187/189 Day Mastery Training Program

Front 1

1.what level of thoracic spine  has the smallest spine canal diameter

2.which  vertebrae as the narrowest of all pedicle diameter in the body?

3.which vertebral body as the shortest pedicle?

 

Back 1

1.T4

2.T4

3. T4

 

Front 2

#1 which  erector spinae muscle is most medial and which is most lateral?

Back 2

#1 spinalis muscle & iliocostalis muscle

Front 3

 In the adult spine, which of the following pedicles have the smallest average transverse diameter. 

1.  T1

2.  T6

3.  T12

4.  L3

5.  L5

Back 3

Of the levels listed, T6 has the smallest pedicle diameter. Ans2

Front 4

what genetic factors related 2 collagen production play a roll and anterior cruciate ligament injuries?

Back 4

COL5a1 gene

Front 5

what is the primary role of the anterior cruciate ligament

Back 5

to prevent anterior translation of the tibia relative to the femur

Front 6

what is the insertion of the anterior cruciate ligament

Back 6

in the RIGHT knee the anterior cruciate ligament originates from the lateral femoral condyle inserts just anterior to the intercondylar eminence of the tibia

Front 7

• the anterior cruciate ligament has to bundles which bundle is tight in flexion?

• the PCL has 2 bundles which is tight in flexion?

• what is the blood supply to the anterior cruciate ligament and what is the anterior cruciate ligament innervation?

Back 7

• the anterior medial bundle is tight in flexion
• PAL posterior anterior lateral flexion
• blood supply of the anterior cruciate ligament is 3- middle  geniculate artery  =anterior cruciate ligament innervation is a posterior articular nerve branch of the tibial nerve

 

Front 8

the predominant collagen type in anterior cruciate ligament is?

#2 the anterior cruciate ligament strength is approximately how much?

Back 8

type I collagen

#2 2200 N

Front 9

patient presents with he felt a pop and had immediate swelling physical exam effusion and quadriceps avoidance gait

 

It was diagnosis?

#2 pathognomonic finding for anterior cruciate ligament on x-ray

Back 9

#1 anterior cruciate ligament tear

#2 Segond fracture which is an avulsion fracture of the proximal lateral tibia

Front 10

if the femoral tunnel is to anterior what is leading to inside the knee?

what if the tibial tunnel is to posterior what is the effect in the knee?

Back 10

tight in flexion and loose in extension

impingement on the PCL

Front 11

if the  tibial tunnel placement is to anterior was the effect of the knee

Back 11

tight in flexion with impingement in extension

Front 12

what are the 2 most common complication with bone patellar bone autograft

What is the maximum load to failure of a quadricep hamstring autograft? 

Back 12

#1 patella fracture and #2 patellar tendon rupture

#2 4000 N

Front 13

reported to most common complications with quadricep hamstring autograft?

Back 13

windshield wiper effect and residual hamstring weakness

Front 14

what are the most common complications with allograft anterior cruciate ligament reconstruction?

Back 14

risk of disease transmission such as HIV and hepatitis, increased risk of rerupture and athletes, and if the graft was radiated decrease structural and mechanical properties of the graft

Front 15

what is the best determinant and skeletal maturity and female

Back 15

onset of menarche

Front 16

what are the most common complications with pediatric anterior cruciate ligament reconstruction

Back 16

increase 5 so injury due to increased tunnel diameter greater than 8 mm, high-speed reaming, interference screw fixation, oblique tunnel positioning

Front 17

contraindication with revision anterior cruciate ligament reconstruction?

Back 17

review harvesting bone patella bone

Front 18

during rehabilitation after an anterior cruciate ligament reconstruction what are the immediate treatments that are most beneficial?

Back 18

aggressive cryotherapy ice, immediate weightbearing, early full passive extension

Front 19

what exercises during postop anterior cruciate ligament reconstruction should be avoided?

Back 19

isokinetic quadricep strengthening and open train quadricep strengthening

Front 20

most effective oriented female athlete to prevent anterior cruciate ligament injury

Back 20

?neuromuscular training M PAULY metric jump training with the goal of increasing hamstring strength to decreased quadriceps dominance ratio

Front 21

most common reason for anterior cruciate ligament failure?

Back 21

surgical technique after most commonly improper tunnel placement with most commonly vertical femoral tunnel leading to rotational instability and positive pivot shift

Front 22

most common organism and anterior cruciate ligament reconstruction infection

#2 how to treat infection in the knee?

