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12 Cards in this Set

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67yo M c/o chronic low & neck pain. lat cervical Fig A. thoracic spine Fig B & C. What is the most likely dx? 1-Ossification pos longitudinal lig; 2-rheumatoid arthts; 3-Ankylosing spndylitis; 4-DJD
5-DISH
67yo M c/o chronic low & neck pain. lat cervical Fig A. thoracic spine Fig B & C. What is the most likely dx? 1-Ossification pos longitudinal lig; 2-rheumatoid arthts; 3-Ankylosing spndylitis; 4-DJD
5-DISH
"flowing" ossification along the anterolateral margins of at least 4 contiguous vertebrae and the absence of changes of spondyloarthropathy or degenerative spondylosis. in AS bone formation is typically see between vertebral bodies).Ans5
"flowing" ossification along the anterolateral margins of at least 4 contiguous vertebrae and the absence of changes of spondyloarthropathy or degenerative spondylosis. in AS bone formation is typically see between vertebral bodies).Ans5
12-yo gymnast c/o progressive low back & buttock pain refractory to conser mangnt x 2 yrs.  MRI Fig A. Surgical managt w/ redctn of L5 on S1 would most  lead to which neurologic complcns? 1-Dec patellar reflexes 2-Weak hip flex; 3-Weak great toe ext;
12-yo gymnast c/o progressive low back & buttock pain refractory to conser mangnt x 2 yrs. MRI Fig A. Surgical managt w/ redctn of L5 on S1 would most lead to which neurologic complcns? 1-Dec patellar reflexes 2-Weak hip flex; 3-Weak great toe ext;
4-Weak knee ext 5-Weak to ankle PF:::L5 @ risk, manifest= 1 weak to hip abd, 2 EHL, 3 tibialis anterior (dual inn w/ L4). Sensory manifest= pain or paresthesia over the lat calf & dorsal foot.Asn3
4-Weak knee ext 5-Weak to ankle PF:::L5 @ risk, manifest= 1 weak to hip abd, 2 EHL, 3 tibialis anterior (dual inn w/ L4). Sensory manifest= pain or paresthesia over the lat calf & dorsal foot.Asn3
17yo high school foot'l lineman  dx'd w/Fig A. continues c/o pain x 6 mth custom (LSO) & avoiding all sports activities. PE c/o pain w/single-limb stand lum ext & nl neuro. How would the surg managt differ if this condtn occurred at L3 instead of L5?
17yo high school foot'l lineman dx'd w/Fig A. continues c/o pain x 6 mth custom (LSO) & avoiding all sports activities. PE c/o pain w/single-limb stand lum ext & nl neuro. How would the surg managt differ if this condtn occurred at L3 instead of L5?
1-Pars interarticularis repair is indctd; 2-Lumbosacral fusi is indctd; 3-Gill procedure is indctd; 4-Comb ant interbody fusn & pos decomprssn is indicated 5-ICBG is indicated :::defect in the pars interarticularis, Scotty dog", @ L4 & above tx in...
1-Pars interarticularis repair is indctd; 2-Lumbosacral fusi is indctd; 3-Gill procedure is indctd; 4-Comb ant interbody fusn & pos decomprssn is indicated 5-ICBG is indicated :::defect in the pars interarticularis, Scotty dog", @ L4 & above tx includes pars interarticularis repair vs @ L5-S1 tx is in-situ fusn w/BG.Ans1
14yo soccer player + hx of intermittent LBP. c/o x 4 mth no sx or limitations in his athletic activity. Tx should include? 1-TLSO; 2-in situ L5-S1 b/l pos-lat fus; 3-repair of pars defect w/ screw fix 4-limt athletic activity; 5-obser w/ no restri...
14yo soccer player + hx of intermittent LBP. c/o x 4 mth no sx or limitations in his athletic activity. Tx should include? 1-TLSO; 2-in situ L5-S1 b/l pos-lat fus; 3-repair of pars defect w/ screw fix 4-limt athletic activity; 5-obser w/ no restriction of activity
Low Grade L5-S1 isthmic spondylolisthesis w/ minimal sx. tx=obser w/ no restriction of activity. classically, gymnasts, football offensive lineman & athletes who do a lot of repetitive hyperextension activities, if sx then brace 6-12 wks no sports...
