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FORMAL EXAMINATION PERIOD: SESSION 1, JUNE 2022

Unit Code: CHIR8401

Unit Name: Diagnostic Imaging 1

Duration of Exam 2 hours and 10 minutes reading time

(including reading time if applicable):

Total No. of Questions: 120

Total No. of Pages 38

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1. On a lateral hand x-ray you observe a small fragment of bone posterior to the carpal
bones as depicted in the image below. Which of the carpal bones was most likely
fractured?

A) Hamate
B) Trapezium
C) Scaphoid
D) Triquetrum
In Isthmic spondylolisthesis, the slippage occurs as a result of a defect or fracture in a
specific area of the vertebra called the pars interarticularis.

2. Which is the best imaging modality to use if you need to determine if an isthmic
spondylolisthesis at L5 is an active lesion?

A) CT Active lesion: An area of tissue damage, abnormality, or pathology that is

currently active or actively progressing.
B) Lateral lumbar x-ray
C) STIR MRI
D) Oblique lumbar x-ray

3. Which of the following conditions is thought to be primarily caused by herniation of

the nucleus pulposus, preventing fusion of the vertebral ring epiphysis?

A) Butterfly vertebra
B) Limbic bone
C) Kummel's disease
D) Scheuermann's disease

2
 Does the question mean what would be not a likely finding in osteoporosis? 3 of the findings are
found

4. Which of the following is the most reliable x-ray finding to indicate osteoporosis in the
spine?
Osteoporosis- Spinal
-Curve changes: hyperkyphotic
A) 'Pseudo-hemangioma' appearance
-Accentuation of vertical trabeculae
B) Vertebra plana -Washed out appearance (pseudo-haemangioma
C) 'Empty-box' appearance appearance)
D) Hyperkyphosis -Cortical thinning
-Changes in vertebral shape

5. What is the technical term for an abnormal separation of a syndesmosis?

A) Subluxation
B) Syndesmososis
C) Dislocation
D) Diastasis
Syndesmosis: Refers to a specific type of joint characterized by the presence of strong fibrous CT
that help stabilize the joint & limits it's ROM.
6. The joint space loss associated with osteoarthritis in the extremities is typically:
-Loss of joint space
-Asymmetrical pattern
A) Symmetrical both with a joint space and between left and right
B) Symmetrical within a joint space, asymmetrical between left and right
C) Asymmetrical, both within a joint space and between left and right
D) Asymmetrical within a joint space, symmetrical between left and right

7. If a patient has Kohler's disease, which is the LEAST likely radiographic finding you
would observe?

A) Decreased size of the bone

B) Solid periosteal reaction
C) Increase density of the bone
D) Fragmentation of the bone
Köhler's disease, also known as Köhler's bone disease, is a condition that primarily affects children. It is a form of osteochondrosis, which refers to a group of disorders involving the
temporary or permanent loss of blood supply to a bone, leading to its degeneration and potential deformity.

8. The appearance of a Cam impingement may be simulated by faulty patient positioning,

in particular:

A) Hip abduction
B) Hip adduction
C) Hip internal rotation
D) Hip external rotation

3
9. Which structure is indicated by number 2 in the image below?

A) L3 pars interarticularis
B) L2 pedicle
C) L2-3 intervertebral foramen
D) Thecal sac

10. What is the most common method of spread of infective organisms into the bone?
Most common spread of infection into the bone: Hematogenous
A) Surgical complication (thru the bloodstream), contiguous (spread into bone from an
B) Spread through the bloodstream adjacent contaminated site) & direct trauma.
C) Traumatic injury
D) Spread from a neighbouring structure

11. What is the most common benign tumour of the spine?

A) Giant cell tumour lytic (Comprise 15% of benign bone tumours)

B) Aneurysmal bone cyst lytic (About 1% of biopsied tumours)
C) Osteoblastoma lytic (Rare benign osteoblastic neoplasm: About 1% of all benign bone tumors)
D) Haemangioma lytic (Most common benign tumour of the spine)

4
 12. An adolescent female presents with a thoracic spine scoliosis. Previous imaging (taken
2-years previously) demonstrated no extension of the scoliosis into the lumbopelvic
spine. To reassess this patient, in addition to thoracic spine x-rays, would you also
request lumbopelvic x-rays and why?

A) Yes, to assess for a potential cause of the scoliosis

B) No, to avoid increased radiation exposure to the developing organs
C) Yes, to assess the stage of maturity of the patient
D) Yes, to assess whether the curve has now extended into the lumbar spine
The division of the patella into 2 parts is usually present from birth, although it may not be noticeable until later in childhood or
adolescence when the patella undergoes further growth and ossification. The separation is typically located at the upper or outer
portion of the patella but can occur in other areas as well.
13. What is the most likely location of a bipartite patella?

A) Superomedial quadrant
B) Inferolateral quadrant
C) Inferomedial quadrant
D) Superolateral quadrant
Osteochondritis dissecans: Joint condition that involves the detachment of a piece of cartilage & underlying bone from the joint surface. It
most commonly affects the knee, but can also occur in other joints such as the elbow, ankle or hip.
14. Where is an osteochondritis dissecans lesion most commonly found at the ankle?