Back 22

?staph aureus

perform immediate joint aspiration with Gram stain and cultures and then do immediate arthroscopic I and D and may retain graft if multiple I and D's and antibiotics for 6 weeks

Front 23

most common nerve irritation after anterior cruciate ligament reconstruction?

Back 23

saphenous nerve

Front 24

most common complication the results and reoperation of an anterior cruciate ligament reconstruction?

 #2 most common complicationat 8-12 weeks postop after an anterior cruciate ligament reconstruction?

Back 24

improper tunnel placement

#2 patella fracture

Front 25

 A patient develops infrapatellar contracture syndrome after undergoing ACL surgery. All of the following findings are consistent with this diagnosis EXCEPT?  

1.  Patella infera

2.  Decreased patellar mobility

3.  Loss of active but not passive flexion

4.  Loss of full extension

5.  Loss of passive flexion

Back 25

 Answer #3 which is incorrect because the resulting stiffness affects both active and passive motion.  

Front 26

A 25-year-old male is one year status post anterior cruciate ligament (ACL) reconstruction using patellar bone-tendon-bone (BTB) autograft. He complains of persistent instability with certain activities. His operative dictation notes excellent stability intra-operatively with femoral fixation at the 12 o'clock position. Based on his femoral tunnel position, his history and examination are most likely to reveal which of the following? 

1.  Positive pivot shift test and instability with cutting activities due to failure to reconstruct the posterolateral bundle of the ACL

2.  Positive Lachman's test and instability with forward running activites due to failure to reconstruct the anteromedial bundle of the ACL

3.  Positive pivot shift test and instability with cutting activities due to failure to reconstruct the anterolateral bundle of the ACL

4.  Positive Lachman's test and instability with forward activites due to failure to reconstruct the posteromedial bundle of the ACL

5.  Positive pivot shift test and instability with forward running activities due to failure to reconstruct the posterolateral bundle of the ACL

Back 26

ACL reconstruction with 12 o'clock femoral fixation would lead to a vertically placed graft and result in continued instability with cutting activities, and a positive pivot shift exam due to failure to reconstruct the posterolateral bundle of the ACL. Current standards for anatomic ACL reconstruction stress the importance of more horizontal graft placement (10:30 in a right knee vs 1:30 in the left knee), to try and reconstruct both the anteromedial bundle which provides anterior-posterior stability, and the posterolateral bundle which provides the rotational stability. Improper femoral graft placement is one of the most common reasons for ACL revision surgery.ans1

Front 27

At what range of motion do seated leg extension exercises place the greatest amount of stress on the anterior cruciate ligament?

1.  0 to 30 degrees

2.  30 to 60 degrees

3.  60 to 90 degrees

4.  90 to 120 degrees

5.  flexion greater than 120 degrees

 

Back 27

Open chain leg extension exercises cause the most anterior shear stress that would affect the ACL. The Wilk article summarizes that isotonic closed kinetic chain exercises produced significantly greater compressive forces compared to the open kinetic chain knee extension. In addition, during closed kinetic chain exercises, a posterior shear force (PCL stress) was generated throughout the entire range with maximal shear occurring from 85° to 105° of flexion. During knee extension, there is an anterior shear force (ACL stress) from 38° to 0° and a posterior shear force from 40° to 101°. According to Beynnon, a closed chain program results in anteroposterior knee laxity values that are closer to normal, and earlier return to normal daily activities, compared with rehabilitation with an open chain program. 

ans1

Front 28

 During anterior cruciate ligament reconstruction, a graft that is tight in flexion but lax in extension may be due to which technical error?

1.  Femoral tunnel is too posterior

2.  Femoral tunnel is too anterior

3.  Femoral tunnel placed at 12:00 position

4.  Tibial tunnel is too anterior

5.  Tibial tunnel is too medial

 

Back 28

The majority of early ACL reconstruction failures are felt to be due to errors in surgical technique. The most common error in ACL reconstruction is aberrant tunnel placement. The femoral tunnel can be placed too anteriorly, thereby causing increased strain on the graft in flexion because of the cam effect of the femoral condyle which can result in graft stretching, laxity in extension, and subsequent failure. Chhabra et al. performed a cadaveric study to demonstrate the anatomic footprints of the anteromedial and posterolateral bundles of the ACL. Markhof et al. performed a cadaveric study analyzing the effects of aberrant placement of the femoral tunnel. Illustration A is a table demonstrating the effects of tunnel malposition. Illustrations B and C are gross anatomy illustrations of normal ACL anatomy. Ans2

Front 29

An 18-year-old athlete is now 3 months out from anterior cruciate ligament reconstruction. He has been unable to obtain full extension of the knee. His range of motion is from 12° to 125° compared to 0° to 140° on the contralateral knee. He has no effusion, no pain at rest, and a stable Lachman’s test. He is having difficulty ambulating without crutches. What is the most common technical error which can account for these findings?

