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CME on the Mini-Symposium on spinal injuries
CME SECTION
CME on the Mini-Symposium on spinal injuries 1 A patients initial assessment after suffering a spinal cord injury reveals complete loss of motor function below the level of the injury, but there is preservation of perianal sensation. What is the approximate chance of this patient regaining limb function to allow ambulation? A 2e3% B 10% C 20% D 33% E 70% 2 Which of the following is not one of the Nexus low risk criteria for determining whether a cervical spine radiograph should be conducted after trauma. A No evidence of intoxication B No focal neurological deficit C No history of stroke or neurological deficit D No midline posterior tenderness E No painful, distracting injury 3 Which of the following best summarizes the results of the NASCIS trial investigating the use of steroids in acute spinal cord injury A Steroid treatment was associated with improved motor and sensory recovery provided administration was within 24 h of injury B There was no difference in outcome between the two groups C The steroid treated group had no neurological benefit and a higher morbidity rate due to infections D Those treated with steroids showed a trend toward better motor recovery, particularly if administered within 8 h of injury E Those treated with steroids showed a trend toward better sensory recovery, particularly if administered within 3 h of injury 4 Which of the following has not been identified experimentally as a potential benefit of induced hypothermia in the spinal cord injured patient A Improved spinal cord blood flow B Reduced cerebral blood flow C Reduction in neutrophil infiltration D Reduction of CSF glutamate E Reduction of vasogenic oedema 5 Injury to which nerve is most commonly associated with occipital condyle fractures A facial B hypoglossal C spinal accessory D optic E vagus
ORTHOPAEDICS AND TRAUMA 28:2
6 Above what threshold is divergence of the lateral masses of C1 taken to be associated with transverse ligament rupture and consequently significant instability A 2 mm B 5 mm C 7 mm D 10 mm E One third of the canal width 7 Approximately what proportion of type 2 odontoid peg fractures would heal if treated in a hard collar A 10% B 30% C 50% D 70% E 90% 8 Which of the following statements about the treatment of cervical spine fractures in patients with fused spines due to ankylosing spondylitis is untrue A About 75% will develop a postoperative complication if treated surgically B Immobilization in a halo vest should be performed if surgery is not carried out C Long segment fixation should be used D The pull-out rate for screws in the ankylosed spine is much higher than in the ‘normal’ mobile spine E The risk of neurological complications is significantly higher in the stiff spine 9 Which of the following statements about the posterior longitudinal ligament of the spine is untrue A It is narrower at the level of the bodies and wider at the level of the discs B It resists separation of the posterior parts of the vertebral bodies C It runs down the posterior wall of the spinal canal D Its deep fibres span approximately 2 intervertebral discs E Its superficial fibres span up to 5 intervertebral discs 10 Which of the following statements is correct concerning surgery to remove retropulsed fragments of bone from the spinal canal in patients with incomplete spinal cord injury A It is associated with a worse neurological outcome due to iatrogenic complications B It should be carried out in all cases as the neurological outcome is transformed C It significantly reduces the risk of future symptoms of spinal stenosis D The patients’ neurological status is likely to improve with or without removal of the bone fragments E Without surgery the neurological status remains static but improves with decompression
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CME SECTION
11 Which of the following constructs is preferred in managing an unstable lumbar fracture by surgical fixation A Fix from one level above to one below and supplement with a brace if needed B Fix from one level above to both segments below C Fix from both segments above to both segments below D Span 2 levels above and 3 below E Span at least 3 levels above and below
ORTHOPAEDICS AND TRAUMA 28:2
12 Approximately what proportion of osteoporotic spinal fractures come to medical attention. A 10% B 25% C 50% D 75% E 100%
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CME on the Mini-Symposium on spinal injuries 1 A patients initial assessment after suffering a spinal cord injury reveals complete loss of motor function below the level of the injury, but there is preservation of perianal sensation. What is the approximate chance of this patient regaining limb function to allow ambulation? A 2e3% B 10% C 20% D 33% E 70% 2 Which of the following is not one of the Nexus low risk criteria for determining whether a cervical spine radiograph should be conducted after trauma. A No evidence of intoxication B No focal neurological deficit C No history of stroke or neurological deficit D No midline posterior tenderness E No painful, distracting injury 3 Which of the following best summarizes the results of the NASCIS trial investigating the use of steroids in acute spinal cord injury A Steroid treatment was associated with improved motor and sensory recovery provided administration was within 24 h of injury B There was no difference in outcome between the two groups C The steroid treated group had no neurological benefit and a higher morbidity rate due to infections D Those treated with steroids showed a trend toward better motor recovery, particularly if administered within 8 h of injury E Those treated with steroids showed a trend toward better sensory recovery, particularly if administered within 3 h of injury 4 Which of the following has not been identified experimentally as a potential benefit of induced hypothermia in the spinal cord injured patient A Improved spinal cord blood flow B Reduced cerebral blood flow C Reduction in neutrophil infiltration D Reduction of CSF glutamate E Reduction of vasogenic oedema 5 Injury to which nerve is most commonly associated with occipital condyle fractures A facial B hypoglossal C spinal accessory D optic E vagus
ORTHOPAEDICS AND TRAUMA 28:2
6 Above what threshold is divergence of the lateral masses of C1 taken to be associated with transverse ligament rupture and consequently significant instability A 2 mm B 5 mm C 7 mm D 10 mm E One third of the canal width 7 Approximately what proportion of type 2 odontoid peg fractures would heal if treated in a hard collar A 10% B 30% C 50% D 70% E 90% 8 Which of the following statements about the treatment of cervical spine fractures in patients with fused spines due to ankylosing spondylitis is untrue A About 75% will develop a postoperative complication if treated surgically B Immobilization in a halo vest should be performed if surgery is not carried out C Long segment fixation should be used D The pull-out rate for screws in the ankylosed spine is much higher than in the ‘normal’ mobile spine E The risk of neurological complications is significantly higher in the stiff spine 9 Which of the following statements about the posterior longitudinal ligament of the spine is untrue A It is narrower at the level of the bodies and wider at the level of the discs B It resists separation of the posterior parts of the vertebral bodies C It runs down the posterior wall of the spinal canal D Its deep fibres span approximately 2 intervertebral discs E Its superficial fibres span up to 5 intervertebral discs 10 Which of the following statements is correct concerning surgery to remove retropulsed fragments of bone from the spinal canal in patients with incomplete spinal cord injury A It is associated with a worse neurological outcome due to iatrogenic complications B It should be carried out in all cases as the neurological outcome is transformed C It significantly reduces the risk of future symptoms of spinal stenosis D The patients’ neurological status is likely to improve with or without removal of the bone fragments E Without surgery the neurological status remains static but improves with decompression
123
CME SECTION
11 Which of the following constructs is preferred in managing an unstable lumbar fracture by surgical fixation A Fix from one level above to one below and supplement with a brace if needed B Fix from one level above to both segments below C Fix from both segments above to both segments below D Span 2 levels above and 3 below E Span at least 3 levels above and below
ORTHOPAEDICS AND TRAUMA 28:2
12 Approximately what proportion of osteoporotic spinal fractures come to medical attention. A 10% B 25% C 50% D 75% E 100%
124