Low Grade L5-S1 isthmic spondylolisthesis w/ minimal sx. tx=obser w/ no restriction of activity. classically, gymnasts, football offensive lineman & athletes who do a lot of repetitive hyperextension activities, if sx then brace 6-12 wks no sports.Ans5
What additional dx test is most sensitive to dx pediatric spondylolysis when AP & lat = nl? 1-Flex-ext lat xrays; 2-Obli xrays lumbosacral spine 
3-Single photon emission computed tomography (SPECT) 4-Indium-labeled bone scan; 5-Ultrasound
What additional dx test is most sensitive to dx pediatric spondylolysis when AP & lat = nl? 1-Flex-ext lat xrays; 2-Obli xrays lumbosacral spine
3-Single photon emission computed tomography (SPECT) 4-Indium-labeled bone scan; 5-Ultrasound
AP & lat, = demonstrate 80% of defects, oblique= demonstrate 15% of defects. If no lesion is seen on plain xrays, SPECT can be considered as a dx study. MRI for demonstrating normality of the pars, but high false (+) rate for dx of pars defects.Ans3
AP & lat, = demonstrate 80% of defects, oblique= demonstrate 15% of defects. If no lesion is seen on plain xrays, SPECT can be considered as a dx study. MRI for demonstrating normality of the pars, but high false (+) rate for dx of pars defects.Ans3
35yo F s/p MVA, W/u reveals open R fem fx, & neck pain. CT C spine shows R sided C6/7 facet dislocation. Which of the following images is most representative of this injury?
35yo F s/p MVA, W/u reveals open R fem fx, & neck pain. CT C spine shows R sided C6/7 facet dislocation. Which of the following images is most representative of this injury? (nl in picture)
"hamburger bun" sign of nl facet jnts & R "reverse hamburger bun" sign dx of facet dislctn. NOT Left sided! flex-distrctn pos structures are disrupted, NOT ant structures therefore ant plating BAD, YES pos techniques=triple-wire, sublaminar wiring...
R "reverse hamburger bun" sign = facet dislctn on R. , flex-distrctn pos structures are disrupted, NOT ant structures therefore ant plating BAD, YES pos techniques=triple-wire, sublaminar wiring, pos hook plate stabilzn, R & L"hamburger bun" sign = nl facet jnts.
awake & cooperative pt presents ER w/ the injury CT scan Fig A. Prior to the CT had an ASIA E. After CT  he ASIA D. What is 1st step in managt? 1-MRI; 2-Immediate CR w/ cerv tx; 3-Immediate ant ORIF/S; 4-Spinal dose steroids; 5-Cer immobilization,...
awake & cooperative pt presents ER w/ the injury CT scan Fig A. Prior to the CT had an ASIA E. After CT he ASIA D. What is 1st step in managt? 1-MRI; 2-Immediate CR w/ cerv tx; 3-Immediate ant ORIF/S; 4-Spinal dose steroids; 5-Cer immobilization, obser, serial neurologic exams
Dx=b/l C5-6 facet dislocation. B/c pt is alert, coop & sober, next step =-CR w/ cranial tx while the pt is awake. THEN MRI. ASIA IS D =motor func below neuro level, but > 1/2 mus below neuro level weak but w/ mus grade > 3.
Dx=b/l C5-6 facet dislocation, b/c pt is alert, coop & sober, next step =CR w/ cranial tx while the pt is awake. THEN MRI. ASIA IS D is a change and must be corrected emergently.Ans2
young boy is MVA & c/o  neck pain. CT is (-) for fx. Based on the presence of the ossification center in Fig A, what is the most likely age bracket of this pt? 1:< 1 yr; 2:1-3 yrs; 3:3-6 yrs; 4:8-10 yrs; 5: >12 yrs
young boy is MVA & c/o neck pain. CT is (-) for fx. Based on the presence of the ossification center in Fig A, what is the most likely age bracket of this pt? 1:< 1 yr; 2:1-3 yrs; 3:3-6 yrs; 4:8-10 yrs; 5: >12 yrs
scan= fused basilar synchondrosis w/ a C2 secondary ossification center that is NOT yet fused. Therefore pt is most likely 8-10 yrs of age.(basilar) synchondrosis does not fuse until ~6 yrs,  secondary ossification center appears around age 3 & fu...
scan= fused basilar synchondrosis w/ a C2 secondary ossification center that is NOT yet fused. Therefore pt is most likely 8-10 yrs of age.(basilar) synchondrosis does not fuse until ~6 yrs, secondary ossification center appears around age 3 & fuses w/ the odontoid around 12 yr.Ans4
67yo M smoker s/p MVA c/o neck pain, neuro exam nl. Fig A. pt evaluated & surg Tx recomm. pt left AMA. 7 mths later he returns w/ continued neck pain. current neuro exam =no deficits. A current CT scan and MRI is performed Figure. What is the most...