1.  Femoral tunnel drilled too anteriorly

2.  Failure to cycle the knee prior to final tibial fixation

3.  Femoral tunnel drilled too vertically

4.  Tibial tunnel drilled too vertically

5.  Tibial tunnel drilled too anteriorly

 

Back 29

A tibial tunnel drilled too anteriorly will limit full extension and causes tightness in flexion. 

incorrect Answers:

1. Femoral tunnel drilled too anterior will lead to tightness in flexion and laxity in extension.

2. Failure to cycle the knee may lead to stretching out of the ACL and residual laxity in flexion and extension.

3. Femoral tunnel drilled to vertically is associated with transtibial drilling and will result in rotational instability.

4. Tibia tunnel drilled to vertically is not typically a problem with ACL reconstruction.

ans5

Front 30

The saphenous nerve is most likely to be injured with which of the following steps during an anterior cruciate ligament (ACL) reconstruction with hamstring autograft?

1.  Incision for an anteromedial portal with the knee flexed

2.  Incision for an anteromedial portal with the knee extended

3.  Incision for an accessory medial portal the with knee flexed

4.  Hamstring harvest with the knee extended

5.  Tibial tunnel aperture fixation with the knee at 30 degrees of flexion

Back 30

The saphenous nerve is most at risk during the hamstring harvest of an ACL reconstruction. At the joint line, the saphenous nerve is deep to the broad sartorious fascia, and superficial to the gracilis. Bertram et al describe a case report of a patient who sustained saphenous neuralgia following an ACL reconstruction utilizing a hamstring harvest. Symptoms can include paresthesias in the anteromedial region of the lower leg and tenderness at the medial side of the knee. They note that hip external rotation and knee flexion while harvesting the hamstring tendons allows the tendinous structures and saphenous nerve to relax, thus decreasing the chance of injury. Solman et al also stress the understanding of such anatomical relationships of the medial side of knee's anatomy to avoid pitfalls such as saphenous nerve injury during a hamstring harvest. Illustration A provides a depiction of the saphenous nerve with relation to the medial knee. Illustration B is an example of a cadaveric dissection showing the anatomic relationship of the saphenous nerve (black arrow) as it courses superficially along the sartorial fascia (labelled with S).Ans4

Front 31

1.0 xray  =15 genu varum in children 3 years of age, bilateral 

obesity

1.1 tx

1.2x-ray with 16° genu varum in a 3-year-old with the diagnosis and treatment

1.3 x-ray with 16° genu varum in a 13-year-old was the diagnosis and treatment?

 

Back 31

1.1 treatment for mild cases observation in infantile BLOUNTS disease 

1.2BLOUNTS disease lateral tibia and fibular epiphysiodesis 25 percent require formal osteotomy

1.3 proximal tibia fibula osteotomy

Front 32

A 15-year-old male presents with pain and progressive deformity about his left knee. A standing AP radiograph is seen in figure A, with the tibial growth plate nearly closed. Physical examination reveals significant varus and a leg-length discrepancy of 2.5cm right greater than left. Which of the following is the most appropriate method of management at this time?

1.  Orthotics

2.  Hemiepiphysiodesis of the left proximal tibia, medial side only

3.  Hemiepiphysiodesis of the left proximal tibia, medial and lateral sides

4.  Left proximal tibia osteotomy with placement of lengthening external fixator

5.  Left proximal tibia osteotomy with plate fixation

Back 32

Incorrect Answers:
Answer 1: Orthotics are not effective in the treatment of adolescent Blount's disease.
Answer 2: Hemiepiphysiodesis will not be able to provide correction in the setting of closed growth plates.
Answer 3: Hemiepiphysiodesis will not be able to provide correction in the setting of closed growth plates.
Answer 5: Proximal tibial osteotomy with plate fixation will allow for alignment correction, but will be unable to treat the leg-length discrepancy.ans4

Front 33

most common cause of acquired spastic equinovarus deformity of the foot? what is the underlying etiology of this deformity?

was the treatment of this condition?

