S1_L5: Thorax and Spine Conditions Flashcards
(103 cards)
1
Q
TRUE OR FALSE: The adult vertebral column presents four anteroposterior curvatures. The cervical and lumbar curve are both concave anteriorly
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
C. Only the 1st statement is true
2
Q
The following statements are true about Kyphosis/Hyperkyphosis, EXCEPT:
A. known as “round back”
B. normal in thoracic and lumbar level
C. anteroposterior curvature of the spine
D. convexity is directed posteriorly
E. None of the above
A
B. normal in thoracic and lumbar level
NOTE: It is normal in thoracic and sacral level
3
Q
Match the following conditions to its proper description.
- also called adolescent kyphosis, juvenile kyphosis, vertebral epiphysitis
- usually caused by post menopausal osteoporosis or long-term corticosteroid therapy
- deformity is a localized, sharp, posterior angulation
- produced by an anterior wedging of one of the two thoracic vertebrae
- structural sagittal plane deformity in the thoracic or thoracolumbar spine
A. Dowager’s hump
B. Hump back
C. Scheuermann’s kyphosis
A
- C
- A
- B
- B
- C
4
Q
Match the following conditions to its proper description.
- also known as Gibbus deformity
- growth disturbance of the vertebral epiphyses usually due to vascular disturbance
- results from an infection (tuberculosis), fracture, or congenital bony anomaly of the spine
- characterized by wedging of the anterior side of the vertebral bodies
causing excessive kyphosis - characterized by a severely kyphotic upper posterior (dorsal) region, which results from multiple anterior wedge compression fractures in several vertebrae of the middle to upper thoracic spine
A. Dowager’s hump
B. Hump back
C. Scheuermann’s kyphosis
A
- B
- C
- B
- C
- A
5
Q
TRUE OR FALSE: In Scheuermann’s kyphosis, the first subjective complaint is fatigue and pain in the back. This condition is more common in males.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
A. Both statements are true
6
Q
In the criteria in the diagnosis of Scheuermann’s kyphosis, there must be a present (1)_______ degrees thoracic kyphosis and wedging of
(2)_______ degrees in atleast (3)____ adjacent vertebra
A
- > 45
- 5
- 3
7
Q
In Scheuermann’s kyphosis, symptoms usually begin between ages?
A
12- 16
8
Q
The spine consists of how many vertebrae?
A
33
9
Q
How many sacral vertebrae does an induvial usually have?
A
5 (fused)
10
Q
How many coccygeal vertebrae does an induvial usually have?
A
3 or 4 (fused)
11
Q
These 2 curvatures are termed primary and appear during the embryonic period proper. Which curves are they?
A
Thoracic and sacral
12
Q
These 2 curvatures are Termed secondary, appear later (although before birth) and are accentuated in infancy (1-2 months) by support of the head and by the adoption of an upright posture (10-11 months). In which direction is it concave?
A
posteriorly
13
Q
A normal thoracic spine extends from the 1st to the 12th vertebra and should have a slight kyphotic angle, ranging from ____.
A
20° to 45°
14
Q
What is the normal range of lumbar lordosis?
A
40° to 80°
15
Q
The following is true about Vertebra Plana, EXCEPT:
A. Also known as Eosinophilic granuloma
B. Also known as Calve’s disease
C. Affects only a single vertebra
D. Vertebral lesion is a pathologic fracture
E. None
A
E. None
16
Q
TRUE OR FALSE: Scoliosis is the older term and refers to an abnormal side bending of the spine but gives no reference to the coupled rotation that also occurs.
Rotoscoliosis is a more detailed definition, used to describe the curve of the spine by detailing how each vertebra is rotated and side flexed in relation to the vertebra below.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
A
A. Both statements are true
17
Q
What should be the level or range of the apex of the curve for a scoliosis to be considered in the thoracolumbar category?
A
T12 – L1
18
Q
What should be the level or range of the apex of the curve for a scoliosis to be considered in the cervical category?
A
C1 – C6
19
Q
What should be the level or range of the apex of the curve for a scoliosis to be considered in the thoracic category?
A
T2 – T11
20
Q
In Dextroscoliosis, where is the side of convexity?
A
Right
21
Q
A pt presents with a T8 apex and right convexity
How will the scoliosis be described/ termed as?
A
dextrothoracic scoliosis
22
Q
A pt presents with a L5 apex and left convexity
How will the scoliosis be described/ termed as?
A
levolumbosacral scoliosis
23
Q
Thoracic curve more than 60 – 90 degrees result in (1)_____ and (2)_____
A
- cardiopulmonary compromise
- restrictive lung disease
24
Q
Average amount of progression is how many degree per year?
