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X-ray 2 Mid term Dr. Kettner Decreased space is assoc. with? uncovertebral arthrosis rostral caudal sublaxation neurofibroma leg l;enght inequality Least likely to fuse after fracture ? scaphoid bone Increased retropharangeal space results from ? acute hematoma adjustment takes ? 0.5 seconds ALL ligament injury is from ? - hyper extension Hyperflexion injury injures the ? interspinous lig. & Lig. Flavum L4 with Lateral herniation ? -a positive toe walk (orhto test) With a C/S cord injury you see a ? -Positive babinski Wolf’s law is electrical and mechanical = ? - Biopotential Most common missed C/s fracture ? - Pillar fracture Instability of C/S = ? 3.5 mm translation and 11 degreesrotation M/C type of odontoid fracture is ? Type 2 Saddle distribution ? Cadia equina syndrome Syrinx in C/S produces? Shoulder pain complication of DJD is ? Rostral caudal migranes & 2 more answers Elbow fracture = ? Posterior fat pad elevation Most common disruption of the spinal laminar line is ? short C1 / C2 arch Most common complication of decreased disk degeneration ? Rostral caudal sublaxation Disc degeneration Lig. Laxity Bennet’s fracture is at ? Metacarpal M/C injury to an athlete is a ? Lig. Injury Sclerosis of foot ? Metacarpal (?) Complication of Paget’s is ? Osteo Arthritis Hip pain is ? Syphilis Posterior dislocation with radius fracture is ? Collie’s fracture Why take full spine x-rays ? Not patient education What does an adjustment do ? Stimlates opiate receptors (think answer was all of the above) These apparantley questionsthat some one wrote down after a test which were retyped in on 2/22/97. Not sure when or who they originated from. Good luck ! tab XR2MTSPKettner Order of search pattern (from top to bottom) Soft tissue Periosteum Cortex Medulla Joint capsule X-ray II Midterm Dr. Kettner Decreased space is associated with? Uncovertebral arthrosis Rostrocaudal caudal subluxation Neurofibroma Leg length inequality Least likely to fuse after fracture? Scaphoid bone Increased retropharangeal space results from ? Acute hematoma Adjustment takes? 0.5 seconds ALL ligament injury is from? Hyperextension Hyperflexion injury injures the: Interspinous ligament and ligamentum flavum L4 with Lateral herniation? A positive toe walk (orthopedic test) With a cervical spine cord injury you see a? Positive Babinski Sign Wolf’s Law is electrical and mechanical? Biopotential Most common missed cervical spine fracture? Pillar fracture Instability of cervical spine = 3.5 mm translation and 11 degrees of rotation Most common type of odontoid fracture is? Type 2 Saddle distribution? Cauda Equina syndrome Syrinx in cervical spine produces? Shoulder pain Complication of DJD is? Rostral caudal migraines and 2 more answers Elbow fracture? Posterior fat pad elevation Most common disruption of the spinal laminar line is? Short C1/C2 arch Most common complication of decreased disc degeneration? Rostral caudal subluxation Disc degeneration Ligamentous laxity Bennet’s fracture is at? Metacarpal Most common injury to an athlete is a? Ligamentous injury Sclerosis of foot? Metacarpal (?) Complication of Paget’s is? Osteoarthritis Hip pain is? Syphilis Posterior dislocation with radius fracture is? Colle’s fracture Why take full spine x-rays? Not patient education What does an adjustment do? Stimulates opiate receptors (think answer was all of the above) These apparently questions that some one wrote down after a test which were retyped in on 02/22/97. Not sure when or who they originated from. Matching Cartilage erosion Degenerative spondolisthesis and decreased joint space Periosteal stimulation Osteophyte Rostral caudal subluxation Disc thinning Hypercellularity Sclerosis Synovial intrusion Subchondral cyst Spondolysis Deformans Vertebral body osteophyte Osteoarthritis Decreased apophyseal joint DISH Ligamentous ossification, following ligamentous ossification Intervertebral Osteochondrosis Cartilage nodes and vacuum phenomenon Fragmentation Joint mice Disruption of the capsule Deformity Neuropathic Joints Diabetes Mellitus (main cause) What is the iatrogenic cause of Charcot’s joints? Steroids Earliest Radiographic sign of neuropathic joint is? Metatarsal fracture Radiographic features of neuropathic Debris Density Distention (The other 3D’s include destruction, dislocation, disorganization) Which are explanations of the articular changes in the neuropathic joint? Loss of joint sensitivity Traumatized joint Relation of ligaments Neuropathic joints secondary to diabetes mellitus occur in. Tarsals Neuropathic joints secondary syphilis occur in ? Hip Knee Spine Neuropathic joints secondary syringomyelia can occur ? Elbow (shoulder) wrist The criteria for the radiographic diagnosis of DISH include? Normal disc space Normal apophyseal. joints Which