Deck 10: Bony Thorax-Sternum and Ribs

Question 1

The only bony connection between the shoulder girdle and the bony thorax is the acromioclavicular joint.

Answer 1

False

Question 2

The widest aspect of the thorax generally occurs at the level of:

A) the eleventh and twelfth ribs.
B) T7.
C) the sternoclavicular joints.
D) the eighth or ninth ribs.

Answer 2

the eighth or ninth ribs.

Question 3

What is the name of the part labeled i in this figure?

A) Facet for the first rib
B) Body
C) Sternoclavicular joint
D) Sternal angle

Answer 3

Sternoclavicular joint

Question 4

At approximately what age does the xiphoid process become totally ossified?

A) 12 years old
B) 21 years old
C) 40 years old
D) The xiphoid process never becomes ossified.

Question 5

In the erect adult bony thorax,the posterior portion of a typical rib is ____ higher or more superior to the anterior portion.

A) 1 to 2 inches (2.5 to 5 cm)
B) 3 to 5 inches (7.5 to 13 cm)
C) 6 to 8 inches (15 to 20 cm)
D) 10 to 12 inches (25 to 30 cm)

Question 6

Which of the following statements is true about floating ribs?

A) They do not possess a head.
B) They do not possess a costovertebral joint.
C) They do not possess costocartilage.
D) They are ribs 10 through 12.

Question 7

What is the joint classification and type of movement for the costotransverse joint?

A) Cartilaginous with diarthrodial (ginglymus) movement
B) Synovial with diarthrodial (plane) movement
C) Synovial with amphiarthrodial, limited movement
D) Cartilaginous with synarthrodial or no movement

Question 8

The tubercle portion of a typical rib connects the anterior end of the rib to the sternum.

Question 9

The structure labeled iii is costocartilage:

A) of the 10th rib.
B) portion of the first false rib.
C) of the last true rib.
D) of the sixth rib.

Question 10

The xiphoid process corresponds to the vertebral level of:

A) T7.
B) T9-10.
C) T4-5.
D) L1-2.

Question 11

What is the name of the part labeled ii?

A) Xiphoid process
B) Body
C) Sternoclavicular joint
D) Sternal angle

Question 12

The suprasternal,manubrial,or jugular notch all correspond to the level of:

A) T2-3.
B) T1.
C) T4-5.
D) C7.

Question 13

What is the name of the part labeled iv?

A) Facet for the sternum attachment
B) Head of the sternum
C) Facet for the second rib attachment
D) Costocartilage for the first rib attachment

Question 14

What is the primary term for the superior margin of the sternum?

A) Sternal notch
B) Manubrial notch
C) Suprasternal notch
D) Jugular notch

Question 15

Which of the following structures connects the anterior aspect of the ribs to the sternum?

A) Costocartilage
B) Sternal tendons
C) Costovertebral joints
D) Costotransverse joints

Question 16

What is the name of the structure labeled v?

A) Head
B) Body
C) Manubrium
D) Xiphoid process

Question 17

The sternal angle is a palpable landmark at the level of:

A) T4-5.
B) T2-3.
C) T7.
D) T9-10.

Question 18

Which of the following ribs is considered to be a false rib?

A) Seventh
B) First
C) Ninth
D) None of the above

Question 19

What is the joint classification and type of movement for the sternoclavicular joints?

A) Cartilaginous with diarthrodial (ginglymus) movement
B) Synovial with diarthrodial (gliding) movement
C) Synovial with amphiarthrodial, limited movement
D) Cartilaginous with synarthrodial or no movement

Question 20

Which pair of ribs attaches to the sternum at the level of the sternal angle?

A) First
B) Second
C) Third
D) Fourth and fifth

Question 21

Which of the following techniques is most effective in preventing lung markings from obscuring the sternum on an oblique projection?

A) Use a high kV.
B) Oblique as much as needed to not superimpose the sternum over the hilum region.
C) Decrease the source image receptor distance (SID) to magnify the sternum.
D) Use an orthostatic (breathing) technique.

Question 22

What is the recommended degree of obliquity for an RAO projection of the sternum for an asthenic type of patient?

A) 20°
B) 15°
C) 30°
D) 10°

Question 23

What is the recommended SID for the lateral sternum position?

A) 40 inches (102 cm)
B) 44 inches (113 cm)
C) 46 inches (117 cm)
D) 60 to 72 inches (152 to 183 cm)

Question 24

Which two projections must be taken for an injury to the left posterior lower ribs?

A) AP and LPO
B) AP and RAO
C) PA and LPO
D) PA and RAO

Question 25

The left anterior oblique (LAO)position of the sternum provides the best frontal image of the sternum with a minimal amount of distortion.

