Question 1

The image of this patient shows that the patient has what type of injury?&#10;A) Hangman's fracture&#10;B) Jefferson Burst fracture&#10;C) Herniated C2 disk&#10;D) C7 vertebral arch fracture

Accepted Answer

The normally intact "ring" of C1 is broken in three places.

Question 2

The patient in this image has which of the following?&#10;A) A fractured arch at C1&#10;B) A fractured hyoid bone&#10;C) A vertebral body compression fracture&#10;D) A spinal metastatic disease

Accepted Answer

The superior endplate of C7 is depressed and angulated. All of the other vertebral endplates are smooth and mildly concave. In this image one can only see a thin slice through the anterior arch of C1, so one could not make the diagnosis of a fractured arch at C1 in this view. A similar comment can be made about the hyoid bone, for which only a small "slice" is seen. There is no lytic or blastic bone disease to suggest a spinal metastatic disease.

Question 3

Which type of fracture(s) does the image indicate?&#10;A) Chance fracture&#10;B) Clay-shoveler's fracture&#10;C) Hangman's fracture&#10;D) Cervical facet fractures

Accepted Answer

Note that the tip of the C7 spinous process has been avulsed, and the ovoid distal fragment is sitting just below the sharp and pointed margin of the end of the remaining C7 spinous process. A Chance fracture does not occur in the cervical spine. The pedicles of C2 are intact, so a Hangman's fracture is not correct, and likewise no fractures of any facets are shown; any linear radiolucencies in the region of the facets are facet joint spaces and overlapping structures. CT is needed for confident demonstration of facet fractures, so the option for cervical facet fractures is incorrect.

Question 4

This image shows that the patient has which of the following?&#10;A) Severe dehydration of the vertebral disks&#10;B) Transected spinal cord&#10;C) Spinal cord tumor&#10;D) Cerebrospinal fluid (CSF) infection

Accepted Answer

Transected spinal cord is correct because of the transverse band of increased signal interrupting the otherwise intermediate signal cord. All of the disks are at least intermediate in signal, and not the very dark hypointensity seen with severe dehydration of disks. Spinal cord tumor is incorrect because no mass is shown. In fact, the opposite is shown; there is a defect in the cord, not a tumor added to the cord. CSF infection is incorrect because the transection of the cord does not occur with infection.

Question 5

The arrow in the above image indicates:&#10;A) a pars interarticularis defect.&#10;B) a Chance fracture.&#10;C) an arthritic facet joint marginal osteophyte.&#10;D) a calcified herniated disk.

Accepted Answer

Note how the bony projection shown is arising from the articular column. No bone defect is shown, and Chance fractures do not occur in this location. This image does not indicate a calcified herniated disk because on this oblique view the overlapping osseous structure obscures the disks.

Question 6

This image likely shows a patient with:&#10;A) lytic bone disease.&#10;B) scoliosis.&#10;C) vertebral body compression fracture.&#10;D) degenerative disk disease.

Accepted Answer

Lytic bone disease is correct because of a very important observation-there is a pedicle missing on the left. Scoliosis is not appropriate because the scoliosis is not severe, and there is a much more important observation than the mild scoliosis shown. Vertebral body compression fracture is incorrect because no fractures are shown. Degenerative disk disease is incorrect because it is inappropriate to attribute symptoms to the spondylosis shown (which is very common in older individuals), especially when there is such an important finding as a destroyed pedicle. There are two important teaching points to this question. First, a clinically important radiologic finding can be surrounded by trivial incidental findings. Second, because crucially important radiologic findings can be subtle and surrounded by trivial incidental findings, it is important that every medical professional interpreting medical images be provided with relevant clinical information such as oncologic history.

Question 7

The above image depicts a patient with:&#10;A) spondylolisthesis.&#10;B) DISH.&#10;C) lytic bone disease.&#10;D) degenerative disk disease.

