Midterm

Question 1

Your 38 year old patient presetns with a 5 week history of achy low back pain which is worse with movement and better with rest. They have no significant history of previous low back pain. Upon inspection the patient has what you estimate to be at least a 20 degree lumbar scoliosis. Pain is reproduced in all ranges of motion and kemp’s test reproduces the low back pain. The remainder of the exam is unremarkable. Are x-rays indicated

Answer 1

No

Question 2

All of the following are roles that the x-ray report fills except
A. Records findings
B. Provides documentation in med-legal situations
C. Provides a permanent record in case the films are lost or damaged
D. Required for re-imbursement

Answer 2

Required for re-imbursement

Question 3

You have a 29 year old patient who comes in with a 3 week history of LBP which began 2 days after the funeral of their father who died from multiple myeloma of the spine. Your paitent is convinced that he also has cancer and has barely been able to sleep for the last two weeks because of this fear. Your exam is unremarkable. Are lumbar x-rays indicated

Answer 3

Yes

Question 4

The technical component of the global x-ray fee consists of the production of the x-ray

Answer 4

True

Question 5

All of teh follwoing are signs of suspected lumbar neoplasm except
A. Intractable pain
B. ESR > 50 mm/hr
C. Diarrhea
D. Unexplained weight loss

Answer 5

Diarrhea

Question 6

Regarding x-ray fees, which one of the following satisfies the professional component
A. Positioning the patient and taking the x-ray
B. Creating a typed ABCS report
C. Discussing the x-ray findings with the patient
D. Any of the above can satisfy the professioinal component

Answer 6

Creating a typed ABCS report

Question 7

Your 43 year old patient enters 4 days after a motor vehicle accident. She back into a guard rail pulling out of a parking space with an estimated speed of 5-7 miles per hour. She had no pain that day but upon waking she had neck pain 8-9/10. Palpation revealed significant discomfort in both SCM’s but nowhere else. Flexion/extension is limited to 10 degrees in each direction but all other ROM’s are within normal limits. Compression and distraction both produce considerable neck pain. Neurologic exam is unremarkable. Are x-rays of teh cervical spine indicated

Answer 7

No

Question 8

According to yochum and rowe, failure to have a written report when using the gloal fee constitutes fraud

Answer 8

True

Question 9

You have a 24 year old male who presents with a 6 week history of pain and stiffness in the pelvis/lumbosacral region which is present each morning he wakes up and lasts for about an hour until he is up and around at which time things seem to loosen up. Gaenslen’s test and the belt test are positive. Both of his siblings have been diagnosed with isthmic spondylolisthesis. Which is most likely

Answer 9

Possible AS/lumbopelvic x-rays indicated

Question 10

According to GA law and x-ray interpretation, a DC is only held responsible to the same standard of care as a local DC with the same degree of education

Answer 10

False

Question 11

A 43 year old overweight female comes in complaining primarily of leg pain and secondarily of low back pain 3 days after lifting heavy oxes while helping a friend move into a new apartment. She rates the pain 9/10. The leg pain starts in the buttock, goes down the side of the thigh, crosses over the kene and heads to the great toe. SLR and bowstring’s reproduce the leg pain. Sensation to tthe pinwheel is decreased in the same leg pain distribution adn the foot/great toe dorsiflexors are weak. Are x-rays indicated

Answer 11

No

Question 12

With regard to x-ray interpretation and GA law, the local defense represents the standard of care

Answer 12

False

Question 13

You have a 32 year old female who presents with a 7 week history of insidious neck pain. Whe really hasn’t done anythign for it treatment wise thinking it would go away as quickly as it started. Your exam is rather unremarkable. Are x-rays of the c-spine indicated

Answer 13

Yes

Question 14

Malpractice cases always result in board of examiner action

Answer 14

False

Question 15

A 46 year old male presents with low back and leg pain of 8 weeks duration. The leg pain seems worse than the low back pain. Straight leg raise and kemps produce significant low back pain. He states that sitting seems to reduce the symptoms. Are x-rays fo the lumbar spine indicated

Answer 15

Yes

Question 16

Punitive actions by the board of examiners can occur from inaccurate diagnosis of an x-ray without a malpractice case being filed

Answer 16

True

Question 17

A patient presents the same day they suffered a direct trauma to the posterior ribs. Your exam indicates possible posterior rib fractures in the mid thorax. X-rays are indicated. Which one of the following best identifies the views that should be taken

Answer 17

AP, 10degree and 30 degree posterior oblique, 10 degree and 30 degree anterior oblique

Question 18

Because the x-ray report is a med-legal document, any history included in the report should be as detailed as possible and written in full sentences and/or paragraphs

