Self Assessment Examination Adult S Review | Dr Hutaif - ...

A 68-year-old male presents with bilateral leg pain that worsens with walking and improves when leaning over a shopping cart. Which of the following is the most likely finding on physical examination or diagnostic testing?

A 55-year-old female presents with progressive clumsiness in her hands and difficulty walking. Examination reveals a positive Hoffman's sign and inverted brachioradialis reflex. An MRI of the cervical spine shows severe stenosis at C5-C6 with cord signal change. Which of the following best describes the pathogenesis of the inverted brachioradialis reflex?

In adult spinal deformity surgery, achieving appropriate sagittal balance is critical for good clinical outcomes. According to the SRS-Schwab classification, which of the following spinopelvic parameter targets is most strongly correlated with improved health-related quality of life (HRQOL)?

A 65-year-old female presents with a far-lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely to be compressed, and what is the expected clinical motor deficit?

A 42-year-old male with long-standing ankylosing spondylitis sustains a minor fall and complains of new-onset neck pain. Neurological examination is normal. Radiographs of the cervical spine are difficult to interpret due to marked deformity and osteoporosis. What is the most appropriate next step in management?

A 72-year-old female presents with 6 weeks of severe back pain following a mechanical fall. Radiographs show an L1 vertebral compression fracture with 30% height loss. Neurological exam is intact. She has been treated with bracing, NSAIDs, and physical therapy but reports no improvement in her pain. Which of the following is the most appropriate next step?

A 45-year-old diabetic male presents with severe mid-thoracic back pain, subjective fevers, and acute onset of lower extremity weakness and urinary retention. MRI reveals a large epidural fluid collection at T8-T10 with peripheral enhancement and cord compression. What is the most appropriate definitive management?

Which of the following describes the correct formula defining the relationship between spinopelvic parameters in a standing individual?

A 50-year-old male with a history of intravenous drug use presents with worsening axial back pain, fevers, and elevated inflammatory markers. MRI of the lumbar spine reveals discitis and osteomyelitis at L3-L4 with endplate destruction and a small epidural phlegmon. Neurological examination is fully intact. Blood cultures are positive for Methicillin-sensitive Staphylococcus aureus (MSSA). What is the most appropriate initial management?

A 38-year-old construction worker presents with acute onset of severe low back pain and left leg pain extending to the dorsum of the foot. Examination reveals 4/5 strength in ankle dorsiflexion and decreased sensation over the first dorsal web space. The patellar and Achilles reflexes are 2+ and symmetric. An MRI confirms a herniated nucleus pulposus. At which level and location is the most likely disc herniation?

A 62-year-old female presents with neck pain and right arm radiating pain. She has weakness in triceps extension and wrist flexion, with a diminished triceps reflex. Sensation is decreased over the middle finger. Which cervical nerve root is most likely involved, and what is the corresponding intervertebral disc level?

A 65-year-old male with a history of prior posterior spinal fusion from L2 to L5 presents with a new onset of severe proximal thigh pain and weakness in hip flexion. Radiographs demonstrate a solid fusion from L2 to L5 but reveal adjacent segment disease with severe spinal stenosis and spondylolisthesis at L1-L2. Which nerve root is most likely compromised, and what is the primary muscle affected?

In the setting of adult degenerative scoliosis, which radiographic parameter is considered the most significant predictor of patient-reported clinical outcomes and disability (e.g., ODI scores)?

A 40-year-old female presents with axial low back pain. Radiographs demonstrate an isthmic spondylolisthesis at L5-S1 with a 25% slip (Grade I). Flexion-extension views show 4 mm of dynamic translation. She has failed 6 months of comprehensive non-operative management including physical therapy and epidural steroid injections. What is the most appropriate surgical intervention?

A 78-year-old male with long-standing rheumatoid arthritis presents with progressive quadriparesis and severe neck pain. Flexion-extension radiographs of the cervical spine demonstrate an atlanto-dens interval (ADI) of 11 mm. What is the most appropriate treatment?

A 55-year-old female undergoes a posterior L4-L5 laminectomy and fusion for degenerative spondylolisthesis. On postoperative day 2, she develops a sudden severe headache, photophobia, and nausea when standing, which resolves when lying completely flat. The surgical wound is dry and intact. What is the most likely etiology of her symptoms?

