ࡱ> Z\YY e4bjbjWW f==e0]t$vvvvvvvv$$$$$$$$%'$vvvvv$.vvv...vzvv$v$.8.fb7!$$v:<~P >[$VOrthopedics Final 1991 answers not verified Questions 1-5 use the following answers if major nerve root involved is L3 if major nerve root involved is L4 if major nerve root involved is L5 if major nerve root involved is S1 Diminished ankle jerk S1 Weakness of big toe (first) dorsiflexion L5 Due to L4-5 disc lesion L5 Weakness in foot inversion L4 Weakness in foot eversion S1 In differentiating meniscal from patellar pain which pain pattern is most likely to increase doing DOWN steps? meniscal b. patellar c. neither In differentiating between meniscal and patellar pain patterns which has a more likely history of an acute twisting injury that doesnt hurt when sitting? meniscal b. patellar c. neither d. both One difference between osteitis condensans ilii and blastic mets to the sacrum is that the pain associated with the benign process usually doesnt occur at night while neoplastic pain is common at night. true b. false Although pelvic fractures make up only a small fraction of all skeletal fractures they are second only to skull fractures for morbidity. true b. false Because of the predominately major source of blood from the lateral epiphyseal arteries, adduction fractures of the femoral neck have a greater incidence of avascular necrosis of the head as compared with abduction fractures. true b. false A neuropathic spine, despite having destruction, disorganization and excess ossification is usually hypermobile. true b. false Osteitis pubis is almost always due to an infection spread from pevlic surgery, especially prostatectomy. true b. false A coxa-valgus hip deformity can result in a force greater than seven times body weight acting through the affected femoral head during walking. true b. false Osteoarthritis of the hip usually leads to a flexion, adduction and internal (??external) rotation deformity. true b. false Osteonecrosis of the femoral head is often bilateral and is more common in men. true b. false Which of the following are possible non-mechanical causes of low back pain. (multiple answers possible) prostatitis endometriosis large vowel carcinoma retroperitoneal lymphoma renal stones The #1 cause of disc calcification is: degenerative disc b. alkaptonuria c. ochronosis d. ankylosis and spondylitis e. gout Which of the following statements are true of spina bifida? may be a cause of Arnold-Chiari Syndrome defect occurs during the 21st to 29th day of fetal life dimpling, pigmentation and hypertrichosis may be seen over area of spine may be cause of spastic paralysis and foot deformities e. all of the above The critical zone of the spinal cord is where the canal space is smallest and the blood supply is least. Which one of the following is the critical zone? C1-C7 T1-T4 c. T4-T9 d. T10-L1 e. L2-L5 Which statements are true regarding adolescent kyphosis (Scheuermans disease)? x-rays show Schmorls nodes and anterior body wedging most common in lower T-spine if present examine for spondylolisthesis a and b e. all of the above Which of the following statements are true of ankylosing spondylitis (AS)? chin-on-chest deformity is due to C1-C2 dislocation 20 times more common in offspring of AS parents lower thoracic and upper lumbar first site of vertebral body involvement (begins T/L junction) b and c e. all of the above Which one of the following is not a likely cause of osteoporosis? adrenal cortex formone increase pituitary basophilic adenoma gastrointestinal malabsorption d. sex hormone increase e. inactivity A gibbus deformity of the spine is classically seen in: lymphosarcoma of the spine b. tuberculosis of the spine c. spina bifida occulta d. rheumatoid arthritis of spine e. ankylosing spondylitis The 45 year old veterinarian (D.V.M.) across the street comes in complaining of low back pain for 2 months. ON further questioning he admits to chills, headaches, and spiking fevers. Examination reveals splenomegaly. X-ray shows L2-L3 disc decreased with irregular adjacent vertebral end plates. TB test was negative. Two months later x-rays show L2-L3 bodies fused. He most likely has: fibrositis lymphoma c. brucellosis d. eosinophilic granuloma e. AIDS A ten year old girl present with a one month history of moderate back pain and fatigue. Examination reveals muscle spasm and tenderness of the L1 spinous. Xray reveals a wafer-thin L1 body with good disc spaces. The ESR was normal. The most likely cause is: tuberculosis brucellosis ankylosing spondylitis d. eosinophilic granuloma e. metastasis from Wilms tumor Which of the following looks identical to ankylosing spondylitis on spine radiographs? psoriatic arthritis Reiters disease Rheumatoid arthritis d. enteropathic arthritis e. none of the above Which of the following tumors are classically seen in the anterior portion (body) of the vertebra? (Know what is anterior (malignant) and posterior (benign except hemangioma) eosinophilic granuloma b. anuerysmal bone cyst c. hemangioma b and c e. a and c A 16 year old soccer star presents with pain in right groin and weakness in flexing his right thigh and flexing his right knee. X-ray shows irregularity of the ASIS. He most likely has: avulsion fracture of sartorius b. avulsion fracture of rectus femoris c. avulsion fracture of all the quadriceps d. avulsion fracture of hamstrings avulsion fracture of gracilis Which of the following findings require a more detailed workup and/or consultation in a patient with low back pain? signs/symptoms above L4 multiple root symptoms indolent progressive signs and symptoms presumed disc but with failure to improve e. all the above Which is the most common pelvic fracture? pubic rami (inferior ischial ramus??) b. Duverney (wing of illium) c. transverse sacrum fracture d. Malgaigne e. straddle fracture Radiographs are used to determine swelling of the capsules of the hips in such diseases as synovitis, infection and Legg-Calve-Perthes disease. The distance from the medial femoral head to Kohlers teardrop should be no greater than _____ and the difference between sides no greater than _____. 