Accepted Answer

This image shows disk flattening, vacuum disk phenomenon, and vertebral osteophytes, indicating degenerative disk disease. The vertebrae are in good alignment, so spondylolisthesis is not correct. The osteophytes do not merge with each other, as with DISH. Lytic bone disease is not shown in this image.

Question 8

The above image depicts a patient with:&#10;A) degenerative disk disease.&#10;B) DISH.&#10;C) lytic bone disease.&#10;D) facet joint osteoarthritis.

Accepted Answer

DISH is the best answer because of the bridging syndesmophytes along the anterior margin of the spine. The disk spaces are moderately well preserved, so degenerative disk disease is not an appropriate answer. There is no sign of lytic bone disease. The facet joints are not seen well, so one cannot conclude whether facet joint osteoarthritis is present.

Question 9

Which defect is portrayed in the image of this patient?&#10;A) An L2 pars defect&#10;B) An L3 pars defect&#10;C) An L4 pars defect&#10;D) An L5 pars defect

Accepted Answer

An L5 pars defect is the only correct answer because the "scotty dog" is seen well at every level above L5.

Question 10

The image shows that this patient has:&#10;A) anterolisthesis of the sacrum.&#10;B) retrolisthesis of L5 in relation to the sacrum.&#10;C) bamboo spine.&#10;D) sacral fracture.

Accepted Answer

(B) is the correct answer because of the position of L5 in relation to the sacrum: posterior (A) is wrong because listhesis is always described by the position of the vertebra above. (C) is practically a nonsequitur. (D) The thin disk at S1-S2 should not be mistaken for a fracture. It is smooth, has black cortical margins, and has T2 hyperintensity in the disk.

Question 11

In a patient with back pain and fever, this fat suppressed T2-weighted MRI would suggest:&#10;A) degenerative disk disease.&#10;B) metastatic disease to the spine.&#10;C) spondylolysis.&#10;D) diskitis/osteomyelitis.

Accepted Answer

The answer of   In a patient with back...

Question 12

Your diagnosis based on the image shown is:&#10;A) C4/C5 disk herniation.&#10;B) dens fracture.&#10;C) metastatic disease of the spine.&#10;D) soft tissue neck injury.

Accepted Answer

The answer of   Your diagnosis based on the...

Question 13

What would be your diagnosis based on the image of this patient?&#10;A) The patient has disk herniation with nerve compression.&#10;B) The patient has left L5/S1 facet joint osteoarthritis.&#10;C) The patient has bilateral L5 pedicle fractures.&#10;D) The patient has cauda equina impingement syndrome.

Accepted Answer

The answer of   What would be your diagnosis...

Question 14

The CT shown is from a patient who presented with sciatica. Your diagnosis is most likely:&#10;A) aortic aneurysm.&#10;B) tumor in a pedicle.&#10;C) herniated disk.&#10;D) spina bifida.

Accepted Answer

The answer of   The CT shown is from...

Question 15

Which of the following is NOT true of degenerative disk disease?&#10;A) It is typically associated with marginal osteophytes.&#10;B) It is typically associated with disk dehydration.&#10;C) It is always associated with back pain.&#10;D) It does not require advanced imaging, such as MRI, for diagnosis.

Accepted Answer

The answer of Which of the following is NOT true...

Question 16

Which of the following radiographic views BEST displays a pars interarticularis fracture?&#10;A) AP&#10;B) PA&#10;C) Lateral&#10;D) Oblique

Accepted Answer

The answer of Which of the following radiographic views BEST...

Question 17

In patients who have severe spine trauma but do not show neurologic signs, the procedure of choice is:&#10;A) CT.&#10;B) MRI.&#10;C) radiography.&#10;D) ultrasound.

Accepted Answer

The answer of In patients who have severe spine trauma...

Question 18

Which of the following cervical fractures are typically stable?&#10;A) Teardrop&#10;B) Bilateral facet&#10;C) Anterior wedge compression&#10;D) Hangman's

Accepted Answer

The answer of Which of the following cervical fractures are...