A) Medial malleolus
B) Medial talus
C) Lateral malleolus
D) Lateral talus

15. Which condition is primarily associated with an omovertebral bone and Sprengel's
deformity?

A) Klippel-Feil syndrome
B) Holt-Oram syndrome
C) Achondroplasia
D) Omocervical syndrome

16. When distinguishing between rheumatoid arthritis and psoriatic arthritis, the most
useful characteristic to consider would be the:

A) Type of osseous changes

B) Age of the patient
C) Sex of the patient
D) Distribution of osseous changes

Rheumatoid: Psoriatic:
-Insidious onset articular pain, swelling, tenderness, stiffness -80% have psoriatic nerve involvement
-Bilateral & symmetrical -Early: DIP/PIP swelling, redness, pain, sausage digit
-Fatigue, malaise, muscle weakness, fever -Soft tissue swelling
-Selectively targets synovial tissue: joints, tendons, bursae -Normal bone density
-Bilateral, symmetrical, progressive -Marginal erosions & tapered bone ends
-Other body systems may be involved: heart, lungs, blood vessels, -Pencil in cup deformity
nerves, eyes. -Fluffy juxtaarticular periostitis
-Periods of remission & exacerberation -Mouse ears
-Narrowed or widened joint space 5
-Fibrotic & eventual bony ankylosis
-Arthritis mutilans
 Subchondral cyst: Synovial fluid intrusion into subchondral bone through weakened cartilage and cortical microfractures

17. In which of the following conditions would you be LEAST likely to observe subchondral
cysts on x-ray

A) Rheumatoid arthritis Pannus intrusion into marrow space

B) Reactive arthritis
C) Degenerative joint disease
D) Gout Crystal deposition in bone

18. Osteoporosis exhibits decreased bone density on x-ray because there is:

A) A decrease in the mineralisation of the bone

B) A decrease in the amount of bone matrix and mineralisation of the bone
C) Selective resorption of certain areas of the bone
D) A decrease in the amount of the bone matrix

19. On an APOM cervical x-ray you observe a horizontal lucency at the base of the dens.
Which of the following would be the LEAST likely diagnosis?

A) Mach effect
B) Os odontoideum Separate & mobile ossicle that is detached from the body of the axis vertebra (C2), which is located above the dens
C) Ossiculum terminale The ossiculum terminale develops as a secondary ossification center and eventually fuses with the dens by early adulthood.
D) Type 2 dens fracture
Mach effect: Result of the way our visual system processes and interprets contrast information. Our eyes and brain tend to enhance the perceived contrast at the boundaries between
2 different areas, which can lead to the appearance of exaggerated brightness or darkness. This can potentially lead to misinterpretations or overemphasis on certain features.

20. Which of the following radiographic findings is most consistent with a primary benign
bone tumour?

A) Moth-eaten lytic lesion

B) Laminated periosteal reaction
C) Cortical thinning
D) Soft tissue swelling

21. What is the underlying cause of the premature and excessive degenerative changes
seen in neurotrophic osteoarthropathy?

A) Ineffective protective neurologic mechanisms

B) Joint infection
C) Repetitive knee trauma
D) Autoimmune inflammatory changes

6
22. When is a fracture considered to be 'clinically' united?

A) When the bone has completed the remodelling phase

B) When the soft callus has formed
C) When a solid periosteal reaction starts to form
D) When the developed callus will allow normal physiological stress

23. What does a fat pad sign at the elbow indicate?

A) Occult fracture
B) Inflammatory arthritis
C) Gout
D) Intra-articular swelling

24. A slipped femoral capital epiphysis is an example of which type of Salter-Harris

fracture?

A) Type V
B) Type II
C) Type IV
D) Type I

25. Which x-ray imaging technique would be the best to use to assess both femoral head
height and sacral obliquity?
Option A: Focuses solely on the femoral head and may not provide a complete assessment of the Sacral obliquity.
A) AP femoral head view Option C + Option D: Typically used to assess the Sacroiliac joints rather than Femoral head height
B) AP lumbopelvic view
C) AP modified Ferguson view
D) AP Ferguson view

26. On an x-ray you observe a 'mushroom-cap deformity' at the femoral head. What does
this indicate?

A) Old Perthe's disease

B) Old developmental hip dysplasia
C) Current Perthe's disease
D) Current infection

7
When osteomyelitis persists for an extended period of time, the infection can lead to the death of bone tissue. The body's immune response attempts to contain the infection by forming a layer of
bone (involcrum) around the affected area. However, within this region of infection, a sequestrum can form as a result of the necrotic bone being separated from the surrounding healthy bone.
The sequestrum is essentially a detached piece of dead bone that acts as a focus for ongoing infection. It can prevent proper healing & clearance of the infection, leading to chronic inflammation
and the formation of pus-filled cavities.

27. In relation to osteomyelitis, what is a sequestrum?

A) A separated fragment of necrotic bone

B) A squamous cell carcinoma that develops in the soft tissues adjacent to the area of
osteomyelitis
C) A 'collar' of new bone forming around an infectious focus
D) A drainage defect through the soft tissues

28. On a lateral cervical spine x-ray you note that the posterior aspect of the C1 anterior
arch has a triangular shape, with the apex pointing posteriorly. What would this finding
indicate to you?