5 mm, 2mm b. 11 mm, 2 mm c. 1.1 inches, .2 inches d. 5 cm, 2 cm e. I missed that day and didnt read the book Which one of the following is not a typical finding in advanced osteoarthritis of the hip? cysts in acetabulum b. decreased subchondral bone (lucent subchondral region) c. decreased joint space d. large inderior medial osteophytes e. cysts in femoral head Which one of the following does not point toward a poor prognosis in Legg-Calves-Perthes disease? being a female b. age under 6 (8??) c. horizontal epiphyseal plate d. lateral subluxation of femoral head e. advanced when first diagnosed Which one of the following is the leading cause of secondary protrusio acetabuli? osteoarthritis tuberculosis Ricketts d. rheumatoid arthritis (in females) e. Pagets Which of the following is the joint most commonly affected by osteoarthritis? knee b. elbow c. hip shoulder e. ankle Osteochondritis dissecans of the knee is classically (most commonly) at the: medial aspect of lateral femoral condyle b. lateral aspect of medial femoral condyle c. medial aspect of medial femoral condyle d. lateral aspect of lateral femoral condyle ischial spine Osteoarthritis of the knee usually begins first at the: femoral patellar articulation b. medial femoral-tibial articulation c. lateral femoral-tibial articulation Which one of the following is a good rule for success? associate with criminals b. diagnosis before treatment c. fail state boards d. dont take state boards e. borrow 1 million dollars before age 30 Which one of the following is not associated with osteonecrosis of femoral head? sickle-cell anemia alcoholism c. hemophilia d. fractures of femoral neck e. gout Of the following, the most likely cause for a painful scoliosis in an adolescent is: giant cell tumor b. osteoid osteoma c. chondrosarcoma d. multiple myeloma e. hemangioendothelioma MATCHING slipped femoral capital epiphysis Frohlich type obesity Legg-Calve-Perthes disease peak age 6 years Congenital dysplasia of the hip more common in females Chondrolysis often follows slipped femoral capital epiphysis especially if manipulated Femoral torsion (anteversion) may be underlying cause of idiopathic osteoarthritis of hip Transient synovitis of hip - #1 cause of painful hip before age 10 MATCHING disc problem (classic) facet syndrome (classic) Positive SLR (sciatica) and Valsalva a. Scleratogenous pain pattern b. Accompanied by SI osteoarthritis b. Prefers to stand or lie down a. HAND WRITTEN NOTES Tumors Benign most common hemangioma (findings like a disc) blood tremor inside the book Malignant most common mets, pelvis and lumbar spine Bone forming posterior of spine Osteoma skull, pelvis Osteoid osteoma child with pain with scoliosis (??) Osteoblastoma Malignant need blood supply (flat bones ribs, skull, pelvis - , ends of big bones) Osteosarcoma kids - knee pain, rare but a killer; older Pagets, old fracture, old infection Cartilage tumor enchondroma most common in hand, can tell because it fractures Chondrosarcoma likes flat bones (pelvis) cartilage and bone ossified popcorn in pelvis looks like fibroma but not in soft tissue Cancer rates 31% lung breast colon pancreas Table 9-6 and 9-7 from book page 382 Lumbar root syndromes Root Dermatome Muscle Weakness Reflexes/Special Paresthesias Tests Affected L1 Back, over tro- None None Groin, after holding Chanter, groin posture, which causes pain L2 Back, front of Psoas, hip ad- None Occasionally front Thigh to knee ductors of thigh L3 Back, upper but- Psoas, quadriceps Knee jerk sluggish, Inner knee, anterior tock, front of - thigh wasting PKB positive, pain lower leg thigh and knee, on full SLR medial lower leg L4 Inner buttock, Tibialis anterior, SLR limited, neck- Medial aspect of outer thigh, inside extensor hallucis flexion pain, weak calf and ankle of leg, dorsum of knee jerk, side big toe flexion limited L5 Buttock, back and Extensor hallucis, SLR limited to one Lateral aspect of Side of thigh, lat- peroneals, gluteus side, neck-flexion leg, medial three eral aspect of leg, medius, ankle dor- pain, ankle jerk toes dorsum of foot, siflexors, ham- decreased, crossed- inner half of sole strings calf wast- leg raising-pain and 1st, 2nd and ing 3rd toes S1 Buttock, back of Calf and ham- SLR limited Lateral 2 toes, lat- thigh, and lower strings, wasting eral foot, lateral leg of gluteals, pero- leg to knee, plantar neals, plantar aspect of foot flexors S2 Same as S1 Same as S1 Same as S1 Lateral leg, knee, Except peroneals heel S3 Groin, inner thigh None None None to knee S4 Perineum, geni- Bladder, rectum None Saddle area, geni- tals, lower sacrum tals, anus, impo- tence Manipulation and traction are contraindicated if S4 or massive posterior displacement causes bilateral sciatic and S3 pain. PKB = prone knee bendings. 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