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CME questions on the spinal injuries issue
CME SECTION
CME questions on the spinal injuries issue 1 In a normal person weighing 70 kg in normal walking, approximately what load is being transmitted through the anterior column of the spine?
6 Which of the following statements concerning zone 2 sacral fractures is incorrect
A B C D E
B
A
50 kg 150 kg 280 kg 350 kg 500 kg
C D E
2 If the ‘rule of Spence’ is applied and rupture of the transverse atlantal ligament is diagnosed based on lateral mass displacement of 7 mm or more, what proportion of these injuries are missed A B C D E
7 Which of the following is the most accepted indication for surgical treatment of a sacral fracture A B C D E
None 1 in 500 1 in 100 1 in 20 1 in 4
A B C D E
Both relate to alert, stable patients only NEXUS relates to five simple criteria The specificity of NEXUS is only approximately 12% The CCR can be applied to adults and children Using the CCR, C Spine radiographs can be avoided in around 40% of patients
A B C
Anterior third of the vertebral body Middle third of the vertebral body Nucleus pulposus Pedicles Posterior longitudinal ligament
D E
Expense compared to TLSO High tendency for kyphotic deformity to recur Risk of superior mesenteric artery compression Shown to be ineffective in randomized trials Surgical treatment has become the norm
ORTHOPAEDICS AND TRAUMA 30:5
Application of traction tongs to skull Manual in line support of the head throughout Pillows and rolls to support in patients ‘normal/ comfortable’ posture Rigid collar, spine board and head tape Soft collar only
10 A patient presents with back pain, even when recumbent, and is found to have a metastasis at L3. Which of the following would indicate that the spine is definitely unstable according to the Spinal Instability Neoplastic Score?
5 Why has the use of extension casting for thoracolumbar fractures fallen out of favour in the conservative management of these injuries A B C D E
1% 5% 10% 20% 35%
9 How should a patient with ankylosing spondylitis be positioned and immobilized for transfer to hospital if spinal injury is suspected
4 Which of the following is part of the middle column of the spine A B C D E
Associated foot drop Bowel and bladder dysfunction Part of a lateral compression pelvic fracture pattern Poor tolerance of non-weigh bearing regime Transverse orientation
8 Approximately what proportion of patients under 17 sustaining a spinal cord injury with neurological symptoms/signs will have normal plain radiographs and CT scans?
3 Which of these statements concerning major studies into the use of radiological investigations after trauma (NEXUS and CCR) is incorrect A B C D E
If neurology occurs it most often affects lower sacral nerve roots Most common sacral fracture to be associated with neurological injury Not as common as zone 1 fractures Not normally associated with canal compromise When associated with a vertical shear fracture there is a high risk of nonunion
A B
450
Blastic, unilateral pedicle involvement, 65% collapse, associated with kyphosis Lytic, anterior vertebral body involvement, 70% collapse with kyphosis
Ó 2016 Published by Elsevier Ltd.
CME SECTION
C D E
B C D E
Lytic, unilateral facet involvement, 60% collapse with associated scoliosis Mixed lytic/blastic, bilateral pedicle and facet involvement, 40% collapse, alignment maintained Mixed lytic/blastic, anterior vertebral body involvement with 30% collapse, associated scoliosis
12 Which cells secrete the material forming the bulk of the glial scar after spinal cord injury
11 What is the lowest level of spinal cord injury compatible with use of a manual wheelchair and independent driving of an adapted car with manual controls A
A B C D E
C5
ORTHOPAEDICS AND TRAUMA 30:5
C6 C7 C8 T1
451
Astrocytes Lymphocytes Microglia Neurons Oligodendrocytes
Ó 2016 Published by Elsevier Ltd.
CME questions on the spinal injuries issue 1 In a normal person weighing 70 kg in normal walking, approximately what load is being transmitted through the anterior column of the spine?
6 Which of the following statements concerning zone 2 sacral fractures is incorrect
A B C D E
B
A
50 kg 150 kg 280 kg 350 kg 500 kg
C D E
2 If the ‘rule of Spence’ is applied and rupture of the transverse atlantal ligament is diagnosed based on lateral mass displacement of 7 mm or more, what proportion of these injuries are missed A B C D E
7 Which of the following is the most accepted indication for surgical treatment of a sacral fracture A B C D E
None 1 in 500 1 in 100 1 in 20 1 in 4
A B C D E
Both relate to alert, stable patients only NEXUS relates to five simple criteria The specificity of NEXUS is only approximately 12% The CCR can be applied to adults and children Using the CCR, C Spine radiographs can be avoided in around 40% of patients
A B C
Anterior third of the vertebral body Middle third of the vertebral body Nucleus pulposus Pedicles Posterior longitudinal ligament
D E
Expense compared to TLSO High tendency for kyphotic deformity to recur Risk of superior mesenteric artery compression Shown to be ineffective in randomized trials Surgical treatment has become the norm
ORTHOPAEDICS AND TRAUMA 30:5
Application of traction tongs to skull Manual in line support of the head throughout Pillows and rolls to support in patients ‘normal/ comfortable’ posture Rigid collar, spine board and head tape Soft collar only
10 A patient presents with back pain, even when recumbent, and is found to have a metastasis at L3. Which of the following would indicate that the spine is definitely unstable according to the Spinal Instability Neoplastic Score?
5 Why has the use of extension casting for thoracolumbar fractures fallen out of favour in the conservative management of these injuries A B C D E
1% 5% 10% 20% 35%
9 How should a patient with ankylosing spondylitis be positioned and immobilized for transfer to hospital if spinal injury is suspected
4 Which of the following is part of the middle column of the spine A B C D E
Associated foot drop Bowel and bladder dysfunction Part of a lateral compression pelvic fracture pattern Poor tolerance of non-weigh bearing regime Transverse orientation
8 Approximately what proportion of patients under 17 sustaining a spinal cord injury with neurological symptoms/signs will have normal plain radiographs and CT scans?
3 Which of these statements concerning major studies into the use of radiological investigations after trauma (NEXUS and CCR) is incorrect A B C D E
If neurology occurs it most often affects lower sacral nerve roots Most common sacral fracture to be associated with neurological injury Not as common as zone 1 fractures Not normally associated with canal compromise When associated with a vertical shear fracture there is a high risk of nonunion
A B
450
Blastic, unilateral pedicle involvement, 65% collapse, associated with kyphosis Lytic, anterior vertebral body involvement, 70% collapse with kyphosis
Ó 2016 Published by Elsevier Ltd.
CME SECTION
C D E
B C D E
Lytic, unilateral facet involvement, 60% collapse with associated scoliosis Mixed lytic/blastic, bilateral pedicle and facet involvement, 40% collapse, alignment maintained Mixed lytic/blastic, anterior vertebral body involvement with 30% collapse, associated scoliosis
12 Which cells secrete the material forming the bulk of the glial scar after spinal cord injury
11 What is the lowest level of spinal cord injury compatible with use of a manual wheelchair and independent driving of an adapted car with manual controls A
A B C D E
C5
ORTHOPAEDICS AND TRAUMA 30:5
C6 C7 C8 T1
451
Astrocytes Lymphocytes Microglia Neurons Oligodendrocytes
Ó 2016 Published by Elsevier Ltd.