Back 33

CVA and tBI

overactivity of the gastrocnemius soleus complex and the and varus deformity occurs because of the overactivity of the tibialis anterior?

the treatment is SPLATT Achilles tendon lengthening with split anterior tibialis tendon transfer

 

Front 34

A 65-year-old female developed a right foot deformity 3 years ago following a cerebrovascular accident. She initially underwent early intervention with physical therapy and splinting. However, passively correctable contractures persist and the braces are causing skin problems on the leg. What is the most likely foot and ankle deformity in this patient and the most appropriate surgical treatment to be combined with a planned tendoachilles lengthening (TAL)? 

1.  Spastic equinovarus and split anterior tibialis tendon transfer (SPLATT)

2.  Flaccid equinovarus and medializing calcaneal ostetomy and flexor hallucis longus transfer

3.  Spastic calcaneovalgus and split anterior tibialis tendon transfer (SPLATT)

4.  Flaccid equinovalgus and split anterior tibialis tendon transfer (SPLATT)

5.  Spastic equinovalgus and medializing calcaneal ostetomy and flexor hallucis longus transfer

 

Back 34

The most common physical finding in patients who have had a cerebrovascular accident is spastic equinovarus deformity of the foot and ankle (Illustration A) from an upper motor neuron injury. Ans1

Front 35

1. anterior lateral bowing of the tibia is associated with what condition?
2. what is the treatment

Back 35

1. is associated with pseudoarthrosis of the tibia congenital & neurofibromatosis
2. Treatment is not fractured brace and if pseudoarthrosis or fracture treated with surgical fixation,  IM nail with bone grafting or free fibular graft

Front 36

1. anterior medial border of the tibia associated with what condition
2. what is the treatment

Back 36

1. anteromedial bowing of the tibia is associated with fibular hemimelia
2. treatment is determined by #1 stability #2 level of involvement #3Ankle function #4 the amount of limb shortening#5 not the amount of fibula present
3. Example plantigrade and functional foot  limb lengthening greater than 30% or 10 mm was stable and ankle then do a limb lengthening procedure
4. if the foot is nonfunctional or unstable do syme or boyd amputation
5. If the foot is stable and plantigrade and the limb length is less than 5 cm then do a contralateral epiphysiodesis

Front 37

1. if the child presents with posterior medial bowling what is the diagnosis
2. what is the treatment
3. what is associated with this condition

Back 37

1. physiologic bowing
2. Observation if limb length discrepancy is greater than 5 cm then an age-appropriate epiphysiodesis of the long limb is done
3. calcaneal valgus foot

Front 38

what is the most common complication with surgical treatment of anterolateral bowing of the tibia?

Back 38

recurrent fracture

Front 39

of bowing of the tibia

1. Medial anterior is associated with?  
2. Posterior medial bowing of the tibia is associated with?  
3. Lateralanterior border of the tibia is associated with?

Back 39

1.  Medial anterior =heMiaMilia fibula
2. Posterior medial = Physiologic bowing 2PM
3. Lateral anterior see the foot, pSeudoarthrosis of the tibia, neurofibromatoSiS

Front 40

Anterolateral tibial bowing is associated with which of the following lower extremity conditions in children?

1.  Calcaneovalgus foot deformity

2.  Congenital pseudoarthrosis of the tibia

3.  Fibular hemimelia

4.  Congenital talipes equinovarus

5.  Congenital vertical talus

Back 40

anteroLateral tibial bowing and congenital pSeudoarthroSiS of the tibia are related conditions and represent a continuum of the same disease process. It is most commonly seen in children with neurofibromatoSiS. The radiograph in Illustration A is an example of anterolateral tibial bowing. The radiograph in in Illustration B is an example of congenital pseudoarthrosis of the tibia. ans2

Front 41

when greater than 50% of the Achilles tendon insertion must be removed for debridement what is the treatment?

Back 41

 tendon augmentationwith FDL, FDP H or PB

Front 42

 

what is the treatment forAchilles tendinitis and less than 50% of the tendon has to be removed?

Back 42

the treatment is retrocalcaneal bursa excision, calcaneal bony prominence resection

Front 43

what is the key treatment for Achilles tendinitis to be done doing physical therapy?

