In this patient, which symptom is least likely to be present

By Shane Knight,2014-06-19 06:34
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In this patient, which symptom is least likely to be present

In this patient, which symptom is least likely to be present:

     ; Back pain

    ; Chronic spinal instability Correct, This patient shows ossification of the anterior and posterior

    longitudinal ligaments. This would be seen in a patient who had ankylosing spondylitis and

    therefore would have back pain, peripheral joint pain, may have iritis and would certainly have

    stiffness of the spine. He is most unlikely to have chronic spinal instability. ; Peripheral joint pain

    ; Iritis

    ; Stiffness of the spine

The AP view of this lumbo-sacral spine is:

     ; Normal

    ; Shows a spondylo-listhesis

    ; Shows a spina bifida occulta

    ; Shows a lumbarised first sacral segment Correct, This patient shows a transitional vertebrae at

    the lower lumbar spine. The transition in this x-ray is that S1 has become a lumbar vertebrae by

    virtue of the fact there is a disc space between what would now be termed L6 and S1. This is not

    an uncommon radiological finding and it is associated with an increased incidence of low back


    ; Shows a sacralised fifth lumbar segment

    This woman has a fixed Thoracic Kyphosis measuring 60 degrees. Which one of the following would you NOT consider in your differential diagnosis?

     ; Ankylosing Spondylitis

    ; Spondylolisthesis Correct, Sponylolisthesis does not result in a fixed kyphosis.

    ; Hemivertebra

    ; Unsegmented bar

    ; Scheuermann's disease

This x-ray:

     ; Is a computerised axial tomogram of the foramen magnum

    ; Shows central displacement of the odontoid peg Correct, This computerised tomogram shows a

    section through the atlas. The shape of the vertebra is typical and you can see the small lateral

    foraminae for the vertebral vessels. The opacity in the middle of the cord is that of the odontoid

    process and is abnormal in its position. This is in fact a central dislocation of the odontoid

    caused by rheumatoid. There is an obvious major risk of cord damage in this patient. An os

    odontoideum occurs when the tip of the odontoid process fails to fuse with the rest of the axis. In

    children it can be mistaken for a fracture of the odontoid process. However, the position of such

    an anomaly is normal. Therefore it should be within 2 mm of the anterior border of the atlas. It is

    never displaced centrally.

    ; Is a normal appearance of the atlas

    ; Is a normal appearance of the axis

    ; Shows an undisplaced os odontoideum

This man has non mechanical back pain. The most likely diagnosis is:

     ; Spinal infection

    ; Pagets disease

    ; Spinal neoplasm

    ; Sacro-ileitis Correct, The only obvious change on this radiograph is the obliteration of the sacro-

    iliac joints. Both non specific sacro-ileitis and ankylosing spondylitis are causes of non

    mechanical back pain, the former occurring more commonly in women and the latter in men. All

    the pedicles and vertebral bodies as well as the body of the sacrum are intact and therefore there

    is no evidence of either tumour or infection. Fibrositis is a meaningless term and has no specific

    radiological features.

    ; Fibrositis

An x-ray of this patient's lumbar spine would most likely demonstrate:

     ; A scoliosis

    ; A Spondylolisthesis Correct, The exaggerated lumbar lordosis seen here is a typical example of

    the deformity which is associated with a severe spondylolisthesis. You can also see the step that

    occurs in the lower lumbar spine due to forward slipping of one vertebra on the one below. Other

    associated features with this degree of listhesis would be the so called heart shaped buttocks,

    abdominal crease, tight hamstrings and a waddling type gait.

    ; No abnormality

    ; Sacral agenesis

    ; A retrolisthesis

This patient presents with mechanical back pain. The x-ray demonstrates:

     ; A retrolisthesis of L5 on S1

    ; A spondylolysis of L5 Correct, This patient has a spondylolysis of the pars interarticularis

    between L5 and S1. There is no displacement of the vertebral body and therefore there is no

    spondylolisthesis. There is a suggestion of a posterior displacement of the vertebral body of L4

    and therefore this could be a retrolisthesis of L4 and L5. Scheuermann's disease is a

    fragmentation of the vertebral end plates and is not shown here. A spina bifida occulta shows up

    by defect in the lamina. The lamina is not seen in the lateral projection. ; A scoliosis

    ; Scheuermann's disease

    ; A spina bifida occulta

Which one of the following is correct regarding this patient?

     ; She must have a mobile scoliosis

    ; She can expect her spinal deformity to remain corrected when she is instructed to discontinue wearing

    the brace

    ; She can expect relapse towards the original deformity after discontinuation of the brace.Correct,

    This girl is being treated for her scoliosis with a Milwaukee brace. The object of this brace is to

    prevent the deterioration of the scoliosis. It does not correct the scoliosis in its own right. It is

    applied early in the development of the deformity and in successful cases is kept on until skeletal

    maturity when progress of the deformity is going to be arrested. On removal of the brace, there is

    a tendency to go back to the level of deformity the patient had initially. The scoliosis does not

    have to be mobile although the results are better if it is. It is most effective with the smaller

    degrees of deformity and large curves are often impossible to hold with this brace. The normal

    routine is to wear it all the time, taking it off only for relatively short periods. ; Her spinal deformity must be greater than 50 degrees scoliosis to warrant its use ; The normal routine of use is to wear it by day and leave it off by night

This man

     ; Is normal

    ; Has a hyperlordosis Correct, This man shows an exaggerated lumbar lordosis and a small

    kyphosis. The whole spinal configuration is secondary to the large abdomen which is pulling the

    spine forward. This is the XXXX pregnancy. The same spinal configuration occurs in women for

    other reasons.

    ; Has a fixed flexion deformity of the hip

    ; Has achondroplasia

    ; Has gynaecomastia

These lumps are most likely associated with:

     ; Ankylosing spondylitis

    ; Rheumatoid arthritis Correct, These lumps are most likely associated with rheumatoid arthritis.

    These are typical rheumatoid nodules commonly seen over the subcutaneous borders of the

    ulnar and also often seen in the fingers and adjacent to the flexor tendons of patients with

    rheumatoid arthritis. These lumps are associated with sero positive rheumatoid arthritis and

    usually indciate a fairly active stage of the disease. Ankylosing spondylitis, psoriatic arthritis and

    Reiter's syndrome are all sero negative polyarthridities and are not associated with nodules. The

    only nodules that osteoarthritic patients develop are Heberden's nodes around the distal inter-

    phalangeal joints and these are simply osteophytes.

    ; Psoriatic arthritis

    ; Reiter's syndrome

    ; Osteoarthritis

The abnormality at the L3/4 disc space is most likely to be:

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