Question 19

In a patient with a Chance fracture, you would also likely suspect injury to the:&#10;A) ribs.&#10;B) lungs.&#10;C) pancreas.&#10;D) liver.

Accepted Answer

The answer of In a patient with a Chance fracture,...

Question 20

In a patient with low back pain with or without lumbar radiculopathy, standing radiographs may be helpful because they:&#10;A) may provide functional information regarding the alignment of vertebrae when weight bearing.&#10;B) provide better bone detail.&#10;C) enable more vertebrae to be seen.&#10;D) require less ionizing radiation to produce a comparable image.

Accepted Answer

The answer of In a patient with low back pain...

Question 21

Which radiographic view is BEST for evaluating suspected rotational subluxation at C1/C2?&#10;A) Open-mouth odontoid&#10;B) Lateral C-spine with flexion and extension&#10;C) AP view with cephalad angulation&#10;D) Posterior oblique views

Accepted Answer

The answer of Which radiographic view is BEST for evaluating...

Question 22

Which of the following is NOT associated with an osteoarthritic facet joint?&#10;A) Decreased density of subchondral bone&#10;B) Osteophytes&#10;C) Reduction in joint space&#10;D) Narrowing of the neuroforamen

Accepted Answer

The answer of Which of the following is NOT associated...

Question 23

The pedicle sign refers to which of the following?&#10;A) An increase in the visibility of a pedicle due to blastic disease&#10;B) A decrease in the visibility of a pedicle due to lytic disease&#10;C) The loss of contrast between a pedicle and the spinal canal due to an infection&#10;D) The increase in contrast between a pedicle and the spinal canal due to hyperthyroidism

Accepted Answer

The answer of The pedicle sign refers to which of...

Question 24

DISH is radiologically defined by the presence of:&#10;A) overhanging osteophytes on four or more contiguous facet joints.&#10;B) spondylolisthesis in four or more contiguous vertebrae.&#10;C) bridging syndesmophytes on four or more contiguous vertebral bodies.&#10;D) vacuum disks in four or more sequential disks.

Accepted Answer

The answer of DISH is radiologically defined by the presence...

Question 25

Which of the following is NOT associated with a bamboo spine?&#10;A) Bridging syndesmophytes&#10;B) Sacroilitis&#10;C) Facet joint hypertrophy&#10;D) HLA-B27 genotype

Accepted Answer

The answer of Which of the following is NOT associated...

Question 26

Modic changes refer to:&#10;A) facet joint osteoarthritis.&#10;B) vacuum disks.&#10;C) bone marrow changes associated with disk degeneration.&#10;D) annular fibrosis tears.

Accepted Answer

The answer of Modic changes refer to:&#10;A) facet joint osteoarthritis.&#10;B)...

Question 27

In a patient with radiculopathy whose MRI reveals only an associated annular tear, you would most likely attribute the patient's pain to:&#10;A) inflammatory changes in an adjacent nerve root.&#10;B) nerve compression caused by neuroforaminal stenosis.&#10;C) facet joint arthritis.&#10;D) adhesive arachnoiditis.

Accepted Answer

The answer of In a patient with radiculopathy whose MRI...

Question 28

A sequestered disk fragment refers to:&#10;A) a disk that is both herniated and bulging.&#10;B) a disk fragment resulting from an annular tear.&#10;C) a disk fragment that is pressing directly on the spinal cord.&#10;D) a disk fragment that is separated from the parent disk.

Accepted Answer

The answer of A sequestered disk fragment refers to:&#10;A) a...

Question 29

Which of the following statements about disk herniations is INCORRECT?&#10;A) Larger disk herniations always produce more severe radiculopathy than smaller disk herniations.&#10;B) Midline disk herniations may produce less severe symptoms than foraminal herniations.&#10;C) Chronic disk herniations are more likely to be associated with spondylosis than soft herniations.&#10;D) They may contribute to the development of spinal stenosis.

Accepted Answer

The answer of Which of the following statements about disk...

Deck 3: Spine and Spinal Cord