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WorksheetsChapter 09: Lumbar Spine, Sacrum, and Coccyx Test Bank
Total questions: 75
Worksheet time: 1hrs 15mins
The intervertebral foramina of the lumbar spine are located at an angle of_____in relation to the midsagittal plane.
45°
30° to 35°
70° to 75°
90°
The small section of bone found between the superior and inferior articular processes of the lumbar spine is termed:
pillar.
transverse processes.
articular facets.
pars interarticularis.
The zygapophyseal joints of the upper lumbar vertebrae are____in relationship to the midsagittal plane.
30°
50°
45°
90°
The anterior projecting bony process of the sacrum that forms part of the inlet of the true pelvis is the:
promontory of the sacrum.
body of S1.
apex of coccyx.
sacral foramina.
Another term for the sacral horns is the:
Which specific aspect of the sacrum articulates with the ilium to form the sacroiliac joint?
Promontory
Cornu
Auricular surface
Inferior articular processes
Which one of the following structures of the sacrum is considered to be the most posterior?
Median sacral crest
Promontory
Superior articular processes
Spinous processes
What is the term for the superior aspect of the coccyx?
Base
Apex
Superior margin
Sacrococcygeal junction
The long axis of the sacrum is generally angled more posteriorly in males than females.
True
False
What is the joint classification of the zygapophyseal joints?
Cartilaginous/amphiarthrodial
Synovial/diarthrodial
Fibrous/synarthrodial
Symphyses/amphiarthrodial
The intervertebral joints in the lumbar spine are classified as:
synovial/diarthrodial.
fibrous/synarthrodial.
cartilaginous/amphiarthrodial.
fibrous/amphiarthrodial.
What type of joint movement occurs with the zygapophyseal joints?
Ginglymus
Plane
Ellipsoidal
Trochoidal
Which of the following topographic landmarks corresponds with the L4-5 vertebral level?
Xiphoid process
Lower costal margin
Anterior superior iliac spine (ASIS)
Iliac crest
Which of the following structures is located at the level of the ASIS?
S1-2
Tip of coccyx
Promontory of sacrum
L4-5
Which aspect of the Scottie dog is the inferior articular process?
A
B
C
D
Which aspect of the Scottie dog is the superior articular process?
A
B
C
D
E
Which aspect of the Scottie dog is the transverse process?
A
B
C
D
Which aspect of the Scottie dog is the pedicle?
A
B
C
D
A female is more likely to suffer a fracture of the coccyx due to a backward, sitting type of fall than a male.
True
False
The Scottie dog sign is demonstrated with oblique projections of the thoracic and lumbar spine.
True
False
The anterior oblique (RAO and LAO) positions of the lumbar spine will demonstrate the zygapophyseal joints closest to the image receptor.
True
False
The average degree of rotation required to demonstrate the L3-4 zygapophyseal joints is:
50°.
30°.
20° to 25°.
45°.
Why should the hips and knees be flexed for an anteroposterior (AP) projection of the lumbar spine?
For patient comfort
To reduce the lumbar curvature
To demonstrate any possible spondylolisthesis
Both A and B
Which of the following should be done to reduce scatter radiation from reaching the image receptor for the lateral lumbar, sacrum, and coccyx projections?
Use a lower kV.
Place a lead mat on the tabletop behind the patient.
Increase the source image receptor distance (SID) to 44 inches (113 cm).
Use a smaller image receptor.
Where is the central ray (CR) centered for an AP projection of the lumbar spine with a 14 × 17-inch (35 × 43-cm) IR?
At the iliac crest
At the ASIS
1 to 1.5 inches (2.5 to 3 cm) above the iliac crest
At the lower costal margin
If the waist is supported properly, an average-size patient does not require any CR angulation for the lateral lumbar spine projection.
True
False
If the patient has scoliosis, the convexity of the spine should be down toward the image receptor for the lateral spine projection.
True
False
Which of the following statements is NOT true about the lateral L5-S1 projection?
If the waist is not supported, the CR must be angled 5° to 8° caudad.
A lead mat should be placed on the tabletop behind the patient, and there should be close collimation to improve image quality.
A 14 × 17-inch (35 × 43-cm) IR should be used.
The CR is centered 1.5 inches (3 to 4 cm) inferior to the iliac crest and 2 inches (5 cm) posterior to the ASIS.
Which labeled structure in the figure is the superior articular process?
A
B
C
D
E
Which labeled structure is the pars interarticularis?
A
B
C
D
E
Which labeled structure is the inferior articular process?
A
B
C
D
E
Which labeled structure is the spinous process?
A
B
C
D
E
What CR angulation should be used for an AP axial projection of the L5-S1 joint space on a male patient?