A) Likely congenital anomaly of the dens - assess for os odontoideum or agenesis of

the dens
B) Likely destruction of the dens - assess for infection or metastasis
C) Hypertrophy of the anterior arch secondary to occipitalisation or agenesis of the
posterior arch of the atlas
D) Nothing, this is the normal shape of the C1 anterior arch

29. Which of the below technical factors used to take a CT scan would produce a 'bone
window' image

A) Window width: 40HU; Window length: 350HU

B) Window width: 300HU; Window length: 1900HU
C) Window width: 350HU; Window length: 40HU
D) Window width: 1900HU; Window length: 300HU

30. In which part of the vertebral body does an infection most commonly start?

A) Posterior-inferior corner
B) Anterior-superior corner
C) Anterior-inferior corner
D) Posterior-superior corner

31. What does a 'H-sign' on a bone scan indicate?

A) Scheuermann's disease
B) Sickle cell anaemia
C) Sacral insufficiency fracture
D) Kummel's disease

8
 32. Which of the following radiographic findings is most commonly associated with
rheumatoid arthritis?

A) Dagger sign
B) Boutonniere's deformity
C) Arthritis mutilans
D) Heberden's nodes

33. What is the most common organism to cause a bone infection?

A) Haemophilus influenzae
B) Staphylococcus aureus (90% of the time)
C) Mycobacterium tuberculosis
D) Diplococcus pneumoniae
Pseudotumours: Non-neoplastic (non-cancerous) mass-like lesions that mimic the appearance of tumours. These lesions can occur in various parts of the body & may
result from a variety of underlying causes. Pseudotumours can arise from different mechanisms, such as inflammation, infection, trauma, or fluid accumulation.

34. Which of the following conditions may present with osteoporosis, decreased joint
space, subchondral cysts, soft tissue swelling, and pseudotumours?

A) Rheumatoid arthritis (Osteoporosis, decreased joint space, subchondral cyst, soft tissue swelling)
B) Leukaemia (Osteoporosis)
C) Haemophilia (Soft tissue swelling, Osteoporosis, Subchondral cysts & Pseudotumours)
D) Ollier's disease
Haemophilia: A condition where a person's blood doesn't clot properly. This means that even small injuries or cuts can cause excessive bleeding, and it takes longer for the bleeding
to stop. It happens because the body doesn't have enough of certain substances called clotting factors that help blood to form clots.

35. What structure is indicated by number 17 in the image below?

A) Longissimus muscle
B) Iliocostalis muscle
C) Quadratus lumborum muscle
D) Psoas muscle

9
36. The radiographic finding indicated by the white arrow in the below image is associated
with femoroacetabular impingement. This finding is known as a/an:

A) Fibrocortical defect
B) Herniation pit
C) Bone island
D) Os acetabuli

37. Which of the following radiographic findings would specifically indicate degeneration
of the uncoveretbral joints?
Facet joints:
-Synovial joints:
A) Vacuum phenomenon *Osteophytes, sclerosis, decreased joint space, subluxations/instability (degenerative
spondylolisthesis)
B) Pseudofracture sign -Intervertebral joints:
C) Intercalary bone *Cartilagenous joints, decreased height, osteophytes, subchondral sclerosis, vacuum
phenomenon, calcifications, not synonymous with disc herniation
D) Subchondral sclerosis -Uncovertebral joints cervical spine
*Osteophytes, uncinate process hypertrophy, pseudofracture sign

38. DISH and ankylosing spondylitis can both create fusion of multiple vertebrae. Which of
the following radiographic findings would be more likely to indicate a diagnosis of
ankylosing spondylitis rather than DISH?

A) Fusion of the posterior vertebral elements

B) Non-marginal syndesmophytes
C) Calcification of the posterior longitudinal ligament
D) Fusion of at least 4 contiguous segments

10
39. Which type of MRI sequence was used to take the below image?

T1 weighting: Refers to a MRI sequence that emphasises the differences in T1

relaxation times between tissues. In T1-weighted images, fluids appear dark, while
fat and some normal tissues appear bright.

T2 weighting: Refers to a MRI sequence that emphasises the differences in T2

relaxation times between tissues. In T2-weighted images, fluids, such as
cerebrospinal fluid (CSF), appear bright, while fat & some normal tissues appear
darker.

Contrast: Ability to differentiate between different tissues or structures based on

their appearance in an image.

A) Contrast
B) T1
C) T2
D) STIR

40. A 'raindrop skull' exhibiting uniform circular lytic lesions is most commonly associated
with:

A) Hyperparathyroidism
B) Multiple myeloma
C) Sickle cell anaemia
D) Paget's disease

41. Which structure is calcified in Eagle's syndrome?

A) Oblique atlanto-occipital ligament

B) Sternocleidomastoid
C) Stylohyoid ligament
D) Longissimus colli

11
42. Which of the following radiographic findings is most consistent with a primary
malignant bone tumour?