Back 43

eccentric training

Front 44

A 48-year-old male complains of 5 years of heel pain while running. Initially the pain was relieved with Achilles tendon stretching, orthotics, and open-backed shoe wear. Over the past year these modalities are no longer helpful and he is beginning to have pain with walking. Clinical photograph and radiograph are provided in figures A and B. Which of the following treatment options is the best choice to relieve pain and improve function?  1.  Arizona gauntlet brace

2.  Steroid injection

3.  Achilles tendon debridement

4.  Achilles tendon debridement, calcaneal exostectomy, and FHL transfer

5.  Ankle arthrodesis

Back 44

Clinical photograph and radiograph demonstrate Haglund's deformity and calcifications consistent with insertional Achilles tendonopathy. Failure of conservative management and loss of function are indications for surgical management. Given the large Haglund's deformity on radiograph, calcaneal exostectomy is preferable to tendon debridement alone. ans4

Front 45

Which of the following exercises is important to incorporate into an Achilles tendinopathy rehabilitation protocol following a period of diminished intensity of activities? 

1.  Plyometric

2.  Isokinetic

3.  Concentric

4.  Eccentric

5.  Isometric

Back 45

Eccentric exercises are important to implement into a functional rehabilitation program for Achilles tendinopathy.  Eccentric exercises most efficiently strengthen skeletal muscle. Eccentric exercise is a type of isotonic exercise that includes constant muscle tension while the muscle is lengthening.Ans4 

Front 46

what on the 4 effect of NSAIDs in the body?

Back 46

1. anti-inflammatory
2. antipyretic
3. antiplatelet and
4. analgesic

Front 47

what other contraindications to NSAIDs? (2)

Back 47

1. severe renal disease and gastric ulcers

Front 48

were the side effects of COX 2 specific inhibitors

Back 48

?cardiac toxicity

Front 49

side effects of NSAIDs?

Back 49

1. renal dysfunction
2. Gastric side effects like peptic ulcer perforation, bleeding, or obstruction
3. Delayed fracture healing specifically decreases endochondroma ossification
4. Platelet dysfunction

Front 50

COX to admission has been shown to decrease what an abnormal fracture and models?

Back 50

decrease in endochondral ossification

Front 51

All the following medications binds reversibly to the enzyme COX-1 EXCEPT 

1.  Meloxicam

2.  Diclofenac

3.  Indomethacin

4.  Naproxen sodium

5.  Aspirin

Back 51

Aspirin binds irreversibly to the cyclooxygenase enzyme. Aspirin acetylates platelet cyclooxygenase and permanently inhibits thromboxane (TX) A2 production leading to its antiplatelet effects. The other NSAID's listed above bind reversibly with COX-1. ans5

Front 52

Arachidonic acid is directly metabolized by which of the following substances? 

1.  Carbonic anhydrase

2.  HMG-CoA reductase

3.  1-lipoxygenase

4.  Cyclooxygenase

5.  Thromboxane synthetase

Back 52

Arachidonic acid is the common substrate that is directly metabolized by cyclooxygenase into the prostanoids including prostaglandins, prostacyclin and thromboxane. Cyclooxygenase 1 enzyme, or COX-1, results in prostaglandins responsible for maintenance and protection of the GI tract. Cyclooxygenase-II enzyme, or COX-2, results in prostaglandins responsible for inflammation and pain. Leukotrienes are synthesized from arachidonic acid by 5-Lipoxygenase, not 1-Lipoxygenase. Mevalonate is involved in the HMG-CoA reductase pathway – the metabolic pathway that produces cholesterol (site of action of the statins). A diagram of arachidonic acid metabolism is provided in Illustration A.ans4

 

Front 53

A 45-year-old man is placed on indomethacin for heterotopic ossification prophylaxis following surgery for an acetabular fracture. What is the most likely side effect of this medication? 

1.  Renal failure

2.  Hepatitis

3.  Peripheral neuropathy

4.  Deep vein thrombosis

5.  Gastrointestinal ulceration

Back 53

Indomethacin, commonly used to prevent heterotopic ossification, is associated with a high rate of gastrointestinal toxicity. ans5

Front 54

1. what definition of spondylolisthesis?
2. what activities most likely to increase the prevalence of isthmic spondylolisthesis
3. in the body what is the most common location of his adult Isthmic spondylolisthesis?

