History and examination of the painful and injured spine including special clinical tests

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QUESTION 1 OF 4

72.A 67-year-old man presents to the ED after a minor fall 5 days ago. His back is sore between his shoulder blades. He has a history of ankylosing spondylitis. An x-ray of his spine shows a “bamboo spine”, but no fracture.

QUESTION ID: 3211

1. A CT scan should be performed as it will exclude a fracture and should be performed as an emergency.
2. HLA B27 positive patients have a better clinical response to tumour necrosis factor inhibitors and an earlier age at diagnosis compared with HLA B27 negative patients.
3. If a fracture is diagnosed and surgery is deemed to be necessary, the patient should be nursed flat with full spinal immobilisation until the surgery which will probably require 3 levels fixation above and 3 levels below the fracture.
4. If a fracture is diagnosed, it probably can be treated conservatively.
5. If there are no neurological signs at presentation, it is unlikely any will develop as the spine will be osteoporotic.
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QUESTION 2 OF 4

73. A 27-year-old patient with a fracture dislocation of C5/6 is admitted to your ward.
Which of the following best describes the medical management required for this patient?

QUESTION ID: 3212

1. At all times the mean arterial pressure should be kept above 90mmHg and a systolic pressure above 100mmHg
2. Autonomic dysreflexia is a relatively uncommon but life-threatening condition in people who have a spinal cord injury above the level of T6.
3. Does not require pain relief for musculoskeletal spams beneath the spinal cord injury level.
4. If described as having an ASIA impairment scale (AIS) of “C”, their function is being described as sensory incomplete.
5. Should commence chemical thromboprophylaxis with low molecular weight heparin within 10 days of admission.
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QUESTION 3 OF 4

74.Ankylosing spondylitis(AS)  and DISH (Diffuse Idiopathic Skeletal Hyperostosis ) can mimic each other.
Which of the following is a correct statement when differentiating the two?

 

QUESTION ID: 3213

1. Age of onset is between the second and third decade for AS and after the sixth decade for DISH.
2. AS have normal discs while with DISH the discs could be ossified.
3. The facet joints are normal in AS whilst fused in DISH.
4. There is ossification of ligaments and entheses in DISH while erosive enthesopathy in AS.
5. Unilateral sacroiliac joints are involved in DISH whilst bilateral in AS.
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QUESTION 4 OF 4

84.At which location would a disc prolapse be if a patient presents with an acute left footdrop and weakness of big toe extension?

QUESTION ID: 3221

1. A. L4/5 central disc protrusion
2. L3/4 left paracentral disc protrusion.
3. L4/5 far lateral disc protrusion
4. L5/S1 far lateral disc protrusion
5. L5/S1 left paracentral disc protrusion.
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