A
1
25
Determine the classification of scoliosis.
1. Definite morphologic abnormality
2. Results from temporary postural influence
3. Has a fixed lateral curvature with rotation
4. Spinous process rotated to concavity
5. There is no rotational or asymmetric change in the individual structures of the spine
A. Non-Functional
B. Non-structural
1. A
2. B
3. A
4. A
5. B
26
Determine the classification of scoliosis.
1. metabolic disease
2. leg length discrepancy
3. nerve root irritation
4. infection
5. arthritis
A. Non-Functional
B. Non-structural
1. A
2. B
3. B
4. A
5. A
27
With which other two spine deformities is scoliosis associated with?
kyphosis and lordosis
28
What is the difference between structural and functional scoliosis?
1. structural - you are born with
2. functional - you get from bad posture
29
What type of brace is most commonly used for scoliosis?
milwaukee brace
30
The following is true about Infantile Idiopathic Scoliosis, EXCEPT:
A. More common in boys
B. Curves develop within the first 6 months
C. Regress spontaneously especially if the curve appeared before 12 months
D. Right thoracic curve is most common
E. None
D. Right thoracic curve is most common
NOTE: Left is most common
31
Determine which type of scoliosis is being described.
1. Females more commonly affected
2. Of equal sex predilection
3. Right thoracic curve most common
4. Curves do not resolve spontaneously
5. Increase incidence in children who are daughters of mothers with scoliosis
A. Juvenile Idiopathic Scoliosis
B. Adolescent Idiopathic scoliosis
C. Both
1. B
2. A
3. C
4. A
5. B
32
This is a staging system is used to grade skeletal maturity based on the level of ossification and fusion of the iliac crest apophyses
Risser Index
33
In Risser Index, the iliac crest is divided into how many divisions?
4
34
In an X-ray result, ossification of the lateral 75% of the apophysis has occurred.
Using the Risser Index, in what grade of skeletal maturity is the pt at?
Grade 3
35
In an X-ray result, there is no visible ossification of the iliac apophysis
Using the Risser Index, in what grade of skeletal maturity is the pt at?
Grade 0
36
In an X-ray result, ossification of the lateral 25% of the iliac apophysis has occurred
Using the Risser Index, in what grade of skeletal maturity is the pt at?
Grade 1
37
In an X-ray result, complete excursion of the ossified apophysis before fusion has occurred.
Using the Risser Index, in what grade of skeletal maturity is the pt at?
Grade 4
38
TRUE OR FALSE: Based on Risser Index, peak growth velocity is the best predictor of curve progression.
True
39
TRUE OR FALSE: In a Structural or Non-Functional scoliosis, there is adaptive lengthening of the intrinsic trunk muscles on the concave side and shortening of the intrinsic muscles on the convex side. Adam's sign is not persistent during forward bending.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
B. Both statements are false
40
Determine which structural changes are seen.
1. Where vertebral body rotate
2. Ribs pushed anteriorly
3. Where spinous process does not rotate
4. Ribs are closer
5. Intervertebral disc spaces narrower
A. Convex Side
B. Concave Side
1. A
2. B
3. A
4. B
5. B
41
A pt comes in with a 21 degree scoliosis with a Risser index of grade 2.
As a PT, what are you supposed to do?
A. Prescribe exercises
B. Prescribe Braces
C. Observe only
D. Tell him to opt for surgery
C. Observe only
42
A pt comes in with a 17 degree scoliosis with a Risser index of grade 1.
As a PT, what are you supposed to do?
A. Prescribe exercises
B. Prescribe Braces
C. Observe only
D. Tell him to opt for surgery
A. Prescribe exercises
OR
C. Observe only
43
A pt comes in with a 42 degree scoliosis with a Risser index of grade 3.
As a PT, what are you supposed to do?
A. Prescribe exercises
B. Prescribe Braces
C. Observe only
D. Tell him to opt for surgery
D. Tell him to opt for surgery
44
How many thoracic vertebrae are there?
12
45
How many cervical vertebrae are there?
7
46
How many lumbar vertebrae are there?
5
47
What are the primary curvatures of the spine?
Thoracic and sacral
48
The cervical and lumbar curvature is known as the secondary curves, but what may it be also called as?
lordotic curve
49
What is the most common cause of adult kyphosis?
Degeneration of intervertebral disks
50
Vertebra Plana usually affects children between what ages?
2 – 12 years old
51
Curves of (1)_____degrees should be observed for progression in (2)______
1. 40-50
2. adulthood
52
When a scoliosis is termed as juvenile, it means that the patient is between what age?
