Abstract
Spine II Structured SBA Questions
Spine II Structured SBA Questions
1. A 40-year-old patient with a background of ankylosing spondylitis with spinal deformities has arrived at the ED after an RTA at 70 miles per hour. He is conscious and speaking, with a blood pressure of 90 and HR of 120.
Which of the following is likely to negatively affect the outcome of this patient?
2. Which of the following statement is true regarding pelvic incidence?
It changes with posture like other parameters of pelvic morphology
It is pelvic tilt minus the sacral slope
It is the angle formed between a line drawn from the centre of the S1 end plate to the centre of the femoral head and a second line drawn perpendicular to the S1 end plate, intersecting it at the centre
Lower pelvic incidence necessitates more lumbar lordosis to maintain sagittal balance
There is no correlation between pelvic incidence and the Meyerding Newman grade of spondylolisthesis
3. A 13-year-old girl is seen in the paediatric clinic with scoliosis. It was noticed by her mother 18 months ago that it is gradually getting worse.
Which of the following is not an indication of MRI scan of the full spine?
4. An 8-year-old boy has come to the orthopaedics clinic with back pain and scoliosis. The boy’s mum mentions that the pain is more prevalent at night and has responded to anti-inflammatory agents.
Which of the following is the only TRUE statement about this condition?
5. A 40-year-old man has arrived in the ED with penetrating injury to his upper abdomen. His BP is 100, HR 110 and RR 20. He has 15/15 GCS and normal neurology in all four limbs.
His CT shows minimal tear to his descending aorta with no bony injuries. He undergoes laparotomy with repair of the descending aorta. His surgery lasts for 4 hours under general anaesthesia, with his blood pressure always above 110mm Hg. Post-op he wakes up with weakness of the muscles in his foot, reduced sensations in both lower limbs but intact proprioception. His power, sensations and proprioception are normal in both upper limbs. His blood pressure now is 120mm Hg, HR 90, SaO2 100% on 2 litres of oxygen, RR 18.
Which of the following is the MOST likely cause of the patient’s weakness?
6. A 60-year-old man with a background of hypertension has been referred by his GP with symptoms of low back pain, neurogenic claudication and gait disturbances. On examination, he has brisk reflexes in all four limbs and 4/5 power in all four limbs. He denies any symptoms of bowel or bladder dysfunction. His lumbar spine is tender in the region of the facets, and lumbar extension is painful. Both pedal pulsations are well felt. His GP has already performed an MRI of the lumbar spine that shows severe canal stenosis at L34, L45.
The NEXT most appropriate step in the management of this patient is which of the following?
7. Which of the following is a true statement regarding the Smith–Robinson (anterior cervical spine) approach?
Dissection of the longus colli muscle risks damage to the parasympathetic chain
Hyoid bone roughly lines up with C5
The location of the maxilla decides the ease of access to the C23 disc
The superficial fascia, pretracheal fascia and prevertebral fascia are encountered from superficial to deep
Utilises the plane between the carotid sheath laterally and the trachea with internal jugular medially
8. A 68-year-old female sustains an osteoporotic fracture. After failure of conservative treatment, she undergoes vertebroplasty.
Which of the following statements is correct regarding this procedure?
Chemical destruction of the nerve endings due to chemical composition of the cement has been proposed
Vertebroplasty has more advantages than kyphoplasty
Vertebroplasty is indicated in patients with ongoing pain after recent unhealed fracture, pain confirmed at the level of fracture by examination and MRI showing low signal on T2
It works by destruction of the nerve endings due to extreme low temperature reached by the polymerisation of the injected cement
It works by stabilisation of the fractured bone by forming a chemical bond
9. An 8-year-old boy presents with fever and low back pain. He is very tender in the L23 region. Hip and knee examinations are normal. His inflammatory markers are raised.
Which of the following is a true statement about this condition?
12. An 11-year-old girl comes to the spinal clinic with recent onset of noticing deformity. She has no neurology in her legs and no generalised syndromic features. AP radiograph of her spine is as depicted in Figure 9.1.
Figure 9.1 AP radiograph spine
Which of the following is an ideal indication of a brace?
13. A 4-year-old boy is brought unconscious to the ED with a history of a motor vehicle accident.
Which of the following is true about paediatric spinal trauma?
Injury to the spinal cord can only happen with visible changes on rays and CT scan
CT scan is the investigation to diagnose injury to the cord and ligament injuries
Upper cervical trauma is more common in children younger than 8 years of age
The child should be immobilised on a standard spinal board
There can be a normal anterior translation between C5 and C6
14. A 30-year-old male ankylosing spondylitis patient with kyphosis needs a sagittal correction spinal procedure.
Which of the following statements correctly describes pedicle subtraction osteotomy?
