Download Anatomy back forum 2010

BACK FORUM 2010
1. Describe the physical presentation of a patient with spina bifida occulta. Describe the
results from a CT scan of the vertebral column from a patient with spina bifida occulta at L4.
a. You would notice atleast one malformed vertebrae. Occulta just involves the
bone arch. Mostly asymptomatic
b. Just that the L4 vertebrae is malformed. Spinal cord should be intact.
2. What spinal nerve would be affected with a posterior herniation of an intervertebral disc
C6-7-? L4-L5?
a. C7 nerve would be affected
b. L5 nerve would be affected
3. A patient presents with spinal stenosis. What are possible etiologies?
a. Osteophytes are a possible cause that can narrow the intervertebral foraman
which can compress and narrow the area that the spinal nerves run through
b. Hypertrophy of ligamentum flavum, or posterior longitudinal
c. Dural tumors can put pressure and narrow vertebral canal.
d. Arthritis, inflammation of the vertebral discs.
e. If plane synovial joints can be inflamed and cause stenosis
4. From what view is the “Scotty Dog” best observed? What are the constituent parts? What
part is most likely fractured in spondylolisthesis?
a. Scotty dog is best observed by an oblique radiograph
b. It is made up of the superior articular process, costal process, and
parsinterarticularis
c. The parsinteroticularis
5. Describe the anatomy that makes cervical dislocation possible.
a. The synovial joint between the vertebrae can allow for sliding of the vertebrae
and then the vertebrae are locked into this dislocated position due to the
spinous process.
b. All about the articular processes and articular facets.
c. Very difficult to do this in the thoracic region b/c their articular facets are
vertical. Lumbar articular facets are in parasagittal plane.
6. What is a Hangman’s fracture? How does it occur? What are the usual consequences?
a. It is when you fracture both pedicles of C2 or parsinterarticularis
b. It can occur when you experience severe hyperextension (like being hanged)
c. Paralysis or death? May even have paralysis from C2 down.
7. What is a Jefferson fracture? How does it occur? What are the usual consequences?
a. A bone fracture in the first vertebrae (atlas). Usually a four part break in the
anterior and posterior arch.
b. Can be caused by a large load of force on top of the head or hitting the top of
your head real hard to compress your vertebrae. (diving and hitting bottom)
c. Pain in the neck, possibly neurological problems. It is possible that the spinal
cord can be injured resulting in loss of motor control for breathing.
8. Describe the expected physical examination findings in a patient with injury to the spinal
accessory nerve on the left.
a. Innervates trapezius. problems with shrugging shoulders. May also have
problems rotating scapula. May not be able to put arm above 90 degrees
(abduction). Problems with retraction of the scapula.
9. A 36-year-old female with neck pain. Physical examination reveals (on the left) a band of
tight, ropey muscle extending from the transverse processes of T1-6 to about the level of
the inferior nuchal line. What muscle is most likely exhibiting somatic dysfunction?
a. The semispinalis muscles
10. What muscles can rotate the vertebral column?
a. Multifidus, erector spinae, rotatores, semispinalis. Splenous capitis and splenious
cervis. Inferior oblique.
11. An avulsion (broken off) fracture of the vertebral spines at T10 – L2 would affect what
muscles?
a. Multifidus, spinalis, serratius posterior inferior, latissimus dorsi, trapezius.
Iliocostalis lumborum
12. Draw the muscles comprising the suboccipital triangle!
a. Rectus capitis posterior minor, oblique capitis superior, oblique capitis inferior
b. Suboccipital triangle houses the vertebral artery and suboccipital nerve
13. Where does anesthesia injected into the sacral hiatus go?
a. If you put a needle into the hiatus, you’re in the epidural/extradural space which
houses the internal venous plexus, still outside the dura. So this is a way to do
anesthesia outside the dura.
14. Describe the anatomy of removing CSF from the lumbar cistern.
a. Have to put needle below L2. (we go between spinous processes and
ligamentum flavum)
b. Skin to fascia to fat to supraspinous ligament to interspinous ligament to
epidural space to epidural fat to dura mater to arachnoid mater then STOP!
15. Examination of a patient reveals fecal incontinence after suffering a vertebral compression
fracture that affect the sacral spinal cord. What vertebra is affected?
a. Most likely the L1 vertebrae
16. A patient presents with a skin rash on his trunk. The rash is restricted to a thin strip that
runs from posterior to anterior at about the level of the nipple. What is the diagnosis?
Explain the distribution of the rash.
a. It follows a Dermatome problem b/c the virus infects dorsal root ganglia and
follows their axons to the skin.
b. It is herpes zoster
17. Three patients present for follow-up physical examination. Predict the results:
a. A 34-year-old male with an avulsion of the posterior roots at C5-6
i. Sensory loss in those areas affected. Also loss of proprioreception but
muscle strength would be the same
b. A 56-year-old male with stenosis of the intervertebral foramina between C4-5 and C5-6.
c. Spinal nerves go through intervertebral foramin Possible numbness (sensory) in
that area or loss of motor function (motor) at that level (paralysis). Possible
difficulty breathing (cuz breathing nerves are at C3,4, and 5.
d. A 67-year-old male with injury to the anterior horn of his spinal cord at C5-6.
e. Motor loss but no sensory loss.
f. Anterior horn is where motor leaves.
g. Decreased reflexes and weakened muscles. Muscle atrophy.
h. When muscles lose their innervation, they fibrillations and fasculations
(twitching)