A patient with suspected diffuse idiopathic skeletal hyperostosis (DISH) is evaluated in the clinic. Which of the following radiographic criteria is essential for the formal diagnosis of DISH (Resnick and Niwayama criteria)?

A 60-year-old male with a history of prostate cancer presents with mid-back pain that is worse at night and not relieved by rest. Plain radiographs are unremarkable. An MRI of the thoracic spine reveals a T8 vertebral body lesion that is hypointense on T1-weighted images and hyperintense on T2-weighted images, with enhancement following gadolinium administration. There is no epidural extension or mechanical instability. What is the most appropriate next step in management?

Which physical examination test is most specific for evaluating the presence of cervical radiculopathy?

A 45-year-old female undergoes an anterior cervical discectomy and fusion (ACDF) at C5-C6. During the immediate postoperative period in the recovery room, she develops a rapidly expanding anterior neck mass, respiratory distress, and stridor. What is the most critical and immediate step in her management?

A 68-year-old female is scheduled to undergo a primary total hip arthroplasty (THA). She has a history of a solid instrumented lumbar fusion from L2 to the sacrum. How does this patient's prior spinal fusion alter the normal spinopelvic biomechanics during the transition from a standing to a sitting position, and what compensatory intraoperative adjustment in acetabular component positioning should the surgeon consider?

During a primary total knee arthroplasty (TKA), the surgeon checks the gap balancing with spacer blocks. The extension gap is symmetric and rectangular, allowing appropriate tension. However, the flexion gap is tight and symmetric. Which of the following is the most appropriate next step to balance the knee?

A 60-year-old female presents with lower back pain and neurogenic claudication. Radiographs reveal a grade I degenerative spondylolisthesis. At which spinal level is this condition most commonly found, and what anatomical variation is most heavily implicated in its pathogenesis?

A 23-year-old overhead athlete presents with recurrent anterior shoulder instability. Advanced imaging is obtained.

The concept of the 'glenoid track' is utilized to evaluate his bipolar bone loss. Which of the following defines an 'off-track' Hill-Sachs lesion?

A 35-year-old highly active man underwent a primary total hip arthroplasty with a ceramic-on-ceramic bearing. Two years later, he complains of a loud squeaking sound emanating from his hip when he walks or bends, though it is painless. Which of the following technical factors is most strongly associated with the development of this specific complication?

A 52-year-old man presents with acute onset, severe right leg pain radiating down the anterior thigh to the medial aspect of his lower leg. Physical exam reveals weakness in knee extension and a diminished right patellar reflex. MRI demonstrates a far lateral (extra-foraminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 28-year-old manual laborer sustains a high-energy fall onto the point of his shoulder. Radiographs demonstrate a >100% superior displacement of the clavicle relative to the acromion. Regarding the key stabilizing structures of this joint, which of the following best describes the anatomy and function of the coracoclavicular (CC) ligaments?

During a total knee arthroplasty, the surgeon inadvertently positions the femoral component in internal rotation relative to the epicondylar axis. Which of the following complications is most likely to result from this malrotation?

The diagnosis of periprosthetic joint infection (PJI) involves multiple diagnostic modalities. The synovial fluid alpha-defensin test is increasingly used for its high sensitivity and specificity. What is the fundamental biological origin of alpha-defensin in this setting?

A 62-year-old male presents with deteriorating fine motor skills in his hands and broad-based gait. Examination reveals hyperreflexia in the lower extremities and a positive Hoffmann's sign. Striking the brachioradialis tendon yields a diminished brachioradialis reflex but brisk, involuntary flexion of the ipsilateral fingers. What is this specific physical finding called, and what level of pathology does it indicate?

A patient requires revision of a failed total hip arthroplasty due to massive aseptic loosening.

Preoperative radiographs demonstrate superior migration of the acetabular component greater than 3 cm, complete destruction of the teardrop, and medial migration past Kohler's line with disruption of the ischium. According to the Paprosky classification, what grade is this defect, and what is the most appropriate reconstructive strategy?