A) Expansive lytic lesion

B) Calcification in the matrix
C) Permeative lytic lesion
D) Fracture

43. Which structure is indicated by number 12 in the image below?

A) L5 right superior articular facet

B) L4 left inferior articular facet
C) L5 left superior articular facet
D) L4 right inferior articular facet

44. An osseous tumour arising within the cortex will always:

A) Be prone to fracture
B) Be eccentric
C) Have associated soft tissue swelling
D) Have an associated periosteal reaction

12
 45. Which of the following tumours is most likely to be highly expansive with an egg-shell
thin margin?

A) Non Hodgkin's lymphoma

B) Giant cell tumour
C) Osteosarcoma
D) Aneurysmal bone cyst

46. Which of the following spinal radiographic findings would be more likely to indicate a
diagnosis of Pott's disease rather than osteolytic metastases?

A) Lytic erosion of the pedicle

B) Gibbus deformity with decreased disc height
C) Gibbus deformity without decreased disc height
D) Lytic erosions in 2 adjacent vertebral bodies

47. What is the minimum Cobb angle required to define a lateral curvature of the spine as
a scoliosis?

A) 15 degrees
B) Any degree of lateral curvature is defined as a scoliosis
C) 20 degrees
D) 10 degrees

48. On an AP lumbopelvic x-ray you observe a lumbosacral transitional segment. The right
transverse process is enlarged. The left transverse process is enlarged and forming a
pseudojoint with the sacrum. Which Castellvi classification would this be best
described as? Castelli Classification:
-Type 1: Enlarged & dysplastic transverse process (Ia- unilateral/Ib- bilateral)
-Type 2: Pseudoarticulation of the enlarged transverse process with the sacrum (IIa- unilateral/ IIb- bilateral)
A) Type IIb -Type 3: Enlarged transverse process fuses with the sacrum (IIIa- unilateral/ IIIb-bilateral)
B) Type IV -Type 4: Type IIa on one side & type IIIa on the contralateral side
C) Type IIa
D) Type IIIa

49. A sacral obliquity, with the sacrum low on the right side, will usually be associated with
a/an:

A) Increased lumbar lordosis

B) Right convex lumbar scoliosis
C) Left convex lumbar scoliosis
D) Alignment change in the spine, but the direction and location of the change cannot
be predicted

Sacral obliquity: Refers to an abnormal tilt or rotation of the sacrum, which is a triangular bone located at the base of the spine between the hip bones.

13
50. What is the most common tumour of the spine?

A) Chordoma
B) Multiple myeloma
C) Lytic metastases
D) Plasmacytoma

51. Which condition will present with the radiographic findings depicted in the image
below?

-Lead, phosphorus & bismuth cause similar

appearances
-May be ingested, inhaled or implanted
-Rare disorders
-Sudden abdominal pain, encephalopathy, paralysis
-Transverse linear sclerosis at metaphysis

A) Lead poisoning
B) Scurvy Condition that results from a severe deficiency of vitamin c in the diet. It is essential for the synthesis of collagen, a protein that helps in
the formation of CT, including skin, blood vessels, gums & bones.
C) Osteomalacia
D) Fluorosis Chronic ingestion of fluorine. Drinking contaminated water (Aka China & India). Industrial/ laboratory exposure. Osteoporosis followed
by sclerosis, mainly axial skeleton.

52. A 'hinged fragment sign' is typically seen with a:

A) Fibrosarcoma
B) Simple bone cyst
C) Fibrous dysplasia
D) Giant cell tumour

53. Which is the most accurate imaging modality to detect osteoporosis?

A) DEXA
B) X-ray
C) MRI
D) Quantitative CT

14
54. What is syndactyly?

A) Osseous erosion of the tip of the digits Breakdown of bone that occurs from excess inflammation in your joints.
B) Fusion of the digits
C) Extra digits
D) Elongated digits

55. What is the most likely diagnosis for a patient who has multiple small circular lytic
lesions in the diaphysis of the tibia and subperiosteal resorption of the medial border
of the tibia?

A) Multiple myeloma
B) Hyperparathyroidism
C) Lytic metastases
D) Ewing's sarcoma

56. In the below image a spondylolisthesis is demonstrated. Which spinal level is being
affected and what grade of spondylolisthesis is depicted?

A) L5, Grade 1-2

B) L5, Grade 2-3
C) L4, Grade 2-3
D) L4, Grade 1-2

15
57. Which of the following involves traction apophysitis of the tibial tuberosity?

A) Osgood-Schlatter's disease
B) Blount's disease
C) Sinding-Larsen-Johanssen disease
D) Sever's disease

58. On a lateral knee x-ray you observe multiple small circular opacities in the joint space
and suprapatellar bursa. What is the most likely diagnosis?

