Congenital and acquired conditions causing deformity around the spine e.g. scoliosis and kyphosis

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QUESTION 1 OF 9

You are seeing an otherwise well pre-menarchal 12-year-old schoolgirl referred in with a thoracic scoliosis. She is otherwise well. Examination is unremarkable aside from the left thoracic scoliosis with a small rib hump.She has a normal neurological examination. Whole spine x-rays confirm the scoliosis with apex at T8 with Cobb angle of 20° and normal segmentation.
The most appropriate next step in management is:

QUESTION ID: 55

1. A. Application of CTLSO brace
2. B. Application of TLSO brace
3. C. MRI scan whole spine
4. D. Observation with repeat x-ray in 3-6 months
5. E. Posterior instrumented correction and fusion
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QUESTION 2 OF 9

You are seeing a 16-year-old female with a scoliosis first diagnosed 4 years previously. She is otherwise well and is now 2 years post menarchal. Examination demonstrates a thoracic scoliosis, right sided rib hump on Adam’s forward bending and the right shoulder slightly higher than the left. A whole spine MRI scan is normal, aside from the scoliosis. At presentation radiographs showed a right thoracic curve measuring 25°. A PA standing whole spine radiograph taken today is shown below:

Regarding her potential curve progression:


QUESTION ID: 1056

1. A. Curve resolution may occur if the rib vertebral angle difference (RVAD) is <20°
2. B. Given the size of the curve it is likely to progress rapidly
3. C. Her curve is likely to progress slowly during adult life
4. D. She has significant spinal growth remaining, over which time her curve may worsen
5. E. The curve is not likely to progress now she is skeletally mature
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QUESTION 3 OF 9

You are seeing a 16-year-old female with a scoliosis first diagnosed 4 years previously. She is otherwise well and is now 2 years post menarchal. Examination demonstrates a thoracic scoliosis, right sided rib hump on Adam’s forward bending and the right shoulder slightly higher than the left. A whole spine MRI scan is normal, aside from the scoliosis. At presentation radiographs showed a right thoracic curve measuring 25°. A PA standing whole spine radiograph taken today is shown below:
You are counseling the patient and family about the condition. They would like to know the likely outcome if left untreated. You explain that without treatment, compared to someone unaffected, she is more likely to:

QUESTION ID: 1057

1. A. Have back pain and depression
2. B. Have concerns about cosmesis
3. C. Have reduced life expectancy
4. D. Struggle with activities of daily living like prolonged sitting
5. E. Struggle with childbirth and have an increased need for caesarian section
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QUESTION 4 OF 9

You are seeing a 16-year-old female with a scoliosis first diagnosed 4 years previously. She is otherwise well and is now 2 years post menarchal. Examination demonstrates a thoracic scoliosis, right sided rib hump on Adam’s forward bending and the right shoulder slightly higher than the left. A whole spine MRI scan is normal, aside from the scoliosis. At presentation radiographs showed a right thoracic curve measuring 25°. A PA standing whole spine radiograph taken today is shown below:
The patient opts for surgical management by way of posterior instrumented correction and fusion. Bending films are obtained demonstrating the main thoracic curve reduces to 40°. A left sided proximal thoracic curve measures 15° and lumbar curve 20° on the left bending film.
Surgery should aim to correct and fuse:

QUESTION ID: 1058

1. A. Lumbar and proximal thoracic curves
2. B. Main thoracic curve
3. C. Main thoracic and lumbar curves
4. D. Main thoracic and proximal thoracic curves
5. E. Proximal thoracic, main thoracic, and lumbar curves
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QUESTION 5 OF 9

122.On assessing flexibility of the spine in an infant with scoliosis.
What is the best way of doing this is:

Vertical suspension.png

QUESTION ID: 2193

1. Ask the child to forward flex
2. Ask the child to lateral flex
3. Lifting the child up from under their arms
4. Patient prone ask to hold the top of the bed and pull downward from the waist
5. Place the child on the examiner’s knee with the concave side down.
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QUESTION 6 OF 9

98.Have a look at this patient.
What clinical feature is LEAST likely to be present?

 Answer C- Flattened lumbar lordosis .jpg

QUESTION ID: 2238

1. Flattened lumbar lordosis
2. Leg lengths equal
3. Normal neurology
4. Normal plumbline
5. Right rib prominence
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QUESTION 7 OF 9

100.This clinical photograph of an adolescent gymnast reveals an exaggerated lumbar lordosis. She also has back pain.
What another clinical feature is she most likely to have?

 Answer D- Tight hamstrings.jpg

QUESTION ID: 2240

1. Numbness over the knee
2. Scoliosis
3. Thoracic kyphosis
4. Tight hamstrings
5. Weak quads
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QUESTION 8 OF 9

78.A teenage girl with thoracic scoliosis of Cobb angle 50 degrees is seen in the clinic. Beaded on history, examination, and investigations, it is suggestive of adolescent idiopathic scoliosis. Family would like to know the long-term sequelae of untreated AIS.
Which of the following is a known outcome of the natural history of AIS?

QUESTION ID: 3216

1. Absence of backpain
2. Increased lumbar lordosis.
3. Psychological concerns
4. Static curve progression
5. Unchanged sagittal alignment
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QUESTION 9 OF 9

63.A 14-year-old, 12 months post menarchal girl presents to your spinal clinic with the condition shown in Figure 1. She is mildly concerned regarding her current shape and but has minimal pain. Her neurological examination is unremarkable.
The most appropriate intervention at this time is:

QUESTION ID: 3314

1. Anterior release and posterior instrumented correction
2. MRI whole spine
3. Observation clinical and radiographic follow up in 6-12 months.
4. Posterior instrumented correction
5. Referral for brace
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