The Grammont design principles for a reverse total shoulder arthroplasty (RTSA) revolutionized the treatment of cuff tear arthropathy. Which of the following statements best describes the primary biomechanical changes achieved by this design compared to normal shoulder anatomy?

A 55-year-old patient presents with symptomatic isolated medial compartment knee osteoarthritis. You are considering a unicompartmental knee arthroplasty (UKA). Which of the following is generally considered an absolute contraindication to performing a UKA?

A 70-year-old male with long-standing ankylosing spondylitis presents to the emergency department after a low-energy fall from a standing height. He reports severe, new-onset lower neck pain. Plain radiographs of the cervical spine appear heavily ossified but no obvious fracture is visualized. Neurologic examination is completely normal. What is the most appropriate next step in management?

Three years following a primary total knee arthroplasty, a 68-year-old woman sustains a sudden 'pop' and inability to actively extend her knee after stumbling on a stair. Examination and imaging confirm a complete rupture of the mid-substance of the patellar tendon. The primary implants are well-fixed. What is the most appropriate and reliable surgical intervention?

A 64-year-old male who underwent a primary metal-on-polyethylene total hip arthroplasty 5 years ago with a modular femoral head presents with new-onset persistent anterior groin pain and swelling. Radiographs show well-fixed implants. Aspiration yields sterile, straw-colored fluid. Blood tests reveal significantly elevated serum cobalt and chromium levels. MRI with MARS technique reveals a large cystic mass surrounding the hip joint. What is the most likely etiology of this pathology?

A 72-year-old male complains of severe right shoulder pain and an inability to lift his arm above his waist. Examination reveals pseudoparalysis of the shoulder with active forward flexion to 45 degrees, but intact active internal rotation. MRI reveals a massive, fully retracted supraspinatus and infraspinatus tear with grade 4 Goutallier fatty infiltration. The subscapularis and teres minor are intact. Glenohumeral arthritis is absent. What is the most reliable definitive surgical treatment for this patient?

Two years after an uncomplicated primary posterior-stabilized total knee arthroplasty, a patient complains of recurrent knee effusions and a sensation of the knee 'giving way' specifically when descending stairs or getting out of a low chair. On examination, the knee has 0-125 degrees of motion, is stable to varus/valgus stress at 0 degrees, but has notable anteroposterior translation and laxity at 90 degrees of flexion. Which intraoperative technical error most likely caused this complication?

A 74-year-old male presents with bilateral buttock and calf pain that worsens with walking and is relieved by sitting or leaning forward over a shopping cart.

He undergoes a stationary bicycle test, during which he pedals continuously for 20 minutes while leaning forward without experiencing leg pain. What anatomical mechanism explains the relief of his symptoms during lumbar flexion?

During a total hip arthroplasty using the direct anterior approach (DAA), the surgeon exploits the internervous plane between the sartorius and the tensor fasciae latae (TFL). Which nerve provides the motor innervation to the muscle located immediately lateral to this interval?

A 62-year-old male undergoes a C3-C6 posterior cervical laminectomy and instrumented fusion for severe cervical spondylotic myelopathy. On post-operative day 1, he demonstrates a new, isolated weakness in shoulder abduction and elbow flexion, but sensation is fully intact. Which of the following is the most widely accepted etiology for this complication?

A 70-year-old man undergoes an L4-L5 posterior decompression and fusion for severe spinal stenosis. Postoperatively, he develops a new foot drop and numbness over the dorsal web space between the first and second toes. Which nerve root is most likely injured, and what is the primary muscle affected?

A 62-year-old man undergoes a C3-C6 posterior cervical laminectomy and fusion for cervical spondylotic myelopathy. On postoperative day 2, he develops profound weakness in bilateral shoulder abduction and elbow flexion, but no new sensory changes or long-tract signs. What is the most likely cause of this complication?

When calculating the pelvic incidence (PI) in a patient with adult spinal deformity, which two anatomical landmarks are utilized to form the angle?

A 54-year-old diabetic male presents with severe back pain, fever, and progressive lower extremity weakness. MRI reveals an anterior epidural abscess at L2-L3 with extensive vertebral body destruction and kyphosis. He is unable to move his legs against gravity. What is the most appropriate definitive surgical management?