of the following can result nerve compression ? Central canal stenosis Lateral recess stenosis Neuroforaminal stenosis Facet hypertrophy Comminuted fractures include which of the following ? Y-fractures Crush fractures Of the following signs and symptoms which one of the following is most suspicious of a fracture? Deformity Cord compression AKA Myelopathy Central stenosis Lateral stenosis Neural foramina stenosis Coupling Reversal Radiographic sign of reversible dysfunction Periostitis as a result of arterial occlusion Solid and wavy Paget’s disease Thick cortex and increased trabeculae Osteomyelitis of the spine resembles Spondlolysis deformans Heterotrophic ossification can occur with Spinal cord injury* Myositis ossificans Traumatic dystrophic calcifications Athletic injuries Soft tissue calcification occurs in Hypercalcemia Gas in soft tissues are a result of Gangrene* Clostridim Perfrigens Distorted facial plane lines are a result of Infection* Tendonitis Fluid Infection Most common malignant tumor of the spine Metastatic carcinoma Most common benign neoplasia of the spine Hemangioma Most common primary malignancy of the spine Multiple myeloma A 3cm patch of calcification is present in the abdominal aorta. What study would be indicated for diagnosis? Ultrasound Pain in the lumbar spine associated with hypertrophy and subluxated superior articulating process is due to compression of the ? Sinovertebral nerve AKA Ford’s disc Facet Syndrome is due to compression of the? Posterior primary rami A whiplash patient in MVA which is least likely to show on x-ray ? Fracture of the neural arch Brace and transport to ER If patient has a dislocation Inflammatory arthropathy Must be included in the differential if ADI. > 5mm Reversible dysfunction Lumbar spinous to the convexity Instability 4.00mm of translation Lumbar spine lateral flexion translocation Stability Osteophytosis Lateral recess stenosis Which of the following factors affect the rate of fracture healing? Age nutrition Location Blood supply (All) Which of the following are causes of delayed union? Severe trauma Osteoporosis Distraction (All are causes of delayed union , comminution is not) Clinical presentation of dislocation includes? Crepitus Reduction in ROM Contour abnormality (All of the above is the answer) When a fracture heals with angulation deformity which of the following is present? Malunion Causes of dislocation include? Trauma Congenital Altered articular surface Muscle imbalance (PONY did not say) A compression fracture w/ more than two fragments is referred to as? Comminuted What is the mechanism of injury which will result in the spinous process being avulsed? Pony said flexion (might be extension would check this) Case study : A 61year old presents with pain in the posterior thigh (bilateral.) , with hyporeflexia in the lower extremities, numbness, and tingling into the posterior buttock, thighs down the back of the legs. You suspect cauda equina syndrome, but CT of L3-l5 is negative. The top of your differential diagnosis should include? Conus medularis syndrome Patient presents with a fracture of the base of the proximal head of the 5th metatarsal, it is? Jone’s fracture 45 year old patient with chronic RA suggest what nutritional supplement ? Antioxidants In order for anterolisthesis of L4/L5 to occur which of the following must be present? (Multiple answer) Spinal tumor Pars fracture Severe spine trauma Apophyseal joint degeneration You have a 24 year old who has known spondolytic spondolisthesis of 10%. What imaging modality will you employ, since you have been treating him for three weeks with no response? Traction/compression Your patient has been in an auto accident which of those listed below are the most likely zones for fracture of the cervical spine? C2 and C6 Pillar fracture most common at C6 Which is least likely about a massive midline herniation? Can cause pain, reduce reflexes, numbness Atrophy both of the calves Most commonly present at L4-L5 Recompression no later than 48 hours will prevent nerve root damage * (Should say decompression) Massive midline disc herniation is another way of describing what clinical diagnosis? Cauda Equina syndrome Which of the following is not Roentgen evidence of delayed non-union of the bone? Fragment ends are smoothing Motion between fragments Sclerosis of fragment ends Periosteal callus A perched facet in the cervical spine defines which of the following? The same as facet dislocation on kyphotic hyperangulation Unstable joints > 11 degrees Unstable joints 3.5 mm translation Usually ……bilateral at the same time (All of the above) X Ray MT - Dr. Kettner (“Old Pony” Retyped 02.22.97) L5 lesion of disc (or S1 nerve root syndrome) ? Decreased Achilles DTR Cannot toe walk (i.e. a positive toe walk test) Shawl distribution? Syrinx shoulders Bilateral