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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
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*
Radiographic sign of reversible dysfunction
Solid and wavy
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