20° cephalad
30° cephalad
35° caudad
40° to 45° cephalad
Carefully placed gonadal shielding must always be used on female patients for the AP lumbar spine projection.
True
False
MRI (magnetic resonance imaging) is superior to CT (computed tomography) for evaluation of spinal cord and intervertebral disks.
True
False
Bone densitometry produces very little skin dose to the patient.
True
False
Conventional radiography does not detect bone loss from conditions such as osteoporosis until bone mass has been reduced at least 30%.
True
False
The AP and lateral projections for a pediatric scoliosis study should include the entire lumbar and thoracic spine.
True
False
The second projection for the Ferguson method of the scoliosis series requires that the concave side of the curve be built up 3 to 4 inches (8 to 10 cm) by placing blocks beneath the patient’s foot.
True
False
A key advantage of a posteroanterior (PA) projection taken during a pediatric scoliosis study as compared with the AP projection is that it reduces:
breast and thyroid dose by 90%.
female ovarian dose by 25% to 30%.
breast dose by 15% to 20%.
breast and thyroid dose by 150%.
Where is the CR centered for an AP axial projection of the sacrum?
At the level of the ASIS
At the level of the symphysis pubis
1 to 1 1/2 inches (3 to 4 cm) below the iliac crest
2 inches (5 cm) above the symphysis pubis
What type of CR angulation is required for an AP axial projection of the coccyx?
(a)
The radiographic appearance on an oblique lumbar spine in which the neck of the Scottie dog appears broken suggests the presence of:
spondylolisthesis.
spina bifida.
compression fracture.
spondylolysis.
A destructive type of lesion with irregular margins and increased density is an indication of possible:
osteoblastic type of metastases.
osteolytic of type metastases.
spondylolisthesis.
spondylolysis.
A fracture through the vertebral body and posterior elements caused by lap seat belts during an auto accident involving sudden deceleration is a ____ fracture.
compression
Jefferson
teardrop burst
Chance
Which of the following is a condition of unknown cause in which calcification of bony ridges between vertebrae occurs, creating a lack of mobility with a “bamboo” appearance?
Scheuermann disease
Ankylosing spondylitis
Spondylolisthesis
Osteoblastic type of metastases
An anterior wedging of vertebrae with a loss of body height but rarely causing neurologic symptoms is called:
a teardrop burst fracture.
a chance fracture.
a compression fracture.
spondylolysis.
Sciatic type of pain resulting from a “slipped disk” indicates:
spondylolisthesis.
herniated nucleus pulposus.
ankylosing spondylitis.
spina bifida.
An abnormal lateral curvature of the spine is a congenital condition termed:
spina bifida.
spondylolisthesis.
lordosis.
scoliosis.
What CR angle should be used for a lateral sacrum/coccyx projection?
15° cephalad
30° cephalad
None. CR is perpendicular to the image receptor.
10° cephalad
A radiograph of a left posterior oblique (LPO) projection of the lumbar spine reveals that the downside pedicle is projected too far posterior on the vertebral body. What specific positioning error is present on this radiograph?
Excessive rotation of the spine
Insufficient rotation of the spine
Tilt of the spine
Incorrect CR placement
A radiograph of a lateral projection of the lumbar spine reveals that the mid- to lower-intervertebral joint spaces are not open. The patient’s waist was supported. Which of the following modifications will help open these joint spaces during the repeat exposure?
Increase the SID for less divergence of the x-ray beam.
Decrease waist support and/or angle the CR 5° to 8° cephalad.
Have the patient hold her breath on a deeper inspiration to expand the thorax and straighten the spine.
Increase waist support and/or angle CR 5° to 8° caudal.
A radiograph of an AP axial sacrum reveals that it is foreshortened and the sacral foramina are not clearly seen. The patient was in an AP supine position, and the technologist angled the CR 10° cephalad. What specific positioning error is present on this radiograph?
Excessive CR angulation
Rotation of the sacrum
Insufficient CR angulation
Wrong direction of the CR angle
A radiograph of an AP axial coccyx reveals that the symphysis pubis is superimposed over the distal end of the coccyx. Which of the following modifications will correct this problem during the repeat exposure?
Decrease the CR angulation.
Increase the CR angulation.
Slightly oblique the patient.
Ask the patient to empty her bladder.
A radiograph of an AP axial L5-S1 projection reveals that the joint space is not open. The following factors were used on this female patient: 80 kV, 40-inch (102 cm) SID, grid, 35° caudad angle, and CR centered to the ASIS. Which of the following factors needs to be modified to produce a more diagnostic image?
Increase the CR angulation.