A 60-year-old female with metastatic breast cancer presents with severe, mechanical back pain. Which of the following parameters is evaluated in the Spinal Instability Neoplastic Score (SINS) to determine her need for surgical stabilization?

A 45-year-old man with a 15-year history of ankylosing spondylitis falls from a standing height. He complains of severe neck pain but his neurological examination is normal. Plain radiographs of the cervical spine appear unremarkable. What is the most appropriate next step in management?

A 65-year-old female presents with neurogenic claudication and an L4-L5 degenerative spondylolisthesis. She has failed 6 months of conservative treatment. According to the Spine Patient Outcomes Research Trial (SPORT), which of the following is true regarding her treatment options?

A 42-year-old man presents with acute onset of saddle anesthesia, bilateral sciatica, and urinary retention with a post-void residual volume >500 mL. An MRI confirms a massive L4-L5 herniated nucleus pulposus. Current literature suggests optimal clinical and functional outcomes are achieved if surgical decompression is performed within what maximum timeframe?

A 55-year-old woman underwent an L4-S1 posterior spinal fusion 5 years ago. She now presents with new-onset L3 radiculopathy. Radiographs demonstrate a new grade 1 spondylolisthesis at L3-L4. Which of the following is considered the strongest modifiable intraoperative risk factor for the development of adjacent segment disease (ASD)?

A 48-year-old man presents with severe acute right anterior thigh pain and weakness in knee extension. An MRI reveals a far-lateral (extraforaminal) disc herniation at the L3-L4 level. Which nerve root is most likely compressed by this specific herniation?

In a high-risk patient undergoing posterolateral lumbar fusion, recombinant human bone morphogenetic protein-2 (rhBMP-2) is utilized off-label. Which of the following is a recognized complication specifically associated with the use of rhBMP-2 in the spine?

A 38-year-old male is scheduled for an anterior lumbar interbody fusion (ALIF) at L5-S1 for severe degenerative disc disease. He is counseled regarding the risk of retrograde ejaculation. Injury to which of the following structures is primarily responsible for this complication?

A 65-year-old man presents with mild back stiffness. Radiographs show flowing ossification along the anterolateral aspect of four contiguous thoracic vertebral bodies with preservation of disc height and absence of sacroiliac joint sclerosis. What is the most likely diagnosis?

A 55-year-old male presents with progressive upper extremity clumsiness and lower extremity spasticity. CT imaging reveals ossification of the posterior longitudinal ligament (OPLL) from C3 to C6. If an anterior cervical corpectomy is planned, what is the most significant intraoperative risk specifically associated with OPLL excision?

A 45-year-old female presents with right-sided neck pain radiating to her thumb and index finger. Physical examination reveals weakness in wrist extension and a diminished brachioradialis reflex. Which cervical nerve root is most likely affected, and between which vertebrae does it exit?

A 28-year-old male is involved in a motor vehicle accident and sustains an L1 burst fracture with 40% loss of anterior vertebral body height and 30% canal compromise. He is neurologically intact, and MRI confirms the posterior ligamentous complex (PLC) is intact. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is the appropriate management?

An 82-year-old man sustains a Type II odontoid fracture after a ground-level fall. He is neurologically intact but has multiple medical comorbidities. Which of the following treatments is associated with an unacceptably high rate of mortality in this specific demographic and is generally avoided?

A 45-year-old male presents with severe acute right leg pain radiating to the anterior thigh. Physical examination reveals weakness in right knee extension and a diminished patellar tendon reflex. An MRI of the lumbar spine reveals a far-lateral (extraforaminal) disc herniation at the L4-L5 level. Which nerve root is most likely compressed?

A 62-year-old female presents with neurogenic claudication. Radiographs demonstrate a grade 1 degenerative spondylolisthesis at L4-L5. Which of the following anatomical variations is most strongly associated with the development of degenerative spondylolisthesis at this level?

A 50-year-old male presents to the emergency department with severe lower back pain, new-onset urinary retention, and perianal numbness following a heavy lifting injury. Post-void residual is 400 mL. Which of the following is the most appropriate management?

A 48-year-old mechanic complains of right arm pain, numbness in his long (middle) finger, and weakness when extending his elbow and flexing his wrist. Examination reveals an absent triceps reflex on the right. An MRI of the cervical spine is most likely to show nerve root compression at which level?

