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CCOC 2 > CCOC dag 2 > Flashcards

CCOC dag 2 Flashcards

1
Q
  1. A 50 year old lady suffer from back pain who
    worsens in extension. The best therapy is
  2. extension based therapy
  3. flexion based therapy
  4. core strengthening
  5. aerobic training
  6. spine surgery.
A
  1. flexion based therapy
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2
Q
  1. A 60 year old farmer suffers from low back pain. MRI
    show black disc on several levels. The most important
    pain generator of low back pain is believed to be
  2. facet joints
  3. discogenic
  4. sacro iliac joint
  5. nerve roots
  6. muscle thigtness
A

.

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3
Q
  1. A 65 year old pensionado suffers from heavy midline back pain, X ray shows a severe facet joint artritis. The following is CORRECT about facet joint innervation
  2. facet joints are innervated by the medial branch of
    the dorsal ramus after it exits the neuroforamen
    above and at the level of the facet
  3. Facet joints are innervated by the lateral branch of
    the dorsal ramus after it exits the neuroforamen above and at the level of the facet
  4. Facet joints are not innervated
  5. Facet joints are innervated by the medial branch
    of the dorsal ramus after it exits the neuroforamen below the level of the facet
  6. Facet joints are innervated by the medial branch
    of the dorsal ramus after it exits the neuroforamen above and at the level of the facet
A
  1. Facet joints are innervated by the medial branch

of the dorsal ramus after it exits the neuroforamen above and at the level of the facet

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4
Q
  1. The use of an EMG in the diagnosis of myelopathy is
  2. positive only if ventral gray matter containing α motor neurons is affected
  3. to evaluate the motor unit at rest for spontaneous muscle activity
  4. positive by the abcence of fasciculations indicating upper motor neuron disease
  5. to test pain fibers
  6. positive when it differs from a polyradicular picture
A
  1. positive only if ventral gray matter containing α motor neurons is affected
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5
Q
  1. In individuals older than 60 years of age
  2. 41% will have abnormal MRI scans
  3. 21% will have herniated discs
  4. abnormal findings are not present in almost all people older than age 60 years
  5. 30% will have osteoporotic fractures
  6. low back pain is the leading cause of disability
A
  1. 21% will have herniated discs
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6
Q
  1. A 45 year old worker suffers from a throracic disc
    herniation at level T8-T9 Thoracic disc herniation (TDH)
  2. represent 10%-20% of cases of symptomatic herniated discs
  3. most occur in the caudal third of the thoracic spine
  4. more men than women are affected
  5. mostly individuals from 20-30 years of age are affected
  6. central herniations are easier to acces via a posterior approach
A
  1. most occur in the caudal third of the thoracic spine
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7
Q
  1. A 53-year-old female complained of progressive radiating pain into her both legs with mild low back pain. Her walking distance was reduced to 100 m, after which she had to stop and lean forward or sit down. Physical
    examination and MRI illustrated spinal stenosis at L4/5.
    Which of the following answers is true
  2. when the spine is in flexion the spinal canal
    diameter diminishes
  3. the symptoms usally start proximally and
    progress distally
  4. in most patient with lumbar stenosis
    weakness, numbness and reflex abnormalities occur
  5. laminectomy with fusion is the golden
    standard in surgery
A
  1. the symptoms usally start proximally and

