In this patient, which symptom is least likely to be present:
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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:
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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
problems.
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?
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Ankylosing Spondylitis
Spondylolisthesis Correct, Sponylolisthesis does not result in a fixed kyphosis.
Hemivertebra
Unsegmented bar
Scheuermann's disease
This x-ray:
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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:
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Spinal infection
Pagets disease
Spinal neoplasm
Sacro-ileitis Correct, The only obvious change on this radiograph is the obliteration of the sacroiliac 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:
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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:
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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?
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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
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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:
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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 interphalangeal 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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Caused by acute infection
Indicative of acute disc prolapse
Secondary to acute trauma
Indicative of chronic segmental instability Correct, This x-ray shows sclerosis at the end plates
of adjacent vertebra in the lower lumbar spine. It also shows new bone formation at the margins
of the end plates or the attachment of the anterior longitudinal ligament. These radiological signs
are said to be indicative of chronic spinal instability. Even though the end plates are sclerotic,
they are not eroded and therefore acute infectional tuberculosis is excluded.
Tuberculous
The spinal deformity seen here is a:
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Scoliosis
Spondylolisthesis Correct, The deformity seen here is a spondylolisthesis. The term refers to a
forward slipping of one vertebra on the one below. In this case, L5 has slipped forward on S1. As
part of this pathology you can also see the elongated pars interarticularis.
Diastematomyelia
Retrolisthesis
Spina bifida
This computerised axial tomogram is taken at the level of the first cervical vertebra.
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It is normal
It shows central migration of the odontoid Correct, The radio-dense, circular lesion in the central
canal of the axis is the odontoid peg, which is grossly displaced. The patient had rheumatoid
arthritis and the very slow rate of migration was not associated with any neurological symptoms.
Nevertheless there is an obvious risk of severe neurological damage.
It shows central calcification of the spinal cord typical of syringomyelia
There is a contrast enhanced spinal cord tumour
There is congenital absence of the odontoid
The trabecular architecture of this lumbar spine:
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Is normal
Shows evidence of secondary neoplasia Correct, There are multiple radio-dense lesions
throughout this spine, most evident in the veterbral bodies. There are also poorly defined
radiolucent areas scattered among the dense lesions. Less than half of the trabecular
architecture looks normal. Multiple, combined radiodense and radiolucent lesions are invariably
secondary deposits, usually from either a prostatic or breast primary. None of the other
alternatives produce radiodense areas. Hyperparathyroidism can cause cystic lesions.
Shows changes characteristic of post menopausal osteoporosis
Shows evidence of hyper-parathyroidism
Is typical of osteomalacia