parasthesia Adult ADI? = 3mm C5-C6 Neuropathy? Arm distribution Abdominal Aorta (probably aneurysm)? Ultrasound used to detect Runner’s leg hurts after 20 minutes? Stress fracture MRI Static magnetic field applied across patient’s body Causes alignment of H+ protons Good for evaluating spinal stenosis Most common C1-C2 instability? Os Odontoidium Most dangerous X-ray finding? Acute hematoma of the Retropharangeal Interspace Radiographic overlay? Penning Method Athletic injuries are most often? Ligamentous Myositis Ossificans? Most common in the quadriceps Calcification of muscle Central canal stenosis? Proliferation of bone around the facet joint From increased pressure on the posterior motor unit From degenerative process of osteoarthritis Cervical canal stenosis Compression of the cord Quadraparesis after trauma Congenital (if patient born with too large of a vertebral body) 7 % of the population 30-35 % football/rugby players affected (no neck) All segments are stenotic Cauda Equina syndrome Saddle distribution (bilateral) Incontinence Pain in the buttock Weak legs If you adjust class 3 (III) sprain? Dislocation Class III sprain most common in? Flexion Finger print in cervical spine? Flexion Interspinous gap Kyphosis Instability of C4-C5? Translation greater than 3.5mm What changes mechanical energy to electric energy? Pizoelectric (bipolar) Bennet’s fracture? Metacarpal Herniation in the cervical spine Myelopathy? UMNL Increased DTR Spastic paresis + Babinski Clonus Radiculopathy? LMNL Decreased DTR Decreased dermatomes Decreased myotomes Somatovisceral? Latency period Cord compression? Disc (especially T7-T9) Osteoporosis Apophyseal Joints/Costovertebral joints Normal disc Normal body Joint space narrowing and sclerosis Spondolysis Deformans Annulus fibrosis (most common site) Normal to slightly decreased disc Osteophytosis of vertebral body joint losing stability DISH Joints normal All 4 segments effected Normal disc Normal body Osteochondrosis Was all of the above Categories of DJD Abnormal concentration of force on normal articulation Normal concentration of force etc. (Couldn’t read this, but it is in action notes) Rostral Caudal Subluxtion Degenerative subluxation Disc thickens (keeps height) Disc not thin, it recedes into vertebral end plates so disc space IVF (does something) Superior facet of inferior vertebra, now higher in IVF Discogenic Spondlolysis? Narrowing of disc space DJD Retrolistesis and lateral listhesis (get with trauma) Anterolisthesis (from facet arthrosis) Stenosis (DJD) Ligamentous hypertrophy Anterolisthesis True / False True Reduction is the restoration of fracture fragments to their normal anatomical position The second phase of fracture healing is repair Greenstick fractures only occur in children Subluxation can be evaluated by clinical biomechanical or radiographic methods False Fractures of the appendicular skeleton are most likely to be missed Fixation of a fracture occurs prior to external fixation Necrotic tissue about the fracture site stimulates vaso constriction and plasma exudation The spinal compression fracture is a type of transverse fracture A dislocation is described by the next most distal articulation Fractures tend to have a greater degree of neurologic damage than dislocations XR2MTSPKettner Order of search pattern (from top to bottom) Soft tissue Periosteum Cortex X-ray II Midterm Dr. Kettner Decreased space is associated with? Uncovertebral arthrosis Rostrocaudal caudal subluxation Medulla Joint capsule Neurofibroma Leg length inequality Least likely to fuse after fracture? Scaphoid bone Increased retropharangeal space results from ? Acute hematoma Adjustment takes? 0.5 seconds ALL ligament injury is from? Hyperextension Hyperflexion injury injures the: Interspinous ligament and ligamentum flavum L4 with Lateral herniation? A positive toe walk (orthopedic test) With a cervical spine cord injury you see a? Positive Babinski Sign Wolf’s Law is electrical and mechanical? Biopotential Most common missed cervical spine fracture? Pillar fracture Instability of cervical spine = 3.5 mm translation and 11 degrees of rotation Most common type of odontoid fracture is? Type 2 Saddle distribution? Cauda Equina syndrome Syrinx in cervical spine produces? Shoulder pain Complication of DJD is? Rostral caudal migraines and 2 more answers Elbow fracture? Posterior fat pad elevation Most common disruption of the spinal laminar line is? Short C1/C2 arch Most common complication of decreased disc degeneration? Rostral caudal subluxation Disc degeneration Ligamentous laxity Bennet’s fracture is at? Metacarpal Most common injury to an athlete is a? Ligamentous injury Sclerosis of foot? Metacarpal (?) Complication of Paget’s is? Osteoarthritis Hip pain is? Syphilis Posterior dislocation with radius fracture is? Colle’s fracture Why