2015 Spine (S/t/bs) Antomy And Science (1-9)

Front 1

• _____direct and regulate processes of embryonic differentiation and segmentation along craniocaudal axis

Back 1

homeobox, or Hox genes

Front 2

majority of rotation occurs where in the C-spine?

Back 2

C1/C2-atlas & axis

Front 3

majority of flex/ext occurs where in the C-spine?

Back 3

occiput/atlas

Front 4

majority of later bending occurs where in the C-spine?

Back 4

c3-c7

Front 5

which cervical vertebra does NOT have the vertebral artery?

Back 5

C7-Vertibal artery

Front 6

which cervical vertebra does NOT have a bifid spinous process?

Back 6

C1 & C7

Front 7

• Spinal canal normal diameter is ____
  • • ____indicates possible cord compression

Back 7

-17mm=nl

-<13mm =compression

Front 8

where is the C8 nerve root

Back 8

at the C7 level

Front 9

the secondary ossification center fuses to the dens at ~ age ___?

Back 9

age 12

Front 10

What does this image demonstrate?

-why is it significant?

-

• apex is supplied by branches of___artery
• base is supplied from branches of ___artery

Back 10

-a vascular watershed exists between the apex and the base of the odontoid

- watershed area is thought to affect healing of type II odontoid fractures-apex- internal carorid A

base-vertebral A

Front 11

Occipital-C1-C2 Ligamentous Complex

-which ligament limits anterior translation of the atlas

Back 11

transverse ligament

Front 12

Occipital-C1-C2 Ligamentous Complex

-which ligament limit rotation of the upper cervical spine

Back 12

apical ligaments

Front 13

Occipital-C1-C2 Ligamentous Complex

-which ligament limit rotation of the upper cervical spine

Back 13

alar ligaments

Front 14

• vertebral artery travels through transverse foramen of __ to___?

Back 14

C1 to C6

Front 15

• contains palpable carotid tubercle which is a valuble landmark for anterior approach to cervical spine?

Back 15

C6

Front 16

• which have bifid spinous process

Back 16

C2-C6

Front 17

which have a transverse foramen

Back 17

C1-c7

Front 18

• which has nonbifid spinous process

Back 18

C7

Front 19

superior articular facets of the subaxial cervical spine (C3-C7) are oriented in a ___ direction at C3 and ___ direction at C7

Back 19

-posteromedial

-posterolateral

Front 20

Range of motion is greatest at more ___, owing to the orientation of the ___

Back 20

cephalad levels

-facet joints.

Front 21

When viewed on axial imaging, the superior articular process is ___to the inferior articular process

Back 21

-anterior

Front 22

A 3-year old male falls from a table and is brought to the emergency room with neck pain, but no neurologic deficits. Cervical spine radiographs show a synchondrosis separating the odontoid process from the body of the axis. Which of the following best describes this radiographic finding?

Back 22

-synchondrosis separating the odontoid process from the body of the axis is a normal radiographic finding in a 3 year old.

- tip of the dens is not ossified at birth but appears at age 3 years and fuses to the dens by age 12 years

Front 23

-5 root test for sensory & reflex?

- 6 nerve off of C5?

what do these 6 nerve innervate?

Back 23

S-Lateral arm below deltoid

R-Biceps

1. -dorsal scapular N->Rhomboid mn, mj, levator scapula
2. long thoracic N->Serratus anterior
3. phrenic N->diaphragm
4. N to longus colli and scalene M
5. dorsal-visceral motor, somatic motor, and sensory information to and from the skin and deep muscles of the back
6. ventral rami->bothsensory and motor, sinuvertebral nerve branches, also supply structures anterior to the facet joint, including the vertebral bodies, the discs and their ligaments, and joins other spinal nerves to form the lumbo-sacral plexus.

Front 24

C5 root

-primary motion & muscles tested?

Back 24

c5-Shoulder abduction
C5-Elbow flexion (palm up)

-Deltoid
Biceps

Front 25

What is a potential complication of an amputation at the level of the distal interphalangeal joint?

Back 25

A lumbrical plus finger is descibed as paradoxical extension of the IP joints while attempting to flex the fingers. In the case a lumbrical plus finger secondary to a DIP amputation, the PIP will extend upon attempted finger flexion.

Front 26

Carpal tunnel what is the most radial structure?

what is the CT?

Back 26

most radial FPL

- 1 consists of nine flexor tendons

2-one nerve (median nerve)

3-FPL

Front 27

which nerve lies between PL and FCR at level of the wrist flexion crease

Back 27

palmar cutaneous branch of median

Front 28

Carpal tunnel is narrowest at the level of the ___?

Back 28

hook of the hamate

Front 29

the most specific test (76%) for carpal tunnel syndrome?

Back 29

self administered hand diagram

Front 30

is the most sensitive test to diagnose carpal tunnels syndrome?

Back 30

carpal tunnel compression test (Durkan's test)

Front 31

demyelination leads to what effect to NCV ? (faster slower, increase decrease)

NCV distal sensory latency of= CTS?