A) HADD
B) CPPD
C) Neurotrophic osteoarthropathy
D) Synovial chondromatosis

59. Which of the following is likely to be an unstable fracture?

A) Flexion teardrop fracture

B) Type 1 odontoid fracture
C) Vertebral compression fracture
D) Clay-shoveller's fracture

60. A Hangman's fracture is usually an example of which classification of spondylolisthesis?

A) Pathological
B) Traumatic
C) Dysplastic
D) Isthmic

61. Which of the following conditions would be LEAST likely to present with a solid
periosteal reaction?

A) Paget's disease
B) Stress fracture
C) Brodie's abscess
D) Osteoid osteoma

16
 62. As rheumatoid arthritis develops there is an increase in blood flow to the juxta-
articular bone. What radiographic finding does this result in?

A) Subchondral cysts
B) Symmetrical loss of joint space
C) Marginal erosions
D) Osteoporosis

63. Why does an increase in secretion of parathyroid hormone result in increased bone
resorption?

A) To release magnesium stores into the bloodstream

B) To release calcium stores into the bloodstream
C) To release sodium stores into the bloodstream
D) To release phosphate stores into the bloodstream

64. Which of the following statements is true regarding femoroacetabular impingement?

A) A Cam impingement can be caused by overcoverage of the femoral head

B) Femoroacetabular impingement should be suspected when the extrusion index is
more than 25%
C) Radiographic evidence of femoroacetabular impingement will always be associate
with a clinical presentation of hip pain
D) A coxa profunda deformity is an example of a pincer impingement

65. Which of the following is NOT a radiographic finding commonly associated with
developmental hip dysplasia

A) Altered Shenton's line

B) Underdevelopment of the femoral head epiphysis
C) Increased inclination of the acetabular roof
D) Crescent sign

Crescent sign: Refers to a radiographic finding observed in certain bone conditions, most notably in avascular necrosis. Avascular necrosis is a condition characterized by the death of
bone tissue due to a lack of blood supply. The crescent sign represents an area of bone collapse or subchondral fracture. It is typically seen in the context of avascular necrosis of the
femoral head but can also occur in other affected bones.

17
 66. What tumour is depicted in the image below?

A) Sessile osteochondroma
B) Osteoid osteoma
C) Pedunculated osteochondroma
D) Osteoma

67. What is the underlying cause of a hemivertebra? Failure of growth of one of vertebral body ossification centres

A) Failure of fusion of the vertebral body growth centres Week 2; Lecture: Agenesis & Hypoplasia: Pg 7
B) Extra development of the vertebral body on one side
C) Fusion of 2 vertebral bodies on one side
D) Agenesis of a vertebral body growth centre

68. What is the main difference between a stress fracture and an insufficiency fracture?

A) A stress fracture will more likely present with a solid periosteal reaction, whereas
an insufficiency fracture will more likely present with a laminated periosteal
reaction
B) An insufficiency fracture is not a true fracture but rather an area of bone that is
not ossified
C) An insufficiency fracture occurs in pathological bone
D) A stress fracture results from repeated minor stress, rather than a single overt
trauma

Stress fracture Insufficiency fracture

-Fatigue fracture -Stress fracture through weakened bone
-Caused by repetitive stress giving formation of microfractures -Osteoporosis
-Eventually microfracture development overtakes formation of new bone -Osteomalacia
& a stress fracture appears -Pagets
-Most common in the lower limbs (repetitive compression) -Fibrous dysplasia
-Insidious onset pain increasing with activity, decreasing with rest
-Incomplete fracture line (Usually horizontal) 18
-Solid periosteal reaction
-Usually unilateral
-Healing response from stress impaction fracture: Sclerotic line
69. Which of the following radiographic findings would be most likely to indicate a recent
vertebral compression fracture?

A) Osteophytic change (From degeneration??)

B) Step defect in the superior endplate (Later stages?)
C) Linear region of increased density under the endplate
D) Anterior wedging of the vertebral body

70. Why do patients with osteomalacia develop intracortical tunnelling?

A) Secondary to a laminated periosteal reaction

B) Increase in uncalcified osteoid in the cortex
C) Erosion of the periosteal cortical surface
D) Erosion of the endosteal cortical surface

71. What is the most likely diagnosis for the below image?

Occipitalisation: You can tell because the C2 anterior arch is translating

past the anterior vertebral line

A) Occipitalisation
B) C1-2 fusion
C) Agenesis of the posterior arch of the atlas
D) Posterior ponticle

19
72. On an x-ray of the proximal humerus you observe a lytic lesion in the metaphysis of the
humerus containing circular calcific densities. Which of the following would be the
LEAST likely diagnosis?

A) Osteoblastoma
B) Chondroblastoma
C) Chondrosarcoma
D) Enchondroma

73. Which of the following conditions would be most likely to result in secondary
deformity?

A) Appendicular osteomyelitis
B) Osteoid osteoma
C) Brodie's abscess
D) Septic arthritis

74. Traction on which soft tissue structure may cause an avulsion fracture of the styloid
process of the 5th metatarsal?

A) Peroneus brevis
B) Gastrocnemius
C) Plantar fascia
D) Tibialis anterior

75. Looser's lines and bowing deformities are commonly seen in all of the following
EXCEPT:

A) Paget's disease
B) Neurofibromatosis
C) Osteomalacia
D) Fibrous dysplasia

76. Which condition is best described as an acute onset of painful regional osteoporosis,
usually following trivial trauma?

