Practice Set 210 of 379
This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.
In the evaluation of infantile idiopathic scoliosis, which of the following radiographic parameters is the most reliable predictor of curve progression?
. Cobb angle > 10 degrees
A 15-year-old boy undergoes posterior spinal fusion for adolescent idiopathic scoliosis. During deformity correction, somatosensory evoked potentials (SSEPs) are lost in the bilateral lower extremities, while motor evoked potentials (MEPs) remain intact. What is the most likely cause?
. Anterior spinal artery syndrome
A 5-year-old boy presents with a 40-degree left thoracic scoliosis. MRI reveals a syrinx extending from T4 to T10. Which of the following curve characteristics most strongly suggested the presence of an underlying neural axis abnormality?
. Male gender
In a child with Duchenne muscular dystrophy, what is the most common indication for spinal fusion surgery for scoliosis?
. Curve magnitude reaching 20 degrees with a rapid growth spurt
An 8-year-old girl with Neurofibromatosis Type 1 presents with a sharp, short-segment thoracic scoliosis of 45 degrees. Radiographs show rib penciling and vertebral scalloping. What is the recommended treatment?
. Milwaukee brace for 23 hours a day
A 14-year-old girl with adolescent idiopathic scoliosis has a major thoracic curve of 55 degrees. On the lateral radiograph, her thoracic kyphosis is measured at +15 degrees. According to the Lenke classification, what is her sagittal modifier?
. Minus (-), because kyphosis is < 10 degrees
A 6-month-old infant is diagnosed with infantile idiopathic scoliosis with a 25-degree left thoracic curve. The rib-vertebral angle difference (RVAD) of Mehta is measured at 25 degrees. What is the expected natural history of this condition?
. Spontaneous resolution without treatment
Which of the following congenital spinal anomalies has the highest rate of progression and warrants early prophylactic in situ fusion?
. Block vertebra
You are evaluating a 14-month-old boy with infantile idiopathic scoliosis. Which of the following radiographic parameters most reliably predicts the likelihood of curve progression?
. Cobb angle > 15 degrees
A 3-year-old girl is diagnosed with congenital scoliosis secondary to a fully segmented hemivertebra in the lower thoracic spine. Which of the following diagnostic screening studies is most critical during her initial systemic evaluation?
. Transthoracic echocardiogram
A 6-year-old boy presents with a 35-degree right thoracic curve. An MRI of the entire spine is unremarkable. Which of the following is the most appropriate management for this patient?
. Observation with radiographs every 6 months
Parents of a newborn diagnosed with congenital scoliosis are seeking counseling regarding the risk of curve progression. Which of the following vertebral anomalies carries the highest risk of rapid progression?
. Block vertebra
A 15-year-old girl undergoes a posterior spinal fusion for adolescent idiopathic scoliosis. On postoperative day 4, she develops significant abdominal distension, bilious emesis, and marked weight loss. Which anatomic structure is most likely directly compressing the obstructed bowel segment?
. Superior mesenteric artery
A 12-year-old boy with Duchenne muscular dystrophy presents with a progressive 45-degree thoracolumbar scoliosis. His Forced Vital Capacity (FVC) is currently 40% of predicted. What is the most appropriate management plan?
. Custom-molded TLSO bracing
A 6-month-old boy is diagnosed with infantile idiopathic scoliosis. He has a 35-degree left thoracic curve. Radiographs demonstrate a rib-vertebral angle difference (RVAD, or Mehta's angle) of 25 degrees. What is the most appropriate management?
. Observation with repeat radiographs in 1 year
A newborn is diagnosed with congenital scoliosis secondary to a fully segmented hemivertebra. Which of the following imaging studies is most critical to obtain during the initial comprehensive evaluation?
. MRI of the cervical spine
A 6-month-old boy is noted to have a 25-degree left thoracic curve. Radiographs indicate a rib-vertebral angle difference (RVAD) of Mehta of 25 degrees. What is the most appropriate management?
. Observation alone
A 70-year-old man with ankylosing spondylitis and a completely fused lumbar spine is undergoing a total hip arthroplasty. How does his stiff spinopelvic anatomy alter the typical acetabular component positioning to prevent posterior dislocation?
. The cup should be placed in more retroversion
A patient with severe spinopelvic stiffness secondary to ankylosing spondylitis is evaluated for a total hip arthroplasty. The patient's pelvis is fixed in a posterior pelvic tilt. How does this fixed deformity affect the functional orientation of the acetabulum when the patient transitions from sitting to standing?
. It causes functional retroversion of the acetabulum.
An extensively porous-coated, cylindrically fully coated diaphyseal engaging stem is used in revision hip arthroplasty. To achieve predictable long-term biologic fixation (osseointegration), what is the minimum required distance of diaphyseal scratch fit?
. 1-2 cm