NCV motor latencies= CTS?

Back 31

-increase latencies (slowing) of NCV

-distal sensory latency of > 3.2 ms

-motor latencies > 4.3 ms

Front 32

EMG test the electrical activity of ___&____?

Back 32

individual muscle fibers and motor units

Front 33

potential pathologic findings of emg with CTS suggestive of demylination? 5

Back 33

1. increased insertional activity
2. sharp waves
3. fibrillations
4. fasciculations
5. complex repetitive discharges

Front 34

nerve histology characterized by what in CTS? 5

Back 34

1. edema,
2. fibrosis,
3. vascular sclerosis are most common
4. lymphocytes
5. amyloid deposits shown with special stains in some cases
   

Front 35

-CTS first line of treatment?

-nocturnal symptoms only?

-___is a good prognostic factor that the patient will have a good result with surgery?

-failure to improve following primary surgery most common reason?

Back 35

1. NSAIDS, night splints, activity modifications
2. night splints
3. temporary improvement with steroid injections
   
4. incomplete release
   

Front 36

CTS

pinch strength return in ___ weeks?

grip strength is expected to return to 100% preoperative levels by ___ weeks postop

Back 36

pinch strength = 6 week

grip strength =12 weeks postop

Front 37

prophylactic antibiotics, systemic or local, are____ for patients undergoing a clean, elective carpal tunnel release

Back 37

NOT indicated

Front 38

A 45-year-old man presents with a three-month history of unilateral symptoms in his right wrist and hand. He first noticed a palpable nodule over the volar aspect of his wrist about three months ago. The nodule would become painful after weekends of heavy drinking at which time he noticed tingling sensation in his index and middle fingers. He notes that ibuprofen has helped improve the pain in the past. On clinical examination, he has a palpable, painless, solid nodule over the volar aspect of his wrist. He has no motor or sensory deficits and negative carpal tunnel provocative tests. An axial CT and MRI image show atypical space occupying lesion - What would be the most appropriate next step in the management of his symptoms?

Back 38

gout. The most appropriate next step in the management of his symptoms would be referral to a rheumatologist where medical therapy, such as prophylaxis with colchicine, could be initiated.

Front 39

This guideline was subsequently endorsed by the American Association of Neurological Surgeons and the Congress of Neurological Surgeons. The guideline makes 9 specific recommendations:

1. tx?
2. indications for surgery x 2 ?
3. tx in pt with dm or cervical radicaulapthy?
4. 4 ex of conserv tx?
5. what is the surgical tx of CTS?
6. not recommended (3)?
7. abx use with CTS?
8. post op recommendation?
9. adjunct to be used to assess patient responses to carpal tunnel syndrome treatment for research?

Back 39

1. A course of nonsurgical treatment is an option in patients diagnosed with carpal tunnel syndrome.
2. Early surgery is an option with clinical evidence of median nerve denervation or when the patient so elects. surgery is suggested when the current treatment fails to resolve symptoms within 2 -7 wks.
3. Sufficient evidence is not available to provide specific treatment recommendations for carpal tunnel syndrome associated with such conditions as diabetes mellitus and coexistent cervical radiculopathy.
4. Local steroid injection, splinting, Oral steroids, ultrasoundis suggested before considering surgery.
5. Surgical treatment of carpal tunnel syndrome by complete division of the flexor retinaculum is recommended as treatment.
6. Heat therapy is not among the options to be used, Routine use of skin nerve preservation and epineurotomy is not suggested when carpal tunnel release is performed.
7. Prescribing preoperative antibiotics for carpal tunnel surgery is an option.
8. the wrist NOT be immobilized postoperatively after routine carpal tunnel surgery.
9. instruments such as:

• Boston Carpal Tunnel Questionnaire
• Disabilities of the Arm, Shoulder, and Hand questionnaire
  

Front 40

carpal tunnel relationship of the FDS tendons & contains 10?

Not the?

Back 40

1. median nerve,
2. FPL
3. 4 tendons each of the FDP and FDS.
4. the 3rd and 4th FDS tendons are volar to the 2nd and 5th FDS tendons.
   
5. not=>Flexor carpi radialis (FCR)

Front 41

EMG's detect the electrical potential generated by ____ when these cells are electrically activated. They give information about the ____

Back 41

muscle cells

-muscle motor unit

Front 42

The nerve conduction (NCV) portion of the electrodiagnostic study measures the speed at which the _____ travels down the axon.

Large, ____ conduct impulses the fastest

- only ____ fibers are evaluated in the nerve conduction portion of the electrodiagnostic study.

Back 42

nerve impulse

myelinated nerve fibers

myelinated nerve fibers

Front 43

General parameters for NCV diagnosis of carpal tunnel syndrome include ___ of >4.5 msec, a ____ of >3.5msec, or a ____ of < 52 m/sec.

Back 43

a distal motor latency

distal sensory latency

-conduction velocity

Front 44

___&___ are measured with NCV's.

EMG's detect the ___ generated by muscle cells when these cells are ___.

