterior (PA)
projection of the chest, the radiographer should

A. place the patient's hands on the hips.

B. rotate the patient's shoulders forward.
C. cross patient's both arm over the head.
D. place the patient's hand behind the back

4. Which of the following pathologic condition of the chest is BEST demonstrated using a
lateral decubitus position?

A. Pneumonia.
B. Asthma.
C. Bronchitis.
D. Pleural effusion.

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CONFIDENTIAL 3 HS/OCT 2009/MRD400

5. Which of the following is (are) recommended when positioning the patient for a lateral
projection of the chest?

I. The patient should be examined upright.

II. The shoulders should be depressed.
III. The shoulders should be rolled forward.

A. I only.
B. I and II only.
C. I and III only.
D. I, II and III.

6. The BEST position to demonstrate fluid in the pleural cavity is

A. lateral decubitus, affected side up.

B. lateral decubitus, affected side down.
C. AP Trendelenburg.
D. AP supine.

7. Which of the following criteria are used to evaluate a PA projection of the chest?

A. Ten anterior ribs should be visualized.

B. Sternoclavicular joints should be symmetrical.
C. The scapulae should be inside the lung fields.
D. An optimum penetration will visualize all twelve thoracic spines.

8. During the chest radiography, the acts of inspiration will

I. elevate the diaphragm.

II. raise the ribs.
III. depress the abdominal viscera.

A. I only.
B. I and II only.
C. II and III only.
D. I, II and III.

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CONFIDENTIAL 4 HS/OCT 2009/MRD400

9. Colles' fracture is (are) associated with a

I. transverse fracture of the radial head.

II. chip fracture of the ulnar styloid.
III. posterior or backward displacement.

A. I only.
B. I and III only.
C. II and III only.
D. I, II and III.

10. Which of the following is required for visualization of the greater tubercle of humerus?

A. Epicondyles should be placed parallel to the film.

B. Arm is in internal rotation.
C. Flex the elbow approximately 90°.
D. The patient's hand should be place on the patient's hip.

11. Which of the following projections will separate the radial head, neck and tuberosity
from superimposition on the ulna?

A. AP.
B. Lateral.
C. Medial oblique.
D. Lateral oblique.

12. Which of the following is proximal to the carpal bones?

A. The distal interphalangeal joints

B. The proximal interphalangeal joints.
C. The metacarpals.
D. The radial styloid process.

13. Which projection of the elbow shows the coronoid process free of superimposition?

A. AP.
B. Medial oblique.
C. Lateral oblique.
D. Lateral.

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CONFIDENTIAL 5 HS/OCT 2009/MRD400

14. In an AP elbow projection, the and located on the medial side.

A. capitulum, radial head

B. trochlea, proximal ulna
C. capitulum, proximal ulna
D. trochlea, radial head

15. A lateral projection of the hand in extension is often recommended to evaluate

I. fractures.
II. foreign bodies.
III. soft tissues.

A. I only.
B. II only.
C. II and III only.
D. I and III only.

16. The medial oblique projection of the elbow will demonstrate the

A. olecranon process within the olecranon fossa.

B. radial head free of superimposition.
C. coronoid process free of superimposition.
D. Capitulum free of superimposition

17. In the lateral projection of the knee, the

A. femoral condyles are superimposed.

B. fibular head and tibia are free of superimposition.
C. knee is flexed about 40° to 50°.
D. patella is not in a lateral profile.

18. In the AP projection of the ankle, the

A. plantar surface of the foot is 45° internally rotated.

B. fibula projects more distally than the tibia.
C. calcaneus is well visualized.
D. centering point is 2.5cm superior from midway between the malleoli.

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CONFIDENTIAL 6 HS/OCT 2009/MRD400

19. Posterior displacement of a tibial fracture would be BEST demonstrated in the

A. AP projection.
B. lateral projection.
C. medial oblique projection.
D. lateral oblique projection.

20. Which of the following projections of the calcaneum is obtained with the leg extended,
plantar surface of the foot vertical and perpendicular to the film, and the central ray
directed 40° caudad?

A. Axial plantodorsal projection.

B. Axial dorsoplantar projection.
C. Lateral projection.
D. Lateral weight-bearing.

21. Which of the following structures will NOT superimposed in the lateral projection of the
knee when the central ray is angled 5° cephalad?

A. Lateral femoral condyle.

B. Medial femoral condyle.
C. Patella.
D. Tibial eminence.

22. In the lateral projection of the ankle, the

A. tibiotalar joint is well visualized.

B. talofibular joint is well visualized.
C. tibia and fibula are free from superimposition.
D. Medial and lateral talar domes is slightly superimposed.