 

Back 54

1. defect in the pars interarticularis
2. repetitive hyperextension example gymnastics weightlifters football
3. L5/S1 with compression of the L5 nerve root caused by foraminal stenosis

 

Front 55

1. what mathematical expression what is pelvic incidents equal to?
2. what is the clinical significance of pelvic incidence?
3. if suspect adult is symmetric spondylolisthesis on x-ray what is the next most appropriate step in assessment?

Back 55

1. pelvic incidents= pelvic tilt +  sacral slow
2. It is a direct correlation with Meyerding grade
3. MRI to rule out foraminal stenosis

Front 56

patient presents with weakness of ankle plantar flexion what caused this injury?

Back 56

S1 nerve root injury

Front 57

patient presents with weakness in hip flexor what caused this injury?

Back 57

  L2/L3 nerve

Front 58

loss of patellar reflex what caused this injury?

Back 58

injury to the L4 nerve root

Front 59

bowel and bladder dysfunction with saddle anesthesia what caused this injury?

Back 59

cauda equinus syndrome

Front 60

patient presents with weakness great toe extension causes injury?

Back 60

L5 nerve root and weakness with ankle dorsiflexion

Front 61

what is treatment of an adult high-grade spondylolisthesis?

Back 61

decompression, L4-S1 posterior lumbar fusion and anterior column support

Front 62

A 26-year-old male presents with chronic back and bilateral leg pain that has not improved with extensive nonoperative management including physical therapy, oral medications, and corticosteroid injections. Radiographs are shown in Figure A. What is the most appropriate next step in treatment?  1.  Placement of epidural spinal stimulator

2.  Lumbar decompression alone

3.  Lumbar decompression with L5 to S1 posterior lumbar fusion

4.  Lumbar decompression, L4 to S1 posterior lumbar fusion, and anterior column support

5.  Minimally invasive direct lateral interbody fusion with percutaneous pedicle screw placement

Back 62

The clinical presentation and imaging studies are diagnostic of a high grade spondylolisthesis that has failed nonoperative management. Surgery is indicated, and the procedure of choice is a posterior lumbar decompression with an instrumented fusion from L4 to S1 with anterior column support.aaans4

Front 63

the patient presents with bilateral sacroiliitis, uveitis and HLA-B27 what is the diagnosis?

Back 63

ankylosing spondylitis

Front 64

what is the diagnosis?  What is the treatment?

Back 64

vertebral scalloping or bamboo spine ankylosing spondylitis marginal syndesmophytes

Front 65

patient with a known history of ankylosing spondylitis presents to the ER after trauma to his neck and initial x-rays are negative what is the next most appropriate step in the management of this patient?

Back 65

CT scan to rule out cervical fractures

MRI scan to rule out epidural hemorrhage after cervical fracture in a young patient

Front 66

All of the following are characteristics of juvenile ankylosing spondylitis EXCEPT? 

1.  Spinal stiffness

2.  Sacroiliitis

3.  Urethritis

4.  Enthesitis

5.  Kyphosis

 

Back 66

Juvenile Ankylosing spondylitis (AS) one of the spondyloarthropathies that is characterized by sacroiliitis, spondylitis, enthesitis, HLA B-27, kyphosis, asymmetric lower extremity inflammatory arthritis, decreased chest expansion, and uveitis, but NOT Urethritis (which is typical of the triad of Reiter syndrome). ans3

Front 67

A patient with ankylosing spondylitis and a hip flexion contracture undergoes uneventful right total hip replacement using a Kocher (posterior) approach. This patient is at increased risk for which of the following complications post-operatively? 

1.  Posterior hip dislocation

2.  Anterior hip dislocation

3.  Deep infection

4.  Osteolysis

5.  Periprosthetic fracture

 

Back 67

Degenerative joint disease due ankylosing spondylitis (AS) with a concomitant hip flexion contracture increases post-operative rates of anterior hip dislocations. Correction of hip flexion contracture with THA can restore sagittal balance. However, when positioning the acetabular component in a patient with AS, one must account for the relationship of the pelvis to the lumbar spine in the sagittal plane in order to avoid an excessively hyperextended hip once the patient resumes an upright position.ans2

Front 68

A 32-year-old man presents with low back and hip pain that has been gradually worsening over the past year. He reports the symptoms are worse in the morning. Radiographs are shown in Figure A. Laboratory studies show a positive HLA-B27. What additional finding will help confirm the diagnosis?