Question 26

Which of the following positions will best demonstrate the axillary portion of the left ribs?

A) AP
B) Posteroanterior (PA)
C) Left posterior oblique (LPO)
D) LAO

Question 27

Where is the CR centered for a PA projection of the sternoclavicular joints?

A) At the level of the vertebra prominens (T1)
B) At the level of the sternal angle (T4-5)
C) Three inches (7 cm) distal to vertebra prominens (T2-3)
D) At the level of the thyroid cartilage (T9)

Question 28

A recommended practice is to decrease the SID to less than 40 inches (102 cm)for the oblique sternum projection to increase the magnification and resultant unsharpness of overlying ribs.

Question 29

A right or left marker may be taped over the area of interest to indicate the location of the trauma to the ribs.

Question 30

Which ribs are considered to be true ribs?

A) First and second ribs
B) First through seventh ribs
C) First through ninth ribs
D) 11th and 12th ribs

Question 31

Which of the following statements is true about radiography of ribs located above the diaphragm?

A) Suspend breathing upon inspiration.
B) Perform the study with the patient recumbent.
C) Use an analog kV range of 85 to 95.
D) Always include an anteroposterior (AP) projection as part of the routine.

Question 32

Which position can replace the RAO of the sternum if the patient cannot lie prone?

A) LAO
B) Left lateral decubitus
C) LPO
D) RPO

Question 33

Which of the following positions will best demonstrate the axillary portion of the right ribs?

A) AP
B) PA
C) LAO
D) RAO

Question 34

How much rotation and which oblique position are required to best demonstrate the left sternoclavicular joints?

A) 10° to 15° LAO
B) 35° to 45° LAO
C) 10° to 15° RAO
D) 5° to 10° RAO

Question 35

Which analog kV range is recommended for an AP study of the ribs found below the diaphragm?

A) 85 to 90 kV
B) 60 to 65 kV
C) 65 to 75 kV
D) 70 to 80 kV

Question 36

Which of the following conditions may occur with trauma to the ribs?

A) Airway obstruction of the trachea
B) Pneumonia
C) Hemothorax
D) Pulmonary embolus

Question 37

Why is the RAO sternum preferred to the LAO position?

A) The RAO produces less magnification of the sternum.
B) The RAO projects the sternum over the shadow of the heart.
C) The RAO reduces dose to the thyroid gland.
D) The RAO projects the sternum away from the hilum and heart.

Question 38

Which two projections must be taken for an injury to the right anterior upper ribs?

A) PA and LAO
B) PA and RAO
C) AP and RAO
D) AP and LPO

Question 39

Which aspect of the rib articulates with the thoracic vertebral body?

A) Neck
B) Tubercles
C) Head
D) Facets

Question 40

The degree of rotation for the right anterior oblique (RAO)projection of the sternum is dependent on the size of the thoracic cavity.

Question 41

Multiple myeloma is seen often in the flat bones of the bony thorax.

Question 42

Which condition of the sternum is often termed "funnel chest?"

A) Pectus excavatum
B) Flail chest
C) Pectus eruptus
D) Pectus deforminens

Question 43

A patient enters the ED with an injury to the left anterior lower ribs.Which of the following projections should be taken to demonstrate the involved area?

A) AP and LAO
B) PA and RAO
C) AP and LPO
D) PA and LAO

Question 44

A radiograph of a lateral projection of the sternum reveals that the patient's ribs are superimposed over the sternum.What needs to be done to correct this problem during the repeat exposure?

A) Increase the SID.
B) Angle the CR 5° anterior.
C) Ensure that the patient is not rotated.
D) Increase the kV.

Question 45

A PA radiograph of the sternoclavicular (SC)joints demonstrates unequal distance from the SC joints to the midline of the spine.The left SC joint is farther from the sternum than the right.What specific positioning error is present on this radiograph?

A) Slight right rotation (right side toward the image receptor)
B) Slight left rotation (left side toward the image receptor)
C) Tilt of the upper thorax
D) Excessive angulation of the CR

Question 46

Which of the following conditions,if severe,requires a decrease adjustment of manual exposure factors?

A) Osteoblastic metastases
B) Osteomyelitis
C) Flail chest
D) None of the above

Question 47

A radiograph of an RAO sternum reveals that it is partially superimposed over the spine.What must be done to eliminate this problem during the repeat exposure?

A) Perform an LPO projection instead of an RAO.
B) Angle CR 5° to 10° laterally to the sternum.
C) Increase rotation of the body.
D) Increase kV.