23. In the mediolateral projection of the foot, the

A. foot should be dorsiflex to form a 90° angle with the lower leg.
B. tarsometatarsal joint is well visualized.
C. fibula overlapping the anterior portion of the tibia.
D. tibiotalar joint is well visualized.

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CONFIDENTIAL 7 HS/OCT 2009/MRD400

24. Which of the following is NOT located on the anterior aspect of the femur?

A. Intercondyloid fossa.
B. Popliteal surface.
C. Adductor tubercle.
D. Bicipital groove

25. The patient is in a 45° oblique with left posterior oblique position. The tube is angled at
15° cephalic and the central ray (CR) is centered to C-4. Which anatomic part is
visualized?

A. Left zygapophyseal joint.

B. Right zygapophyseal joint.
C. Left intervertebral foramen.
D. Right intervertebral foramen.

26. A forward displacement of one lumbar vertebral body over the vertebra or sacrum
beneath it is termed .

A. herniated disk
B. degenerative joint disease
C. spondylolisthesis
D. rheumatoid arthritis

27. To evaluate the degree of ligament injuries, or potential instability of the cervical spine,
projections should be performed.

A. hyperflexion and hyperextension

B. AP and lateral
C. right and left lateral side-bending radiographs
D. upright and supine left and right lateral radiographs

28. Which anatomical part is visualized when the patient is in a 45° oblique left anterior
oblique (LAO) position and the CR is perpendicular to the film through L-3?

A. Left zygapophyseal joint

B. Right zygapophyseal joint
C. Left intervertebral foramen
D. Right intervertebral foramen

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CONFIDENTIAL 8 HS/OCT 2009/MRD400

29. In order to demonstrate the first two cervical vertebrae in the AP projection, the patient
is positioned so that .

A. the glabellomeatal line is vertical

B. the acanthiomeatal line is vertical
C. a line between the mentum and mastoid tip is is vertical
D. a line between the acclusal plane and the mastoid tip is vertical

30. Which of the following are demonstrated in the lateral projection of the thoracic spine?

A. Transverse process.
B. Zygapophyseal joints
C. Intervertebral foramen
D. Spinous process.

31. Which of the following should the patient be instructed to remove prior to X-ray
examination of the cervical spine?

I. Dentures
II. Earrings
III. Necklaces

A. I and II only
B. I and III only
C. II and III only
D. I, II and III

32. Which of the following is NOT demonstrated in the AP oblique projection of the lumbar
spine?

A. Pars interarticularis.
B. Pedicles.
C. Zygapophyseal joints.
D. Intervertebral foramen.

33. Prior to exposure to an AP pelvis projection, the patient is required to internally rotate
the leg between 15° - 20° to .

A. demonstrate the greater trochanter in profile

B. superimpose the lesser trochanter
C. demonstrate the femoral neck without foreshortening
D. better visualize the acetabulum

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CONFIDENTIAL 9 HS/OCT 2009/MRD400

34. For transfemoral lateral hip projection, the gridded cassette is placed

A. lateral to the affected side, parallel to the shaft of femur

B. lateral to the affected side, parallel to the neck of femur
C. medial to affected side, parallel to the greater trochanter
D. medial to the affected side parallel to the lesser trochanter

35. The patient is rotated 25°-30° into a right posterior oblique (RPO) position. The CR is
centered 2.5 cm medial to the elevated anterior superior iliac spine (ASIS). What
structure will be best demonstrated on the radiograph?

A. Right acetabulum.
B. Left acetabulum.
C. Right sacroiliac joint.
D. Left sacroiliac joint.

36. In which of the following positions is the patient instructed to flex the hips and knees and
draw the feet up as much as possible?

A. AP oblique hip, modified Cleaves method.

B. Transfemoral (cross-table) lateral hip.
C. AP pelvis.
D. AP oblique sacroiliac joint (SIJ).

37. To obtain an AP projection of the left ilium, the patient's

A. left side is elevated 40°

B. right side is elevated 40°
C. left side is elevated 15°
D. right side is elevated 15°

38. The two palpable bony landmarks generally used for accurate localization of the hip are
the .

A. ASIS and symphysis pubis

B. iliac crest and the greater trochanter
C. symphysis pubis and greater trochanter
D. iliac crest and symphysis pubis

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CONFIDENTIAL 10 HS/OCT 2009/MRD400