3 – 10 years
53
When a scoliosis is termed as adolescent, it means that the patient is between what age?
above 10 years to skeletal maturity (18 y/o)
54
TRUE OR FALSE: In Adolescent Idiopathic scoliosis, a larger curve at detection means a higher risk. The younger the patient, the lower risk for restrictive lung disease.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
NOTE: Younger the person is, higher risk for progression
55
TRUE OR FALSE: Peak growth velocity in females occurs just before menarche and before Risser 2. Girls usually reach skeletal maturity 3 yrs after menarche.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
B. Both statements are false
NOTE: Before Risser 1 & after 1.5 years
56
TRUE OR FALSE: If curve is >30° before peak height velocity there is a strong likelihood of the need for surgery.
True
57
The curve patterns are named according to the level of the _______
apex of the curve or apical vertebra
58
TRUE OR FALSE: In scoliosis, ribs are farther apart on convex side, but closer on concave side.
True
59
TRUE OR FALSE: In scoliosis, lamina are thinner and vertebral canal narrower on convex side
False
60
It is recommended to wear braces for (1)_______ hours/day until skeletal maturity or surgical intervention deemed necessary. However, the actual wear time required to slow progression is a minimum of (2)______ hours/day
1. 16-23
2. 12
61
A patient presents with a lateral curve with an apex of T9. As a knowledgeable PT, what kind of brace do you expect the pt should be wearing?
TLSO or Boston-style brace
62
A patient presents with a lateral curve with an apex of T6. As a knowledgeable PT, what kind of brace do you expect the pt should be wearing?
Milwaukee brace
63
Bracing success is defined as ______° curve progression
<5
64
Skeletal maturity is defined as: (1-3)
1. 2 years post-menarchal
2. <1cm change in height over 2 visits (6 months apart)
3. Risser 4
65
Match the following techniques used for posterior spinal fusion.
1. Recommends one level above and two levels below the end vertebrae if these levels fall within the stable zone
2. Recommends fusion to the neutral vertebrae
3. Recommends including all major curves in the fusion and minor curves that are not flexible or are kyphotic
A. Moe technique
B. Milwaukee Technique
C. Lenke technique
D. Harrington technique
E. Boston Technique
1. D
2. A
3. C
66
TRUE OR FALSE: Lumbar spine usually exhibits excessive lordosis
True
67
Determine the following condition.
1. Funnel Chest
2. Pigeon Breast
3. Increases AP diameter of thorax
4. Decreases AP diameter of thorax
5. Causes: premature development of emphysema or cor pulmonale
A. Pectus Carinatum
B. Pectus Excavatum
1. B
2. A
3. A
4. B
5. A
68
Determine the following condition.
1. Heart is displaced into the left side
2. Shortening of central tendon
3. Sternum projects forward and down like a keel of a boat
4. Commonly seen in Marfan’s syndrome
5. Impairs the effectiveness of cough and restricts volume of ventilation
A. Pectus Carinatum
B. Pectus Excavatum
1. B
2. B
3. A
4. B
5. A
69
This is a rare, inflammatory disorder characterized by chest pain and swelling of the cartilage of one or more of the upper ribs at the costochondral junction and where the cartilage attach to the sternum
Tietze’s Syndrome
70
Determine the following condition.
1. Also known as chest wall pain
2. Pain spreads to affect the neck, arms and shoulders
3. Localized tenderness and swelling of a single costochondral junction
4. Mild to severe localized pain and tenderness in one or more of the upper four ribs
5. Can resolve without treatment
A. Costochondritis
B. Tietze’s Syndrome
1. A
2. B
3. A
4. B
5. B
71
Determine the if following parts of the lumbar spine is placed anterior or posteriorly .
1. pedicles
2. spinous processes
3. laminae
4. inferior articular processes
5. transverse processes
A. Anterior portion
B. Posterior portion
1. A
2. B
3. B
4. B
5. A
72
This is an irregularity of the spine, where the fifth vertebra is fused to the sacrum bone at the bottom of the spine.
Sacralization
73
This is when top of the sacrum (S1) can be separated from the sacrum and the lumbar spine appears to have 6 vertebrae, not 5.
Lumbarization
74
This is the part of the lamina between the superior and inferior articular process. It is known as the site of stress fracture
Pars interarticularis
75
Determine the following pain generators of the lumbar spine.