67yo M smoker s/p MVA c/o neck pain, neuro exam nl. Fig A. pt evaluated & surg Tx recomm. pt left AMA. 7 mths later he returns w/ continued neck pain. current neuro exam =no deficits. A current CT scan and MRI is performed Figure. What is the most appropriate tx?
1-PT & NSAIDS; 2-Hard Cer Orthosis; 3-Halo Immob; 4-Ant screw osteosynthesis; 5 Pos C1-C2 fusn::: Type 2 odontoid fx w/nonunion, now Tx= pos C1-C2 fusn, bc/inc risk of nonunion 2 ^ poor blood supply, pts w/ risk factors for nonunion, surgical tx i...
1-PT & NSAIDS; 2-Hard Cer Orthosis; 3-Halo Immob; 4-Ant screw osteosynthesis; 5 Pos C1-C2 fusn::: Type 2 odontoid fx w/nonunion, now Tx= pos C1-C2 fusn, bc/inc risk of nonunion 2 ^ poor blood supply, pts w/ risk factors for nonunion, surgical tx is recomm.Ans5
which fx patterns of dens is@ >'t risk for nonunion with nonop tx? 1-Type 2 Odontoid fx w/ slight pos angulation; 2-Type 2 Odontoid fx w/ pos displac & angulation; 3-Type 2 Odontoid fx w/ slight ant displacement; 4-Type 3 Odontoid fx w/ distractio...
which fx patterns of dens is@ >'t risk for nonunion with nonop tx? 1-Type 2 Odontoid fx w/ slight pos angulation; 2-Type 2 Odontoid fx w/ pos displac & angulation; 3-Type 2 Odontoid fx w/ slight ant displacement; 4-Type 3 Odontoid fx w/ distraction but no angulation or ant/pos displac; 5-Type 2 Odontoid fx w/ ant displac
fx are @ risk for nonunion 2^ watershed blood supply at this location. Inc fx displac, pos displac, incrd angulation are all risk factors for nonunion.Type 1=cervical orthosis. Type 2 = halo or operative. Type 3= halo, cervical orthosis, or surger...
fx are @ risk for nonunion 2^ watershed blood supply at this location. Inc fx displac, pos displac, incrd angulation are all risk factors for nonunion.Type 1=cervical orthosis. Type 2 = halo or operative. Type 3= halo, cervical orthosis, or surgery.Ans2
37yo M s/p motorcycle accident, neuro intact. CT scan Fig A. What is the most appropriate managt? 1-Pos C1-C2 fusn; 2-Ant odontoid screw fix 3-  Transoral ant odontoid resec; 4-Cer immob x 6-8 wk external orthosis; 5-Tx soft C orthosis x 2 wks the...
37yo M s/p motorcycle accident, neuro intact. CT scan Fig A. What is the most appropriate managt? 1-Pos C1-C2 fusn; 2-Ant odontoid screw fix 3- Transoral ant odontoid resec; 4-Cer immob x 6-8 wk external orthosis; 5-Tx soft C orthosis x 2 wks then ROM exercises
Type III odontoid fx. Cervical immobilization in a hard external orthosis is  best tx. NOT Ant odontoid screw fix is a surgical tx in Type II fxs w/ oblique fx pattern that is perpendicular to the path of the screw.Ans4
Type III odontoid fx. Cervical immobilization in a hard external orthosis is best tx. NOT Ant odontoid screw fix is a surgical tx in Type II fxs w/ oblique fx pattern that is perpendicular to the path of the screw.Ans4
describe pain pattern, numbness, motor weakness, screening exam, reflexes for L4, L5 S1
describe pain pattern, numbness, motor weakness, screening exam, reflexes for L4, L5 S1
numbness,  motor weakness, screen exam, reflex
L4
L5 
S1
numbness, motor weakness, screen exam, reflex
L3
L4
L5
S1