Correction happens at the level of vertebral body and not the disc
It opens up the anterior column, closes the middle column somewhat and closes the posterior column
It is classically performed at T11/T12 vertebrae
It provides more correction than Smith-Petersen osteotomy and vertebral column resection
PSO is associated with fewer complications
15. All of the following are true about radiology in ankylosing spondylitis EXCEPT which answer?
50% of ankylosing spondylitis patients with fractures can have normal-looking x-rays
The earliest sign on pelvic x-rays is erosion on the iliac side of sacroiliac joint
Marginal syndesmophytes are present in the vertebrae
MRI is the modality for early detection of ankylosing spondylitis
16. A 40-year-old man visits a clinic, complaining of chronic back pain. There are no red flags on history and or abnormalities on examination.
Which of the following is the most appropriate method of treatment?
17. Which of the following statements about spine anatomy is true?
The cell bodies of the sympathetic nervous system are found in the lateral horn grey matter of spinal cord segments T7–T9
The preganglionic sympathetic preganglionic cell bodies lie in sacral segments S2, S3, S4
The C8 nerve exits the foramen superior to the pedicle of C7
The inferior limit of the spinal cord in adults is L1 or L2
The inferior limit of the dural sac and subarachnoid space is the L2 vertebra
18. A 30-year-old man has been brought to the ED after a motor vehicle accident. He appears drowsy and a trauma CT shows a small contusion in the brain with 50% subluxation of the C67 vertebrae. He has triple immobilisation in place. He is also seen by neurosurgeons who say he is able to undergo any cervical procedures.
The most appropriate next step in management of this patient is which of the following?
19. A patient with T4 spinal cord injury and paraplegia is not likely to have which of the following complications?
22. A 13-year-old boy with a background of cerebral palsy presents with the deformity as depicted in sitting spinal radiographs (Figure 9.2).
Figure 9.2 Sitting radiographs spine
Which of the following statements is true regarding this type of scoliosis?
23. A 15-year-old boy presents with Duchenne’s muscular dystrophy. He has a scoliotic curve measuring 35 degrees with apex at T11 and pelvic obliquity.
Which of the following is the most appropriate next step in management?
24. Which of the following is not a criterion for recommending surgery for thoracolumbar burst fractures?
25. Which of the following is true regarding compression fractures of the thoracic or lumbar spine?
26. Which of the following is not a component of Thoracolumbar Injury Classification and Severity (TLICS) score for thoracolumbar fractures?
27. A 36-year-old man is involved in a motor vehicle accident. He is a seat belt–restrained car passenger. He sustains a flexion distraction type of injury of the thoracolumbar spine.
Which of the following is true about this injury?
It will always need surgical stabilisation.
Injury pattern is always through posterior ligamentous complex, facet capsules and intervertebral discs
It will involve the middle and posterior column of the spine
There is a low incidence of intra-abdominal injuries
Progressive kyphosis is a known complication in unrecognised injuries
29. A 70-year-old man with a background of poorly controlled diabetes and prostate cancer with skeletal metastases presents with gait disturbances. There are no abnormalities in upper limb examination, but he has brisk lower limb reflexes and upgoing plantar reflex.
Which of the following is most likely to explain his findings and will need to be investigated further?
32. A 40-year-old man is brought to the ED with a history of a heavy object falling on his head while performing construction work. He was wearing a helmet and had no signs or symptoms of head injury. He complains of neck pain and is in a collar. He has no neurology. CT scan confirms anterior and posterior arch fracture. Open mouth view x-ray shows a combined lateral displacement of 5mm.
Which of the following is true regarding this injury?
34. A 30-year-old rugby player gets involved in a tackle. He complains of unilateral pain along C5 and C6 dermatomes along with transient weakness of deltoid and biceps, with normal cervical range of motion.
Which of the following fits this pattern of injury?
35. Which of the following mechanisms is the least likely injury pattern responsible for stinger or burner?
Axial compression of the cervical spine
Direct blow to a point just above the clavicle
Hyperextension, compression and rotation towards the involved arm
Related posts:
Chapter 11 – Shoulder/Elbow II Structured SBA
Chapter 20 – Pathology I Structured SBA
Chapter 19 – Structure and Function of Connective Tissue Structured SBA
Chapter 5 – Knee Structured I SBA
Chapter 26 – Clinical Environment, Evidence Management and Quality Improvement Structured SBA
Chapter 15 – Hand II Structured SBA
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