39. All of the following are palpable bony landmarks used in radiography of the pelvis
EXCEPT:

A. femoral neck
B. symphysis pubis
C. greater trochanter
D. iliac crest

40. The left SI J is positioned perpendicular to the film when the patient is positioned in a

A. left lateral position

B. 25° to 30° LAO position
C. 25° to 30° left posterior oblique (LPO) position
D. 30° to 40° LPO position

41. For the AP projection of the scapula, the

I. patient's arm is abducted at right angles to the body

II. patient's elbow is flexed with hand supinated
III. exposure is made during quite breathing

A. I and II only
B. I and lilonly
C. II and III only
D. I, II and III

42. Which of the following statements is (are) true regarding the scapula Y projection of the
shoulder joint?

I. The patient is placed in an RAO position.

II. The midcoronal plane is about 60 degrees to the film.
III. The acromion process is free of superimposition.

A. I and II only
B. I and III only
C. II and III only
D. I, II and III

43. Which of the following is used to evaluate the shoulder in its anatomic position?

A. External rotation position

B. Internal rotation position
C. Neutral rotation position
D. Inferosuperior axial position

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CONFIDENTIAL 11 HS/OCT 2009/MRD400

44. The scapular Y projection of the shoulder demonstrates

I. an oblique projection of the shoulder

II. anterior and posterior dislocation
III. a lateral projection of the shoulder

A. I and II only
B. I and III only
C. II and III only
D. I, II and III

45. Which of the following will BEST demonstrate acromioclavicular separation?

A. AP recumbent, affected shoulder

B. AP recumbent, both shoulder
C. AP erect, affected shoulder
D. AP erect, both shoulder

46. In the lateral projection of the scapula, the

I. vertebral and axillary borders are superimposed

II. acromion and coracoid process are superimposed
III. patient may be examined in the erect position

A. I and II only
B. I and III only
C. II and III only
D. I, II and III

47. Which of the following tube angle and direction combinations is correct for an axial
projection of the clavicle, with the patient in the AP recumbent position on the x-ray
table?

A. 10°to15°caudad
B. 10°to15°cephalad
C. 25° to 30° cephalad
D. 25° to 30° caudad

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CONFIDENTIAL 12 HS/OCT 2009/MRD400

48. Which of the following may be used to evaluate the glenohumeral joint?

I. Scapular Y projection
II. Inferosuperior axial
III. Transthoracic lateral

A. I and II only
B. I and III only
C. II and III only
D. I, II and III

49 Which of the following shoulder projections may be used to evaluate the lesser
tubercle in profile?

A. External rotation position

B. Internal rotation position
C. Neutral rotation position
D. Inferosuperior axial

50. Which procedure(s) use quiet, shallow breathing during the exposure to obliterate
prominent pulmonary vascular markings?

I. RAO sternum
II. lateral thoracic spine
III. AP scapula

A. I and II only
B. I and III only
C. II and III only
D. I, II and III

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CONFIDENTIAL 13 HS/OCT 2009/MRD400

PART B (50 marks)

Answer ALL questions.

QUESTION 1

With regards to vertebral column radiography:

a) Describe ONE projection to demonstrate the right intervertebral foramen of the cervical
vertebra.
(6 marks)

b) Explain briefly how patient orientation relative to anode position affects the quality of
image produced in an AP projection of thoracic vertebra.
(4 marks)

QUESTION 2

In relation to AP projections of the ankle (Stress Study):

a) State the purpose of performing the procedure.

(2 marks)

b) Briefly explain how the patient can hold the foot in the stress position.
(3 marks)

c) Briefly describe the image presentation if the patient has a torn ligament affecting the
ankle.
(5 marks)

QUESTION 3

a) In the Medical Imaging department, a patient that is requested to undergo any

interventional procedures is requested to sign a consent form. State THREE criteria for
a patient to be eligible to sign an informed consent.
(3 marks)

b) Tort is a civil wrong committed by one individual against a person or property of another.
This can and may happen to any radiographer if they lack skills or cause harm to the
patient intentionally. Differentiate the following common terminologies that are
associated with tort.

i) Negligence and malpractice.

ii) Battery and assault.
iii) False imprisonment and invasion of privacy.
(12 marks)

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CONFIDENTIAL 14 HS/OCT 2009/MRD400

QUESTION 4

A 30-year old female was involved in a motor-vehicle accident (MVA) and suspected of left
rib fracture. She was unconscious when brought to the Medical Imaging Department on a
stretcher. A chest x-ray was requested to rule out any pneumothorax in the left lung.

a) Describe the MOST appropriate projection to visualise the indication stated.

(10 marks)

b) Explain why chest x-ray examinations should be performed in an erect position if

possible.
(5 marks)

END OF QUESTION PAPER

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