1.  Erythema marginatum

2.  Positive HLA-DR3

3.  Uveitis

4.  Positive Rheumatoid Factor

5.  Elevated urine phosphoethanolamine

 

Back 68

The radiograph in Figure A shows bilateral sacroiliitis. Bilateral sacroiliitis (with or without uveitis) and a postive HLA-B27 is diagnostic of ankylosing spondylitis. ans3

Front 69

 A 45-year-old man with ankylosing spondylitis presents with fixed sagittal imbalance and difficulty with horizontal gaze. His kyphotic deformity is localized to the thoracolumbar spine. Which of the following procedures allows the most correction in the sagittal plane at a single level without having to resect the intevertebral disc? 

1.  Smith-Petersen osteotomies

2.  Pedicle subtraction osteotomy (PSO)

3.  Vertebral column resection (VCR)

4.  Single-level opening wedge osteotomy

5.  Multi-level opening wedge osteotomies

 

Back 69

Pedicle subtraction osteotomy (PSO) provides greater sagittal correction than single-level opening wedge osteotomy and Smith-Petersen osteotomies, with the advantage of working at a single level and not having to resect the intevertebral disc.ans2

Front 70

1. idiopathic scoliosis with cavus foot deformity and what is the next most appropriate step in management?
2.  what other physical exam findings might one found if the test is positive?

Back 70

1.   MRI to rule out neuropraxis abnormality such as syringomyelia or cyst
2. asymmetric abdominal reflexes

Front 71

what is the best predictor of curve progression?

Back 71

in Femaleit is just before menarche or RISSER 1 the best method is it tender method to determine skeletal maturity

Front 72

patient idiopathic scoliosis curve is seen how much curvature is allowed in order to treat in the following method

1. Observation
2. Bracing
3. Posterior spinal fusion
4. Anterior spinal fusion
5. Anterior and posterior spinal fusion
6. with the most common complication with anterior spinal fusion with instrumentation?

 

Back 72

1. less than 25° --observe
2. 45° to 25° -- bracing and skeletally immature that is RISSER 2
3. More than 45° but less than 75° -posterior spinal fusion
4.  thoracolumbar and lumbar cases with  normal sagittal profile
5. more than 75°or stiff curve -- anterior posterior spinal fusion
6. pseudoarthrosis when  thoracic hyperkyphosis is present

Front 73

with the most common organism causing delayed infection after scoliosis surgery?

Back 73

Propionibacterium acnes

Front 74

A mother and her 16-year-old daughter present to your clinic because the daughter has noticed asymmetries in her back. She has no back pain and no neurologic symptoms. She is two years post-menarcheal. After a complete history and physical, you order PA thoracolumbar radiograph, which is seen in figure A. The cobb angle is 38 degrees. When discussing the natural history of the disease, you tell the family they should expect: 

1.  difficulty with vaginal child birth in the future.

2.  decreased pulmonary function in the future

3.  to undergo an MRI to rule out any underlying neurologic pathology, as this is an abnormal curve

4.  an increased risk of chronic back pain over her lifetime

5.  this curve magnitude has the highest curve progression rate without operative intervention

Back 74

Discussion: The patient is presenting with classic adolescent idiopathic scoliosis (AIS). She has an apex at T8, which makes this a main thoracic, Lenke type 1 curve. While AIS is commonly referred to as a painless condition, Weinstein et al. published the 50-year follow-up, of 117 untreated patients with AIS compared to 62 age- and sex-matched controls and found a statistically significant (p = 0.003) increase in chronic back pain over 50 years. Incorrect Answers:
Answer 1: Women who have scoliosis do not have an increased risk of cesarean sections than those without scoliosis
Answer 2: Patients with a 38-degree curve do not have an increased risk of pulmonary dysfunction. 
Answer 3: The patient has a Lenke type 1, main thoracic curve. No advanced imaging is needed
Answer 5: The patient is post-menarcheal by 2 years, and her curve is 38 degrees. She has a low risk of curve progression
ans4

Front 75

When compared to normal controls, adults with untreated idiopathic scoliosis and a Cobb angle of greater than 60 degree at the time of skeletal maturity have a higher rate of which of the following? 

1.  Acute and chronic back pain

2.  Premature death

3.  Disability

4.  Clinical depression

5.  Limitation in activities of daily living

Back 75

Patient with untreated adolescent idiopathic scoliosis with a curve of 60 degrees or greater at skeletal maturity have an increased rate of low back pain relative to normal controls.ans1

Front 76

what is most common complication complication of an untreated scoliosis curve?

Back 76

acute and chronic back pain