take full spine x-rays? Not patient education What does an adjustment do? Stimulates opiate receptors (think answer was all of the above) These apparently questions that some one wrote down after a test which were retyped in on 02/22/97. Not sure when or who they originated from. Matching Cartilage erosion Degenerative spondolisthesis and decreased joint space Periosteal stimulation Osteophyte Rostral caudal subluxation Disc thinning Hypercellularity Sclerosis Synovial intrusion Subchondral cyst Spondolysis Deformans Vertebral body osteophyte Osteoarthritis Decreased apophyseal joint DISH Ligamentous ossification, following ligamentous ossification Intervertebral Osteochondrosis Cartilage nodes and vacuum phenomenon Fragmentation Joint mice Disruption of the capsule Deformity Neuropathic Joints Diabetes Mellitus (main cause) What is the iatrogenic cause of Charcot’s joints? Steroids Earliest Radiographic sign of neuropathic joint is? Metatarsal fracture Radiographic features of neuropathic Debris Density Distention (The other 3D’s include destruction, dislocation, disorganization) Which are explanations of the articular changes in the neuropathic joint? Loss of joint sensitivity Traumatized joint Relation of ligaments Neuropathic joints secondary to diabetes mellitus occur in. Neuropathic joints secondary syphilis occur in ? Hip Knee Spine Tarsals Neuropathic joints secondary syringomyelia can occur ? Elbow (shoulder) wrist The criteria for the radiographic diagnosis of DISH include? Normal disc space Normal apophyseal. joints Which of the following can result nerve compression ? Central canal stenosis Lateral recess stenosis Neuroforaminal stenosis Facet hypertrophy Comminuted fractures include which of the following ? Y-fractures Crush fractures Of the following signs and symptoms which one of the following is most suspicious of a fracture? Deformity Cord compression AKA Myelopathy Central stenosis Lateral stenosis Neural foramina stenosis Coupling Reversal Periostitis as a result of arterial occlusion Paget’s disease Thick cortex and increased trabeculae Osteomyelitis of the spine resembles Spondlolysis deformans Heterotrophic ossification can occur with Spinal cord injury* Myositis ossificans Traumatic dystrophic calcifications Athletic injuries Soft tissue calcification occurs in Hypercalcemia Gas in soft tissues are a result of Gangrene* Clostridim Perfrigens Distorted facial plane lines are a result of Infection* Tendonitis Fluid Infection Radiographic sign of reversible dysfunction Solid and wavy Most common malignant tumor of the spine Metastatic carcinoma Most common benign neoplasia of the spine Hemangioma Most common primary malignancy of the spine Multiple myeloma A 3cm patch of calcification is present in the abdominal aorta. What study would be indicated for diagnosis? Ultrasound Pain in the lumbar spine associated with hypertrophy and subluxated superior articulating process is due to compression of the ? Sinovertebral nerve AKA Ford’s disc Facet Syndrome is due to compression of the? Posterior primary rami A whiplash patient in MVA which is least likely to show on x-ray ? Fracture of the neural arch Brace and transport to ER If patient has a dislocation Inflammatory arthropathy Must be included in the differential if ADI. > 5mm Reversible dysfunction Lumbar spinous to the convexity Instability 4.00mm of translation Lumbar spine lateral flexion translocation Stability Osteophytosis Lateral recess stenosis Which of the following factors affect the rate of fracture healing? Age nutrition Location Blood supply (All) Which of the following are causes of delayed union? Severe trauma Osteoporosis Distraction (All are causes of delayed union , comminution is not) Clinical presentation of dislocation includes? Crepitus Reduction in ROM Contour abnormality (All of the above is the answer) When a fracture heals with angulation deformity which of the following is present? Malunion Causes of dislocation include? Trauma Congenital Altered articular surface Muscle imbalance (PONY did not say) A compression fracture w/ more than two fragments is referred to as? Comminuted What is the mechanism of injury which will result in the spinous process being avulsed? Pony said flexion (might be extension would check this) Case study : A 61year old presents with pain in the posterior thigh (bilateral.) , with hyporeflexia in the lower extremities, numbness, and tingling into the posterior buttock, thighs down the back of the legs. You suspect cauda equina syndrome, but CT of L3-l5 is negative. The top of your differential diagnosis should include? Conus medularis syndrome Patient presents with a fracture of the base of the proximal head of the 5 th metatarsal, it is? Jone’s fracture 45 year old patient with chronic RA suggest what nutritional supplement ? Antioxidants In