progress distally

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8
Q
  1. Mostly acute low back pain disapears within 6 weeks.
    Although its mostly self-limiting a clinician should always
    maintain an awareness of red flags that signify serious
    conditions.which of the following is NOT a red flag sign?
  2. night pain or pain at rest
  3. persistent fever
  4. urinary incontinence or retention
  5. saddle anesthesia
  6. ability to walk for three hours
A
  1. ability to walk for three hours
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9
Q
  1. A ‘vacuum disk’ seen on conventional radiograms of
    CT scans of lumbar spine is:
  2. A sign of degenerative disk
  3. A sign of active infection in the disk space
  4. Should be examined with diskogram and cultures to rule out infection
  5. Pathognomonic of spinal tuberculosis
  6. Is associated with a psoas abscess
A
  1. A sign of degenerative disk
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10
Q
  1. A 71 years-old female is admitted to the hospital with spontaneous acute and severe back pain. Her CRP and ESR are elevated and the MRI scan is consistent with the diagnosis of diskitis L3-L4. In her medical history only a successfully treated Graves disease with normalized thyroid levels 30 years ago. She uses no medications and did not undergo a medical or surgical intervention recently. Which of the following conditions should be ruled out as a source of diskitis?
  2. Rheumatoid arthritis
  3. Thyroid cancer
  4. Endocarditis
  5. Spinal stenosis
  6. COPD
A
  1. Endocarditis
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11
Q
  1. In which of the following conditions is there an
    absolute contraindication to the use of spinal implants?
  2. Pyogenic diskitis with MRSA
  3. Spinal tuberculosis
  4. Epidural abscess with e. coli
  5. Fungal infection of the vertebral body
  6. None of the above
A
  1. None of the above
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12
Q
  1. Which of the following statements about epidural
    infections is false?
  2. Epidural abscesses should always be drained surgically
  3. The majority of epidural infections are caused by s. aereus
  4. Epidural infections may cause neurologic deficits
  5. Epidural abscess can result from extension of vertebral osteomyelitis or diskitis
  6. Epidural abscess can also be caused by a
    granulomatous infection
A
  1. Epidural abscesses should always be drained surgically
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13
Q
  1. The most common reason for missing a spinal
    fracture is:
  2. Inadequate radiologic examination
  3. Multiple extremity injuries
  4. Sedation of the patient at the site of trauma
  5. Intoxication with alcohol or drugs
  6. Lack of MRI facilities at the initial hospital
A
  1. Inadequate radiologic examination
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14
Q
  1. A 75 year-old man known with DM Type II is presented at the ER with back pain after a fall at home from standing height. Neurologic exam is normal. On
    CR of cervical, thoracic and lumbar spine no fractures are seen. Extensive bone bridges between multiple vertebrae are noticed at the cervical, thoracic and
    thoracolumbar junction. What is the proper next step?
  2. Analgesics and outpatient control in one week
  3. A Jewett brace and proper analgesics and follow up by the GP
  4. Admission to the hospital for clinical mobilization
  5. CT or MRI of the whole spine to rule out spinal fracture
  6. Appointment for osteoporosis screening with DEXA scan
A
  1. CT or MRI of the whole spine to rule out spinal fracture
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15
Q
  1. Type A injuries in subaxial cervical and
    thoracolumbar spine:
  2. Are always stable injury patterns
  3. Never cause spinal cord injury
  4. Are a cause of severe acute mechanical instability
  5. Imply intact posterior tension band
  6. Are associated with AIS-A functional
    outcomes
A
  1. Imply intact posterior tension band
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16
Q
  1. Which of the following statements about the
    compression fractures of C1 (atlas) is false?
  2. Majority can be treated conservatively
  3. About 10% of all cervical injuries
  4. Cause frequently neurologic injury
  5. In almost half of the cases there is a concomitant C2 fracture
  6. Can be unstable if transverse ligament is injured
A

.

17
Q
  1. Concerning osteoporosis of the spine the bone
    mineral density (BMD), which of the following
    statement is FALSE:
  2. BMD decrease with age
  3. BMD peaks between 25 and 30 years of age
  4. BMD declines 6% per year in women during the first postmenopausal decade
  5. BMD correlates strongly with bone strength
  6. BMD below 2.5sd the mean young adult is defined osteoporosis (WHO)
A

.