A) Thalassemia
B) Chronic regional pain syndrome
C) Transient regional osteoporosis
D) Multiple myeloma

20
 77. What change creates the 'star sign', associated with ankylosing spondylitis?

A) Calcification of the interspinous ligaments

B) Calcification of the iliolumbar ligaments
C) Fusion of the upper sacroiliac joint space
D) Erosion of the discovertebral entheses

78. What is the most likely diagnosis for the below image?

Paget's disease:
-Aetiology= unknown (associated with genetics + environment)
-Bone enlargement & deformity
-Pathological fracture
-Hypervascularity

A) Paget's disease
B) Osteopetrosis
C) Hyperparathyroidism
D) Sickle cell anaemia

21
Sickle cell anaemia:
-Generalized osteopenia
-Loss of bone density of the spine is one of the important skeletal changes in the sickle-cell anemia
79. What process creates the rat-bite erosions seen in gout?

A) Deposition of intra-osseous tophi in the cortex

B) Inflammatory erosions of the joint surface
C) Deposition of intra-osseous tophi in the medullary cavity
D) Pressure from enlarging soft tissue tophi adjacent to the bone

80. What is the key radiographic finding associated with inflammatory arthritis?

A) Soft tissue deposits/calcification

B) Increased bone/calcification
Radiographic findings include soft-tissue swelling & joint effusion in early stages. Joint space narrowing
C) Soft tissue swelling & erosive changes are appreciated in later stages as the cartilage is destructed due to synovitis &
infection.
D) Osseous erosion

81. How can this AP Lumbopelvic x-ray be improved?

A) Move the patient to the left to include more of the right hip
B) Move the tube higher and to the right to include the right hip
C) Move the tube to the right to include the right hip
D) Move the patient to the right to include more of the left hip and change the
marker to left instead

22
82. Which of the following statements regarding the below image is correct?

A) This is a non-diagnostic lateral foot x-ray and can be improved by rolling the
foot internally and opening the collimation S-I
B) This is a non-diagnostic lateral foot x-ray and can be improved by rolling the
foot externally more
C) This is a diagnostic x-ray lateral foot x-ray if patient area of interest is the 5th
metatarsal
D) This is a non-diagnostic lateral foot x-ray and can be improved by rolling the
foot externally and opening the collimation S-I

83. In the following x-ray of a lateral knee, what correction could you make to improve
the image?

A) Internally rotate the foot

B) Change the marker to a left marker
C) Increase collimation superiorly to include more of the femur
D) Angle cephalad 5 degrees

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84. What is the central ray location for a lateral knee?

A) Midshaft
B) 1cm below the medial epicondyle
C) 1cm below the patella apex
D) At the posterior epicondyles

85. Which of the following x-ray series do not require orthogonal imaging?

Orthogonal imaging means taking pictures of something from different angles that are perpendicular to each
A) Lumbopelvic other. It helps to get a complete & detailed view of the thing being imaged.
B) Hip
C) Acromioclavicular joint
D) Shoulder

86. Where is the central ray for an AP Lumbopelvic x-ray located?

A) Midline at the level midway between the ASIS and pubic symphysis
B) Midline at the level of the pubic symphysis
C) Midline at the level of the ASIS
D) Midline at the level of iliac crest

87. What is the central ray location for a PA wrist x-ray?

A) Midline at the distal ulnar and radius

B) Mid-carpal region of the wrist
C) Anatomical snuff box
D) 3rd metacarpophalangeal joint

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88. Fill in the blanks regarding the below image.
The AP x-ray of the left hand is ______________.
To improve it you would need to ________________.

A) Overexposed, decrease kV
B) Overexposed, decrease mAs
C) Underexposed, decrease mAs
D) Underexposed, increase mAs

89. After introducing yourself to the patient, what do you need to check?

A) Patient details, pregnancy status, and consent

B) Patient details
C) Pregnancy status
D) Patient consent

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90. The following x-ray is diagnostic. What projection are we looking at?

A) AP scapula
B) AP shoulder
C) AP clavicle
D) AP acromioclavicular joint weightbearing

91. What anatomical structures should be seen on an AP hip projection and what is the
centring point?

A) S-I to include superior to the acetabulum and the proximal 1/3 of femur and M-
L to include 3cm past the pubic symphysis to soft tissues. The centre point is
2.5cm inferior to the midpoint between the pubic symphysis and the ASIS
B) S-I to include superior to the acetabulum and the proximal 1/3 of femur and M-
L to include lateral soft tissues of the hip. The centre point is 4.5cm inferior to
the midpoint between the pubic symphysis and the ASIS
C) S-I to include ASIS and the proximal 1/3 of femur and M-L to include lateral soft
tissues of the hip. The centre point is 4.5cm inferior to the midpoint between
the pubic symphysis and the ASIS
D) S-I to include ASIS and the proximal 1/3 of femur and M-L to include lateral soft
tissues of the hip. The centre point is 2.5cm inferior to the midpoint between
the pubic symphysis and the ASIS

92. What anatomical structures should you expect to see on an AP thumb projection?

A) S-I tip of the thumb to the scaphoid and M-L soft tissues of the thumb
B) S-I distal phalanx to the scaphoid and M-L 3cm either side of the thumb
C) S-I tip of the thumb to the distal third of the radius and M-L soft tissues either
side of thumb
D) S-I distal phalanx to the wrist joint and M-L soft tissues of the thumb

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93. What should you remove when x-raying the ankle?