order for anterolisthesis of L4/L5 to occur which of the following must be present? (Multiple answer) Spinal tumor Pars fracture Severe spine trauma Apophyseal joint degeneration You have a 24 year old who has known spondolytic spondolisthesis of 10%. What imaging modality will you employ, since you have been treating him for three weeks with no response? Traction/compression Your patient has been in an auto accident which of those listed below are the most likely zones for fracture of the cervical spine? C2 and C6 Pillar fracture most common at C6 Which is least likely about a massive midline herniation? Can cause pain, reduce reflexes, numbness Atrophy both of the calves Most commonly present at L4-L5 Recompression no later than 48 hours will prevent nerve root damage * (Should say decompression) Massive midline disc herniation is another way of describing what clinical diagnosis? Cauda Equina syndrome Which of the following is not Roentgen evidence of delayed non-union of the bone? Fragment ends are smoothing Motion between fragments Sclerosis of fragment ends Periosteal callus A perched facet in the cervical spine defines which of the following? The same as facet dislocation on kyphotic hyperangulation Unstable joints > 11 degrees Unstable joints 3.5 mm translation Usually ……bilateral at the same time (All of the above) X Ray MT - Dr. Kettner (“Old Pony” Retyped 02.22.97) L5 lesion of disc (or S1 nerve root syndrome) ? Decreased Achilles DTR Cannot toe walk (i.e. a positive toe walk test) Shawl distribution? Syrinx shoulders Bilateral parasthesia Adult ADI? = 3mm C5-C6 Neuropathy? Arm distribution Abdominal Aorta (probably aneurysm)? Ultrasound used to detect Runner’s leg hurts after 20 minutes? Stress fracture MRI Static magnetic field applied across patient’s body Causes alignment of H+ protons Good for evaluating spinal stenosis Most common C1-C2 instability? Os Odontoidium Most dangerous X-ray finding? Acute hematoma of the Retropharangeal Interspace Radiographic overlay? Penning Method Athletic injuries are most often? Ligamentous Myositis Ossificans? Most common in the quadriceps Calcification of muscle Central canal stenosis? Proliferation of bone around the facet joint From increased pressure on the posterior motor unit From degenerative process of osteoarthritis Cervical canal stenosis Compression of the cord Quadraparesis after trauma Congenital (if patient born with too large of a vertebral body) 7 % of the population 30-35 % football/rugby players affected (no neck) All segments are stenotic Cauda Equina syndrome Saddle distribution (bilateral) Incontinence Pain in the buttock Weak legs If you adjust class 3 (III) sprain? Dislocation Class III sprain most common in? Flexion Finger print in cervical spine? Flexion Interspinous gap Kyphosis Instability of C4-C5? Translation greater than 3.5mm What changes mechanical energy to electric energy? Pizoelectric (bipolar) Bennet’s fracture? Metacarpal Herniation in the cervical spine Myelopathy? UMNL Increased DTR Spastic paresis + Babinski Clonus Radiculopathy? LMNL Decreased DTR Decreased dermatomes Decreased myotomes Somatovisceral? Latency period Cord compression? Disc (especially T7-T9) Osteoporosis Apophyseal Joints/Costovertebral joints Normal disc Normal body Joint space narrowing and sclerosis Spondolysis Deformans Annulus fibrosis (most common site) Normal to slightly decreased disc Osteophytosis of vertebral body joint losing stability DISH Joints normal All 4 segments effected Normal disc Normal body Osteochondrosis Was all of the above Categories of DJD Abnormal concentration of force on normal articulation Normal concentration of force etc. (Couldn’t read this, but it is in action notes) Rostral Caudal Subluxtion Degenerative subluxation Disc thickens (keeps height) Disc not thin, it recedes into vertebral end plates so disc space IVF (does something) Superior facet of inferior vertebra, now higher in IVF Discogenic Spondlolysis? Narrowing of disc space DJD Retrolistesis and lateral listhesis (get with trauma) Anterolisthesis (from facet arthrosis) Stenosis (DJD) Ligamentous hypertrophy Anterolisthesis True / False True Reduction is the restoration of fracture fragments to their normal anatomical position The second phase of fracture healing is repair Greenstick fractures only occur in children Subluxation can be evaluated by clinical biomechanical or radiographic methods False Fractures of the appendicular skeleton are most likely to be missed Fixation of a fracture occurs prior to external fixation Necrotic tissue about the fracture site stimulates vaso constriction and plasma exudation The spinal compression fracture is a type of transverse fracture A dislocation is described by the next most distal articulation Fractures tend to have a greater degree of neurologic damage than dislocations