A 35-year-old intravenous drug user presents with progressive back pain, subjective fevers, and bilateral lower extremity weakness. MRI with gadolinium reveals a ventral epidural fluid collection with rim enhancement spanning L2-L4. Which organism is most likely responsible for this condition?

A 55-year-old male with a 20-year history of ankylosing spondylitis presents to the trauma bay after a low-speed motor vehicle collision. He complains of severe lower cervical pain. CT of the cervical spine reveals a transverse fracture through the C6 vertebral body extending into the posterior elements. What is the most appropriate definitive management?

A 60-year-old male with a known history of renal cell carcinoma presents with intractable mechanical back pain. Imaging shows an isolated lytic metastatic lesion at L2 with posterior cortical wall destruction and early cord compression. The Spinal Instability Neoplastic Score (SINS) is 14. What is the most appropriate surgical strategy?

A 72-year-old female with known severe cervical spondylosis falls forward and strikes her chin. She presents with significant weakness in her hands and upper extremities but is able to ambulate with only mild lower extremity weakness. Which of the following spinal cord syndromes does she exhibit?

A 65-year-old male is 3 years status post an L3-L5 posterior lumbar interbody fusion. He now presents with new-onset L2 radiculopathy and imaging shows severe stenosis at the L2-L3 level. Which of the following intraoperative factors during his index surgery places him at the highest risk for developing this adjacent segment disease?

A 55-year-old Asian male presents with progressive clumsiness in his hands and a wide-based gait. CT of the cervical spine reveals a continuous ossified mass posterior to the vertebral bodies from C3 to C6. If an anterior decompression (corpectomy) is planned, what is the most significant intraoperative complication directly associated with the pathology?

A 30-year-old male falls from a ladder and sustains an L1 burst fracture. He is neurologically intact. MRI demonstrates that the posterior ligamentous complex (PLC) is intact. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is the most appropriate treatment recommendation?

A 16-year-old gymnast presents with chronic lower back pain that radiates into her buttocks and posterior thighs. Radiographs demonstrate an isthmic spondylolisthesis at L5-S1. If this patient were to develop radiculopathy due to foraminal stenosis from the pars defect fibrocartilage, which nerve root is most commonly affected?

In the evaluation of adult spinal deformity, assessing spinopelvic parameters is essential. Which of the following statements best describes pelvic incidence (PI)?

A 78-year-old female with osteoporosis suffers a sudden onset of mid-back pain while lifting groceries. Radiographs show an acute wedge compression fracture at T12 with 20% loss of height. She is neurologically intact. What is the most appropriate initial management?

A 65-year-old male presents with severe multilevel cervical spondylotic myelopathy from C3 to C6. Lateral radiographs demonstrate preservation of normal cervical lordosis (20 degrees). Which of the following surgical approaches is most appropriate and minimizes the risk of adjacent segment disease?

A 45-year-old female presents with progressive spastic paraparesis. MRI reveals a large, calcified central disc herniation at T8-T9 causing severe cord compression. Which of the following surgical approaches is absolutely contraindicated?

Recombinant human bone morphogenetic protein-2 (rhBMP-2) is utilized off-label in anterior cervical spine surgery to promote fusion. Its use in this anatomical region is most strongly associated with an increased risk of which of the following complications?

A 70-year-old male is evaluated for mild dysphagia and neck stiffness. Radiographs of the cervical spine reveal flowing ossification along the anterior aspect of 5 contiguous vertebral bodies. The intervertebral disc spaces are well-preserved, and the sacroiliac joints are normal. What is the most likely diagnosis?

A 55-year-old female with long-standing rheumatoid arthritis is scheduled for an elective total knee arthroplasty. Pre-operative flexion-extension cervical spine radiographs reveal an anterior atlantodental interval (ADI) of 11 mm. What is the most appropriate management regarding her cervical spine?

A 58-year-old diabetic male presents with 4 weeks of severe, localized back pain and an elevated CRP. MRI shows fluid in the L3-L4 disc space with corresponding endplate edema. A CT-guided needle biopsy is performed but returns negative for organisms. The patient is hemodynamically stable without neurological deficit. What is the next best step in management?