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12 Cards in this Set
- Front
- Back
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
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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;
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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
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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?
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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
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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
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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
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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
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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)
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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.
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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
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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
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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
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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
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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?
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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
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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
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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
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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
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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
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describe pain pattern, numbness, motor weakness, screening exam, reflexes for L4, L5 S1
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numbness, motor weakness, screen exam, reflex
L3 L4 L5 S1 |