A) Compression bandage
B) Watch Remove what is removable. A patient's cast could not be removed due to the recent trauma
caused to it so it needs to be left on.
C) Rings
D) Patient's cast

94. What is the collimation you need for a lateral humerus x-ray?

A) Size of cassette, 35 x 43cm (Vertical)

B) Shoulder joint to epicondyles of elbow and soft tissues
C) Shoulder joint to elbow joint and soft tissues
D) Elbow joint to greater tuberosity of humerus
None of it mentions the inclusion of the AC (acromioclavicular) joints

95. In the below image, is the patient well-positioned for an AP knee x-ray, or are
corrections needed?

A) The patient needs to remove their pants and shoes

B) The patient needs to rotate their leg so the patella is facing forward
C) The collimation around the patient needs to be closer to the soft tissue
D) The patient is well positioned

96. What instructions should you give to the patient when doing a lateral C-Spine X-
ray? -Cassette (18x24) or (24x30) cm; vertical
-SID: 180cm
-Central ray: C4
A) Suspend on expiration -Tube tilt: 0
-Collimation:
B) Breathe normally *A-P: From 2.5cm in front of the EAM to include all soft tissue structures
C) Suspend on inspiration *S-I: 2.5cm above the EAM to T1

D) Suspend on expiration and relax/drop the shoulders

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97. What is the tube angle used for AP Thoracic X-ray?

A) 0 degrees
B) 15 degrees cephalic
C) 10 degrees cephalic
D) 10 degrees caudal

98. Is the following x-ray of an AP lower leg diagnostic? If it is not, why not?

A) No, it is not diagnostic because the soft tissue around the ankle joint is
overexposed
B) No, it is not diagnostic because the proximal tibia and distal femur have been
cut off
C) Yes, it is diagnostic
D) No, it is not diagnostic because the wrong marker has been used

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 99. How would any faults observed in the following positioning for an AP lower leg
impact the resulting x-ray image?

A) The light not falling onto the cassette is going to render the x-ray image
undiagnostic
B) The whole knee joint is not going to be see on the x-ray image
C) The shoe is going to show up as an artefact over the ankle
D) The wide collimation is going to increase the contrast of the image

100. How would you determine how much to rotate the patient’s leg for a diagnostic
mortise ankle view?

A) Rotate the leg inwards until the 4th toe is in line with the centre of the
calcaneus
B) Look at the AP image taken and see what the joint space is like to determine
the amount of rotation needed for the mortise view, it is not a set degree of
rotation
C) There is no rotation of the leg, only dorsiflexion is required for the view
D) It is always 15-20° internal rotation of the patient’s leg to achieve diagnostic
mortise view

101. The collimation of the PA hand is:

A) Distal 2/3 of the forearm, proximal fingertips, medial skin line to the lateral skin
line
B) Distal 1/3 of the forearm, proximal fingertips, 3cm laterally and medially to the
skin line
C) Distal 1/3 of the forearm, proximal metacarpals, medial skin line to the lateral
skin line
D) None of these options are correct

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102. The following x-ray is of an AP shoulder. What correction is necessary to make it a
proper positioning for an AP shoulder?

Extends past the sternal notch (M-L)

A) The x-ray tube needs to be angled 15 degrees caudad (Not necessary: Only need to do it for clavicle AP)
B) The patient needs to be rotated 30 degrees right side towards the bucky
C) The collimation needs to be reduced M-L
D) The patient needs to externally rotate their arm

103. An 80 year old male patient fell and landed on his left hip. He is now complaining of
pain on the left side and is unable to weight bear. He also has bilateral hip
replacements done a few years ago. How would you achieve a diagnostic image for
this patient?
AP HIP INCLUDES THE ASIS

A) Get the patient lying down with no rotation of their legs and have the top of
the cassette above the iliac crest and collimation opened to the size of the
cassette
B) Get the patient lying down with no rotation of their legs and have the top of
the cassette around the level of the ASIS and collimation opened to the size of
the cassette
C) Get the patient standing up against the bucky, with no rotation of their legs
and have the top of the cassette at around the level of ASIS and collimation
opened to the size of the cassette
D) Get the patient standing up against the bucky, internally rotating their legs 15-
20° with the top of the cassette above the iliac crest and collimation opened to
the size of the cassette
Patient can't weight-bear (cross out C & D)

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104. Which of the following statements is correct regarding this AP Thoracic x-ray
image?

A) The S-I collimation needs to be smaller

B) The image is underexposed
C) The image is undiagnostic and needs to be repeated
D) This image does not need to be repeated

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105. In terms of centering, what is wrong with the image below?