Question 48

A radiograph of an RAO projection of the sternum demonstrates excessive lung markings obscuring the sternum.A 1-second exposure time and an orthostatic (breathing)technique were used.Which of the following will produce a more diagnostic image of the sternum?

A) Ensure that the patient is not breathing during the exposure.
B) Increase the exposure time; decrease the mA.
C) Decrease the kV; increase the mA or time.
D) Initiate exposure on deeper inspiration.

Question 49

The condition,flail chest,is most commonly caused by:

A) pneumothorax.
B) emphysema.
C) blunt trauma.
D) congenital heart defect.

Question 50

Both bony and soft tissue anatomy may be evaluated by CT for pathology involving the sternum or the sternoclavicular joints.

Question 51

A young female patient from the emergency department (ED)is brought to radiology for rib examination.She is able to sit up or stand for the procedure.She indicates that the region of pain is to the right anterior-to-mid axillary region.Which rib projections should be performed to minimize the effective dose to this patient?

A) PA and RPO
B) AP and RPO
C) PA and RAO
D) PA and LAO

Question 52

A patient enters the ED with trauma to the bony thorax.The initial radiographs reveal that there are fractured ribs and a possible pneumothorax of the left thorax.The physician orders a chest study to confirm the pneumothorax; however,the patient cannot stand.Which of the following positions would best demonstrate the pneumothorax?

A) Left lateral decubitus
B) Right lateral decubitus
C) Ventral decubitus
D) Dorsal decubitus

Question 53

Initial PA projections of the SC joints indicate a possible defect involving the left SC joint.The vertebral column is preventing a clear view of it.Which of the following projections will demonstrate the right SC joint without superimposition over the spine?

A) Horizontal beam lateral
B) LAO
C) RAO
D) Erect lateral projection

Question 54

An ambulatory patient enters the ED with a possible injury to the right upper posterior ribs.Which of the following routines should be taken to demonstrate the involved area?

A) Erect PA and LPO
B) Erect AP and RPO
C) Recumbent AP and RPO
D) Erect PA and LAO

Question 55

A patient enters the ED with blunt trauma to the sternum.The patient is in great pain and cannot lie prone on the table or stand erect.Which of the following routines would be best for the sternum examination in this situation?

A) RPO and lateral recumbent projections
B) AP and horizontal beam lateral projections
C) LPO and horizontal beam lateral projections
D) LPO and lateral recumbent projections

Question 56

Fracture of adjacent ribs in two or more places with associated pulmonary injury is known as a(n)_____ rib fracture.

A) compound
B) flail chest
C) acute
D) compression

Question 57

A congenital defect characterized by anterior protrusion of the lower sternum and xiphoid process is termed:

A) pectus excavatum.
B) flail chest.
C) pectus carinatum.
D) sternal protrusion.

Question 58

The radiographic appearance of the erosion of bony rib margins is a possible indication of:

A) osteomyelitis.
B) osteoblastic metastases.
C) spondylolysis.
D) osteolytic metastases.

Question 59

Which disease or condition may be associated with postoperative complications of open heart surgery?

A) Spondylitis
B) Osteoblastic metastases
C) Osteomyelitis
D) Flail chest

Question 60

Both nuclear medicine and MRI (magnetic resonance imaging)studies can be performed to evaluate metastatic rib lesions before conventional rib radiographic examination.

Question 61

Which of the following positioning considerations does NOT apply for a study of the lower ribs?

A) Perform positions recumbent.
B) Use a digital kV range between 65 and 70 kV.
C) Exposure on full expiration.
D) Both A and B are incorrect.

Question 62

What is the minimum number of ribs that must be demonstrated for a unilateral rib study above the diaphragm?

A) Ribs 1 through 6
B) Ribs 1 through 8
C) Ribs 1 through 10
D) All ribs must be demonstrated.

Question 63

A lateral projection of the sternum requires that respiration be suspended on expiration.

Question 64

The use of 125 kV is recommended for AP and PA projections of the ribs to reduce skin dose.

Question 65

A radiograph of an RAO projection of the ribs demonstrates the left axillary ribs are foreshortened,whereas the right side is elongated.Which of the following is the most likely reason for this radiographic outcome?

A) The patient requires more rotation to the right.
B) An LAO was performed rather than the RAO position.
C) The technologist should have performed a PA projection to demonstrate the left axillary ribs, not an RAO.
D) CR angulation was incorrect.

Question 66

A patient with metastatic disease in the ribs comes to radiology following a nuclear medicine scan.The radiologist orders a right,upper posterior rib study performed.Which of the following positioning factors should be followed for this specific study?

A) Perform positions erect if the patient's condition permits.
B) Exposure on full expiration.
C) Include the RPO position as part of the positioning routine.
D) Both A and C are correct.