1. Zygapophyseal joint
2. Disk internal annulus
3. Anterior longitudinal ligament
4. Ligamentum flavum
5. Nucleus pulposus
A. pain generating
B. not pain generating
1. A
2. B
3. A
4. B
5. B
76
These 3 muscles act as chief extensors of the spine
iliocostalis, longissimus and spinalis
77
This muscle acts as a tiny segmental stabilizers that act to control lumbar flexion and provides proprioception for the spine
Multifidus
78
When this muscle is tight, it accentuates the normal lordosis in the lumbar and can cause zygapophyseal joint pain. What muscle is being referred?
Psoas
79
This acts as an abdominal and lumbar “brace”
Thoracolumbar fascia
80
TRUE OR FALSE: Pelvic stabilizers are also considered “core muscles”
True
81
(1)______ is A gelatinous inner . It is (2)_____% water at birth but desiccates as we age and lose some of their height.
1. Nucleus pulposus
2. 90
82
TRUE OR FALSE: The Nucleus pulposus has more collagen and less proteoglycans and water than inner fiber
False
83
TRUE OR FALSE: Lateral fibers of the posterior longitudinal ligaments are thinnest making posterolateral disk herniation more common
True
84
A pt comes in with an affected L1 root.
As a knowledgeable PT, where is paresthesia expected to be located at?
groin area
85
A pt comes in with an affected S4 root.
As a knowledgeable PT, which structures are expected to be affected?
bladder & rectum
86
A pt comes in with an affected L4 root.
As a knowledgeable PT, where is paresthesia expected to be located at?
Medial aspect of calf and ankle
87
A pt comes in with an affected S4 root.
As a knowledgeable PT, what dermatomal innervation will be affected?
Perineum, genitals, lower sacrum
88
A pt comes in with an affected L2 root.
As a knowledgeable PT, what dermatomal innervation will be affected?
Back, front of thigh to bone
89
A pt comes in with an affected S1 root.
As a knowledgeable PT, what dermatomal innervation will be affected?
Buttock, back of thigh and lower leg
90
A pt comes in with an affected L4 root.
As a knowledgeable PT, what structures are expected to have weakness in?
Tibialis anterior & Extensor Hallucis Longus
91
A pt comes in with an affected S1 root.
As a knowledgeable PT, what reflex is expected be affected?
ankle jerk
92
A pt comes in with an affected L5 root.
As a knowledgeable PT, what reflex is expected be affected?
hamstring reflex
93
A pt comes in with an affected L3 root.
As a knowledgeable PT, what reflex is expected be affected?
knee jerk
94
Determine the following condition.
1. Gives pain referred to the buttock area and legs
2. Forward slippage of one vertebral body with respect to the one beneath it
3. Term used to describe anatomic defect in pars interarticularis with adjacent bone sclerosis
4. Happens before actual slipping of disc
5. One of most common causes of back pain in children and adolescents
A. Lumbar Spondylosis
B. Spondylolisthesis
C. Spondylolysis
1. A
2. B
3. C
4. C
5. C
95
At what level does Lumbar Spondylosis commonly occur at?
L4-5 and L5-S1
96
At what level does Spondylolisthesis commonly occur at?
L5-S1, followed by L4–L5
97
What is the most common type of Spondylolisthesis?
Isthmic
98
TRUE OR FALSE: Isthmic Spondylolisthesis caused by absence of bony continuity at the isthmus due to ununited fatigue fracture. Degenerative Spondylolisthesis has the neural arch intact, but the backward displacement accompanies severe degenerative arthritic changes in zygapophyseal joints and subjacent vertebrae.
A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true
C. Only the 1st statement is true
NOTE: It displaced forwardly
99
A pt has his vertebra slipping for about 45%.
Based on your knowledge, what grade will be given based on her findings?
Grade 2
100
A pt has his vertebra slipping for about 72%.
Based on your knowledge, what grade will be given based on her findings?
Grade 4
101
A pt has his vertebra slipping for about 102%.
Based on your knowledge, what grade will be given based on her findings?
No grade will be given for Spondylolisthesis.
It will be considered as spondyloptosis.
102
What are the 2 surgical procedures that may be done for Spondylolysis:?
1. Fusion
2. Laminectomy
103
Determine the condition.
1. Frequently involved in inflammatory arthritis such as the seronegative spondyloarthropathies
2. May have associated tenderness over symphysis pubis
3. (+) Gaenslen’s sign
4. Sprain of the sacrococcygeal ligament form a direct blow or fall such as in sitting down suddenly or sliding down a flight of stairs
5. Pain is severe when patient is sitting on a hard surface or when arising after sitting for a length of time
A. Sacroiliac Disorders
B. Coccygodynia
1. A
2. A
3. A
4. B
5. B