A) Centering is too high

B) Centering is too posterior
C) Centering is too low
D) Centering is too anterior

106. What can be done to improve the image of an AP cervical view below?

A) Collimation needs to be open up to include the orbits Collimation is fine; includes all the required parts

B) Angling the tube up to get C1-C2 in the image (10-15 degrees)

C) Patient needs to open their mouth to show C1-C2 Cervical APOM
D) Patient needs to lift their chin up to prevent the mandible from obscuring some
of the cervical spine (Head slightly extended, to superimpose base of skull & mandible)

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 107. What is the ideal cassette size and orientation to use for an average adult to image
the AP shoulder?

A) 24x30cm portrait
B) 35x43cm horizontal
C) 35x43cm portrait
D) 24x30cm horizontal

108. Why would you decide to take a PA thumb over an AP thumb projection?

A) To account for the patient's flexibility

B) To decrease patient exposure
C) To reduce magnification
D) To increase magnification

109. What should you consider doing next when imaging the lower leg in the AP
projection, but the entire leg does not fit on a 35x43cm cassette portrait?

A) Do two separate pictures-one from knee down and one from ankle up,
ensuring overlap
B) Request for a CT scan
C) Rotate the cassette landscape
D) Try to fit the leg along the cassette's oblique length

110. In the lateral oblique hip (frog leg), the centring point is:

A) At the level of the greater trochanter

B) 2cm below the ASIS
C) Midpoint of the femoral neck
D) At the level of the superior border of the symphysis pubis

-Cassette (24x30cm); vertical

-Patient positioning: Position patient upright at the Bucky with the hip to be imaged abducted to 45 degrees in the frog leg position. (Abducted leg should be positioned as close to
the bucky as possible). Can also be performed non-weight bearing on the table
-Immobilisation: Patient standing with neural/comfortable stance against bucky, arms can hold onto bucky if necessary
-Safety: No gonad shielding, obscures anatomy
-SID: 100cm
-Central ray: Perpendicular to the cassette at the level of midpoint of the femoral neck
-Tube tilt: 0
-Collimation:
*M-L: To include lateral soft tissues of the hip
*S-I: To include ASIS & the proximal 1/3 of the femur

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111. Where should the marker be placed ideally in the following positioning of an AP
lower leg?

A) Letter B
B) Letter C
C) Letter D
D) Letter A

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112. Which of the following statements is correct regarding the below image?

Lateral Lumbopelvic x-ray

-Cassette: 35x43cm; vertical
-Patient positioning: Patient stands perpendicular to bucky, convex side (otherwise left side)
against the bucky with head & feet facing forward. Arms folded in front of patient with support
where possible.
-Immobilisation: Patient standing with neutral/comfortable stance against bucky. Breathing on
suspended expiration.
-SID: 100cm
-Central ray: Midpoint between ASIS & PSIS at the level of the Iliac crest
-Tube tilt: 0
-Collimation:
*A-P: To slightly less than width of image plate. Accommodate for Lumbar lordosis & Sacrum
*S-I: To slightly less than height of image plate. To include T12- Greater Trochanter

A) This image is undiagnostic, it can be improved by centring higher and

collimating more A-P
B) This image is undiagnostic, it can be improved by moving the patient back and
increasing kVP
C) This image is diagnostic
D) This image in undiagnostic, it can be improved by opening up the collimation S-
I and collimating more A-P

113. Which view is being demonstrated in the image below?

A) Axial foot Doesn't exist

B) Mortise ankle
C) AP lower leg Too low to be considered an AP lower leg
D) AP ankle

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114. What is wrong with the lateral forearm x-ray depicted below?

A) The wrong marker has been used

B) Elbow joint is cut off
C) The wrist is over-rotated
D) Image is overexposed

115. You have taken an APOM view of the C-Spine and need to repeat to see the dens
better. How would you position the patient to get a better APOM view?

A) Turn the head slightly to the right

B) Tilt the head up
C) Tilt the head down
D) Turn the head slightly to the left

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116. What is wrong with the positioning for a lateral elbow x-ray shown in the image
below?

A) The hand is pronated and the table is not raised to shoulder level
B) Table is not raised to shoulder level
C) Patient is not leaning over the table
D) Hand is pronated on the table

117. Why do we internally rotate the leg 15-20° for an AP Pelvis x-ray?

A) To elongate the neck of the femur

B) To bring the lesser trochanter into profile
C) For patient comfort
D) To visualise the acetabulum better

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118. What two errors are wrong with the positioning in the below image?

A) No marker; collimation is too wide M-L but S-I is correct

B) No marker; collimation is too wide M-L and S-I
C) No marker; collimation correct M-L but S-I is incorrect
D) No marker; centring point is incorrect Centring point is correct

119. What is the main reason why an AP shoulder is taken with the arm externally
rotated?
-Patient stands at the bucky with arm slightly abducted & externally rotated
(palm facing forward) so epicondyles are perpendicular to the bucky.
A) To be able to visualise the glenohumeral joint space
B) It is more comfortable for the patient
C) It puts the greater tuberosity in profile
D) The elbow would be visualised in an anatomical AP position

120. When doing upper extremity x-rays with the patient sitting down, how should they
be positioned?

A) All upper extremity images are performed standing up

B) With both legs underneath the table
C) With one leg underneath table and one leg parallel to table
D) Legs parallel to the table

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