Answer 18

False

Question 19

A 20 yo female presents with a 3 day history of neck pain and stiffness. Your exam is unremarkable other than some suboccipital tenderness. She says this has occurred every 3-4 months since she turned 16. Are x-rays indicated

Answer 19

Yes

Question 20

You have a 42 yo patient who presents with a 2 week hisotry of an insidious onset of neck pain. Other than palpable midline tenderness the exam is unremarkable. There is no real history of neck pain other than a whiplash from a MVA 5 years ago which was treated with pain killers, muscle relaxants and anti-inflammatories. Are x-rays indicated

Answer 20

No

Question 21

Which one of the following would not be appropriate to put in the body of an x-ray report
A. The gravitational line from C2 falls anterior to C7
B. A left convex rotatory scoliosis is note in teh thoracic spine.
C. Moderate disc space narrowing is present at L5/S1
D. Soft tissue markings are within normal limits

Answer 21

A left convex rotatory scoliosis is noted in the thoracic spine

Question 22

A 48 year old female presents with neck and arm pain/paraesthesia of 2 weeks duration. The exam is for the most part unremarkable. Are x-rays indicated

Answer 22

Yes

Question 23

It is considered acceptable and is legal to take a digital photo of an x-ray and email it to a radiologist for interpretation

Answer 23

False

Question 24

Conclusions/impressions on an x-ray report should be written as full complete grammatically correct sentences rather than phrases

Answer 24

False

Question 25

Any recommendations that are made on an x-ray report should be vague so as to avoid any med-legal implications if the recommendation was incorrect

Answer 25

False

Question 26

A 49 yo female presents 2 days after a MVA. In teh history she says she had her ovaries removed 8 years earlier and her recent DEXA shows she is osteoporotic. She had delayed onset of neck pain but now her traps adn lateral neck musclature are very tender and she has a tension type head ache. The lateral musculature and traps are tender to palpation. The remainder of the exam is basically normal. Are x-rays indicated

Answer 26

Yes

Question 27

A 58 yo male comes in for wellness care following a back talk you gave 1 week earlier. He has never ahd neck pain. On exam the swallowing test is positive and on further questioning he does have some discomfort when he swallows. His cervical exam is otherwise compleltely unremarkable. Which one fo the follwoign would represent the next best step
A. Initiate care wihtout x-ray
B. Send for routine blood chemistry and UA
C. X-ray the C-spine
D. Refer to his general practitioner

Answer 27

X-ray the cervical spine

Question 28

A patient presents with a known history of AS in the SI joints, lumbar spine, and thoracic spine, he is seeking care from you for neck pain that had an insidious onset 6 days ago. Your neck exam is unremarkable. Are cervical x-rays indicated

Answer 28

Yes

Question 29

A 29 yo male presents with LBP 3 days after helping a friend move furniture into an apratment. Other than decreased range of motion, generalized low back tenderness and spasm the exam and history are unremarkable. Are x-rays and indicated

Answer 29

No

Question 30

A patient presents with a 1 week hisotry of LBP after cleaning out a garage. They have some palpable pain and spasm but the exam is otherwise unremarkable. Althought they had a lot of back pain years ago, they have had little to no problems since having a lumbar surgical fusion with the use of metal screws 6 years ago. Are x-rays indicated

Answer 30

Yes

Question 31

A long time 32 yo patient comes in for a normally scheduled appointment. You notice they are quite flustered and on questioning they say they just slipped and fell on the ice in the parking lot. They ahve 1/10 pain around L2 but little to no tenderness or spasm. Are x-rays indicated

Answer 31

No

Question 32

You are leasing space in an office that does not have an x-ray machine but is adjacent to a lab. A 68 year old male you have been treating complains of worsening low ack/SI pain and asks if you can order some lab work. The ESR comes back at 58 mm/hr. Are x-rays indicated

Answer 32

Yes

Question 33

Given the results/circumstances in question number 32, which one of the following is the most likely diagnosis

Answer 33

Skeletal metastasis

Question 34

Failure to recognize a significant x-ray finding that led to a patinet’s death would be ground for malpractice basaed on a crime of omission

Answer 34

True

Question 35

Collimating the x-ray beam as close to teh spine as possible removes all liability for any peripheral soft tissue findings

Answer 35

False

Question 36

In which portion of the report should the following be place? Increased density is noted within teh entire VB of L2 without a change in size or shape to teh segment

Answer 36

B

Question 37

In which portion of the report should the following be placed? Anterolisthesis is noted at C3

Answer 37

A

Question 38

In which portion of the report should the following be placed? Vacuum phenomenon is seen in the L4/L5 disc space

Answer 38

C

Question 39

In which portion of the report should be following be placed? Scattered vascular calcification is noted without evidence of aneurysm formation

Answer 39

S

Question 40

In which portion of the report should be following be placed? Bilateral fusion of the SI joints is noted

Answer 40

C