Back 44

Distal latencies and conduction velocities

-electrical potential

-electrically activated

Front 45

A 45-year-old carpenter complains of difficult gripping a hammer, which worsens with repeated use. On physical exam, he is able to passively flex the proximal interphalangeal (PIP) joint when the metacarpophalangeal (MCP) joint is flexed but not when the MCP joint is extended. What is the most likely explanation?

Back 45

patient exhibits a positive Bunnell test, indicative of intrinsic tightness, which commonly affects those who use objects that require repetitive grip.

Front 46

positive test when PIP flexion is less with MCP extension than with MCP flexion =what test?

Back 46

Bunnell test (intrinsic tightness test

Front 47

___ is characterized by an active flexion lag in fingers adjacent to a digit with a previously injured or repaired flexor digitorum profundus tendon.

Back 47

Quadrigia effect

Front 48

____ is limited MCP flexion secondary extensor tendon adhesion to bone.

Back 48

Extrinsic tightness

Front 49

____ would result in a Boutonniere deformity.

Back 49

Central slip rupture

Front 50

_____is paradoxical PIP extension during active finger flexion.

Back 50

Lumbrical plus

Front 51

Chronic injury to what anatomic structure can lead to a boutonnière deformity of the finger?

Back 51

central slip of the extensor tendon

Front 52

A 54-year-old female presents with a hand deformity. A surgical procedure is being considered that relocates the lateral bands dorsally to counteract the pathophysiology of the deformity. Which of the following deformities does this patient most likely have?

Back 52

Boutonniere deformity is characterized with the PIP in flexion and the DIP in hyperextension

Front 53

Primary lesion is lax volar plate that allows hyperextension of PIP?

Back 53

Swan Neck Deformity

Front 54

A finger deformity caused by disruption of the terminal extensor tendon distal to DIP jointthe disruption may be bony or tendinous?

Back 54

Mallet Finger

Front 55

A 16-year-old football player sustains an injury to his ring finger after making a tackle. A clinical photograph is shown demonstrates the inability to flex the ring finger DIP What is the most likely diagnosis

Back 55

"rugby jersey finger", which is an avulsion of the flexor digitorum profundus (FDP) tendon.

Front 56

A butcher sustains a traumatic amputation of the ring finger through the distal interphalangeal joint. He is brought to the operating room where the flexor digitorum tendon is retrieved and advanced to the distal stump. Three months after surgery the patient notes that when he makes a fist, only his ring finger tip reaches the palm. What is this patient's clinical problem?

Back 56

Quadrigia syndrome occurs when a flexor digitorum profundus (FDP) tendon is shortened and advanced.

Front 57

A 34-year-old seamstress was diagnosed with Parsonage-Turner brachial neuritis in the right upper extremity 1 month ago. She has weak forearm pronation with the elbow in the flexed position. She denies any current sensory changes. A clinical image of her hands attempting to make a clenched fist Which of the following most likely represents her diagnosis and treatment

Back 57

This patient presents with anterior interosseous nerve (AIN) syndrome and is often seen in conjunction with brachial neuritis (Parsonage-Turner Syndrome).

-Anterior interosseous nerve syndrome treated with observation

Front 58

sx: aching pain over proximal volar forearm sensory disturbances over the distribution of palmar cutaneous branch of the median nerve (palm of hand) which arises 4 to 5 cm proximal to carpal tunnellack of night symptoms

xray=supracondylar process dx? define?

Back 58

Pronator Syndrome

-A compressive neuropathy of the median nerve at the level of the elbow

Front 59

Cubital tunnel syndrome is caused by compression of the ulnar nerve between what two structures as it passes posterior to the medial epicondyle?

Back 59

- Osborne's ligament and the MCL

ulnar nerve passes posterior to the medial epicondyle and medial to the olecranon, then enters the cubital tunnel. The roof of the cubital tunnel is primarily made up of Osborne's ligament, and the floor consists of the medial collateral ligament.

Front 60

is not a possible sites of compression for the ulnar nerve?

Back 60

ligament of Struthers

Front 61

A 50-year-old man complains of numbness and tingling along his right small finger. Physical exam is notable for the finding demonstrated compensatory IP hyperflexion of FPL (innervation?) to compensate for the loss of adductor pollicis (innervation?) during key pinch. Elbow flexion reproduces the numbness and tingling. Physical therapy and splinting have failed to relieve the symptoms. Which of the following is the most appropriate surgical intervention to alleviate the symptoms while minimizing complications?

Back 61

- FPL (AIN)

- adductor pollicis (ulnar nerve)

Simple ulnar nerve decompression at the cubital tunnel

Front 62

A 72-year-old female complains of progressive weakness with grasp and key pinch in her left hand. Physical exam of the hand is significant for decreased sensation on the volar aspect of the fourth and fifth digits. Dorsal sensation throughout the hand is normal. A clinical photo displaying bilateral key pinch FPL is used to substitute for the weakened adductor pollicis resulting in flexion of the thumb at the interphalangeal joint, and MCP joint hyperextension.. What is the most likely cause of compression?

Back 62

Ganglion within Guyon's canal