18
Q
  1. Osteoporotic spinal fracture is associated with?
    Which of the following statements is FALSE:
  2. Declines in predicted forced vital capacity
  3. Prior compression fracture
  4. Thinned cortices
  5. 2 – years mortality in these patients is 5 times that of the unaffected population
  6. Reduced BMD
A
  1. 2 – years mortality in these patients is 5 times that of the unaffected population
19
Q
  1. The spine is a frequent site of bone tumors. In daily practice it can be difficult to distinguish an osteoporotic spine lesion from spinal tumor. Specific diagnostic characteristics can be more common in spinal tumors than in osteoporotic fractures. Which of the following statements is FALSE
  2. Blastic or lytic apprearance
  3. Cortical involvement is less discrete
  4. Pedicular involvement
  5. Soft-tissue masses
  6. Below T5 level
A
  1. Below T5 level
20
Q
  1. A 70 year old women with spontaneous and continuous thoracic pain for 4 months without neurological deficit. No symptoms of fever or failure to thrive. Lab: BSE 80 mm/u CRP 24u leucocyts 9.5 10*9. A MRI and Xray were performed (see figure 1 and 2): multiple bone lesions lesion at the vertebral body of
    th10,11,12. The radiological diagnosis is most likely:
  2. Multiple Myeloma
  3. Osteoporosis
  4. Chronic Osteomyelitis
  5. Fibrous dysplasia
  6. Osteoartritis
A
  1. Multiple Myeloma
21
Q
  1. Most frequently a C8 radiculopathy is caused by…..
  2. a contained herniated disc
  3. an extruded herniated disc
  4. nerve root inflammation
  5. brachial plexus problems
  6. osteophytes at the end-plate
A
  1. osteophytes at the end-plate
22
Q
  1. Which of the following myelopathy signs doesn’t belong
    to a cervical spondylotic myelopathy (CSM)?
  2. Babinski Reflex
  3. Absent Knee Tendon Reflex
  4. Spastic Walking Pattern
  5. Tetraplegia
  6. Paraplegia
A
  1. Absent Knee Tendon Reflex
23
Q
  1. The main physiological causative mechanism spinal cord compression leading to cervical spondylotic myelopathy (CSM) is…
  2. A cervical herniated disc
  3. Collapsed discs
  4. Arthrosis of facet joints
  5. Flaval ligament hypertrophy
  6. All of the above
A
  1. All of the above
24
Q
  1. The standard surgical method for most patients with
    cervical spondylotic myelopathy is…
  2. ACDF
  3. Multi-level ACDF
  4. Multilevel ACDF + plate/screw fixation
  5. Cervical Laminectomy
  6. Cervical Laminectomy + lateral mass fixation
A
  1. Cervical Laminectomy
25
Q
  1. Adolescent idiopathic scoliosis: treatment
  2. Treatment by brace is obsolete
  3. Brace treatment aims to halt progression of the curve
  4. Surgical stabilisation should be delayed as long as possible, at least to the end of growth, to allow the spine to grow
  5. An instrumented fusion wit a Harrington rod still forms the golden standard
  6. The current standard of surgical care includes the wake up test to detect neurologic injury
A
  1. Brace treatment aims to halt progression of the curve
26
Q
  1. Congenital scoliosis
  2. Has a polygenetic inheritance
  3. Is associated with congenital heart defects in 10% of patients
  4. Failure of formation leads to a benign form of scoliosis
  5. Failure of segmentation leads to a scoliosis with the convexity on the opposite side to the segmentation
    defect
  6. Treatment by brace is mildly effective
A
  1. Failure of segmentation leads to a scoliosis with the convexity on the opposite side to the segmentation
    defect
27
Q
  1. Spondylolysis and spondylolisthesis in children

(

A
  1. The incidence is 5-10%
28
Q
  1. Operative treatment (instrumented fusion) of adult
    de novo degenerative scoliosis
  2. Osteoporosis does not play a significant role in the operative management
  3. Surgery is rarely effective in improving Quality of Life
  4. Late complications of surgery are rare
  5. Should be aimed at improving the sagital balance more than the coronal balance
  6. Should not include fusion to the sacrum/pelvis
A
  1. Should be aimed at improving the sagital balance more than the coronal balance
29
Q
  1. A 65-years old female patient with seropositive rheumatoid arthritis is planned for total hip arthroplasty (THA) under general anaesthesia. Lateral flexion-extension radiographs of the asymptomatic cervical spine are considered to assess:
  2. Atlanto-axial subluxation
  3. Cranial settling
  4. Subaxial subluxation
  5. A combination of A,B,C
  6. Radiographs of the cervocal spine are not necessary in THA surgery
A
  1. A combination of A,B,C
30
Q
  1. A 45 year-old man with Ankylosing Spondylitis presents with progressive back pain without neurological deficit. Plain radiographs show a discovertebral lesion T10-T11. The diagnostic and treatment policy includes:
  2. Spinal instrumentation and fusion, biopsy and culture
  3. Spinal instrumentation and fusion, no biopsy, no culture
  4. Biopsy, culture and antibiotic treatment
  5. Biopsy, culture and plaster immobilisation
  6. Plaster immobilisation
A

.

31
Q
  1. A patient with alcohol abuse is presented at the A&E department with only minor complains of his cervical spine after a fall from a chair. AP and lateral radiographs of the cervical spine does not shows any fractures. The next step in the assessment or treatment is:
  2. Sent him home
  3. Clinical observation
  4. Philadelphia collar
  5. Additional CT imaging
  6. Additional MRI
A
  1. Additional CT imaging
32
Q
  1. Radiological diagnostic criteria of a patient with
    Diffuse idiopathic skeletal hyperostosis (DISH) are.
    Which statement is wrong?
  2. SI joint erosions/fusion
  3. Anterolateral flowing calcification
  4. Anterolateral ossification > 4 vertebral bodies
  5. Preservation of intervertebral disc height
  6. Absence of degenerative disc disease
A
  1. SI joint erosions/fusion

CCOC 2 (5 decks)

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