Decrease the CR angulation.
Change the direction of the CR angulation.
Center the CR higher to place it parallel to the joint space.
A radiograph of an AP projection of the lumbar spine on an average-size patient reveals that the psoas major muscles and transverse processes are not visible. The following analog factors were used for this projection: automatic exposure control. What is the most likely reason for the lack of visibility of these structures?
Insufficient kVp was used
Excessive mAs was used
Patient motion occurred
Grid was not used
(AEC) with center ionization chamber, 95 kV, 40-inch (102-cm) SID, grid, and 14 × 17-inch (35 × 43-cm) image receptor. Which of the following modifications will be most effective in demonstrating these structures?
Decrease the kV.
Activate all three ionization chambers.
Decrease the mAs.
Increase the kV.
A patient comes to radiology for a study of the lumbar spine. The initial radiographs demonstrate potential pathology involving the L5-S1 zygapophyseal joint. Which of the following positions and/or projections would best demonstrate this joint space?
Lateral L5-S1 position
Right and left 30° oblique projections
Right and left 50° oblique projections
Closely collimated and lateral position of L5-S1 region
A patient comes to radiology for a study of the lumbar spine. He has a clinical history of spondylolisthesis of L5. Which of the following projections will best demonstrate the severity of this condition?
30° oblique projections
50° oblique projections
Lateral L5-S1 projection
AP axial L5-S1 projection
A patient comes to radiology for a follow-up study of the lumbar spine. The patient had a spinal fusion performed at the L3-4 level 4 months earlier. Which of the following would best demonstrate the degree of movement at the fusion site?
Lateral hyperextension and hyperflexion projections
Ferguson method
AP and lateral erect projections
Right and left 45° oblique projections
A young female patient comes to radiology for a scoliosis study. The patient has had this series performed frequently. How much will the breast dose be decreased if a PA rather than an AP projection is taken?
15%
90%
35%
It will not make a significant difference with good collimation.
A patient comes in with a possible compression fracture of L3. Which one of the following positioning routines would best demonstrate the body of L3 and the intervertebral joint spaces above and below it?
Collimated R and L posterior oblique and AP projections
Collimated PA and lateral projections
Erect AP and lateral projections
Collimated LPO and RPO positions
A geriatric patient comes to radiology for a lumbar spine series. She has severe kyphosis of the thoracolumbar spine. Which one of the following modifications should be applied to this patient?
Perform all positions erect.
Perform all positions recumbent, include flexion and extension projections.
Include the entire spine for all projections regardless of what was ordered by the physician.
Use high (90 kV) for all projections.
A female patient is brought to the emergency department (ED) because of a MVA (motor vehicle accident). Her chief complaint is pain in the lower lumbar region. The ED physician orders a lumbar series. Upon questioning, the technologist learns that the patient is pregnant. The ED physician is made aware of the pregnancy but still wants the lumbar spine series performed. What can the technologist do to minimize dose to the fetus and mother?
Use higher kV than normal, reduce mAs accordingly.
Use smallest IR possible.
Collimate as much as feasible.
All of the above should be done.
The use of digital radiography is not recommended for studies of the sacrum and coccyx.
True
False
Which of the following fractures is due to a hyperflexion force injury?
Compression fx
Burst fx
Chance fx
Metastatic fx
The “nose” of the Scottie dog represents the spinous process of a lumbar vertebra.
True
False
The pelvis must remain stationary for the AP right and left bending projections of the scoliosis series.
True
False
For a lateral L5-S1 projection, the CR must be parallel to the:
midsagittal plane.
midcoronal plane.
interiliac line.
transverse plane.
AEC (automatic exposure control) should not be used for an L5-S1 lateral or a lateral sacrum and coccyx.
True
False
How much obliquity of the body is required for posterior oblique positions for the sacroiliac joints?
45°
10° to 15°
60° to 70°
25° to 30°
The LPO position for sacroiliac joints will best demonstrate the right joint.
True
False
A radiograph of the left sacroiliac joint demonstrates it open and clearly seen. Which of the following positions was performed?
LPO
RPO
RAO
AP
Radiographs of oblique projections of the SI joints do not clearly demonstrate the inferior/distal aspect of the joints. What can the technologist do to better demonstrate this region?
Increase rotation of the pelvis.
Initiate exposure upon expiration.
Angle CR 15° to 20° cephalad.
Perform positions erect.
Where is the CR centered for posterior oblique projections of the SI joints?
1 inch (2.5 cm) medial to upside ASIS
2 inches (5 cm) medial to upside ASIS
Centered at upside ASIS
1 inch (2.5 cm) medial and inferior to upside ASIS
