Scoliosis

Scoliosis

Q. 1

Risser Localiser cast is used in the management of:

 A

Kyphosis

 B

Spondylolysthesis

 C

Idiopathic scoliosis

 D

Lordosis

Q. 1

Risser Localiser cast is used in the management of:

 A

Kyphosis

 B

Spondylolysthesis

 C

Idiopathic scoliosis

 D

Lordosis

Ans. C

Explanation:

Idiopathic scoliosis [Ref- Sing Med J. 1988; 29:219-221; Maheshwari Orthopedics 3/e p235]

  • Risser’s Localiser cast is used for non-operative correction of idiopathic scoliosis. Other casts and braces used for scoliosis are: Milwaukee brace, Boston brace
  • Operative management of idiopathic scoliosis includes:
  1. The Harrington Rodding
  2. Rod and sublaminar wiring (Luque)
  3. The Cotrel-Dubousset system

d.Anterior instrumentation (Dwyer; Zielke)

Casts and Splints

Minerva cast———————————— Cervical spine fracture

Hanging cast———————————— Fracture Humerus

Cylinder cast———————————– Fracture Patella

Patellar tendon bearing cast————— Fracture Tibia

Aluminium splint—————————– immobilization of finger

Thomas splint———————————- Fracture femur

Bohler Braun splint————————– Fracture femur

Toe rising splint——————————- Foot drop

Knuckle bender splint———————– Ulnar nerve palsy

Cock up splint——————————— Radial nerve palsy

Dennis Brown splint————————- CTEV

  • Also Know

Risser’s sign:

This is a sign to assess skeletal maturity as the scoliotic curvature progresses most during the period of rapid skeletal growth.

The iliac apophyses start ossifying shortly after puberty. Once the iliac crests are completely ossified, further progression of the scoliosis is minimal (Risser’s sign)


Q. 2

Progression of congenital scoliosis is least likely in which of the following vertebra anomalies?

 A

Fully segmented Hemivertebra

 B

Wedge vertebra

 C

Block vertebra

 D

Unilateral unsegmented bar with Hemivertebra

Q. 2

Progression of congenital scoliosis is least likely in which of the following vertebra anomalies?

 A

Fully segmented Hemivertebra

 B

Wedge vertebra

 C

Block vertebra

 D

Unilateral unsegmented bar with Hemivertebra

Ans. C

Explanation:

Block vertebra type of scoliosis has the best prognosis. The progression is slow and it can be corrected easily, whereas unilateral thoracic unsegmented type carries worst prognosis.

Ref: Orthopaedic Surgery Essentials in Pediatrics By Kathryn E. Cramer, Susan A. Scherl, 2004), Page 65; Campbell’s Orthopaedics, 11th Edition, Page 2607.


Q. 3

Which of the following is the MOST common skeletal manifestation in Type-1 Neurofibromatosis?

 A

Cortical thinning of long bones

 B

Pseudoarthrosis

 C

Sphenoid dysplasia

 D

Scoliosis

Q. 3

Which of the following is the MOST common skeletal manifestation in Type-1 Neurofibromatosis?

 A

Cortical thinning of long bones

 B

Pseudoarthrosis

 C

Sphenoid dysplasia

 D

Scoliosis

Ans. D

Explanation:

Von Recklinghausen’s Disease or NF-1 – skeletal manifestations
 
Scoliosis is the most common skeletal manifestation of NF-1, affecting 10%–30% of patients.
 
More Info: There are two other bony lesions distinctive enough to be included in the diagnostic criteria for NF-1. 
 
1. Dysplasia of the wing of the sphenoid bone, results in poor formation of the wall and/or floor of the orbit. This leads to proptosis (from herniation of meninges or brain into the orbit) or enophthalmos.
 
2. Dysplasia of a long bone, characterized by congenital thinning and bowing, affects approximately 2% of children with NF-1.
Although the tibia is most commonly affected, the femur, humerus and other long bones may also be involved.
Failure of primary union following a fracture results in a “false joint” or pseudarthrosis.
 
Ref: Listernick R., Charrow J. (2012). Chapter 141. The Neurofibromatoses. In L.A. Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds), Fitzpatrick’s Dermatology in General Medicine, 8e.

Q. 4

Which of the following abnormality is seen in a preoperative pulmonary function test, done in a patient with severe kyphoscoliosis?

 A

Increased FRC

 B

Increased RV/TLC

 C

Reduced FEV1/FVC

 D

Reduced FEV25-75

Q. 4

Which of the following abnormality is seen in a preoperative pulmonary function test, done in a patient with severe kyphoscoliosis?

 A

Increased FRC

 B

Increased RV/TLC

 C

Reduced FEV1/FVC

 D

Reduced FEV25-75

Ans. B

Explanation:

Kyphoscoliosis is a combination of excessive anteroposterior and lateral curvature of thoracic spine.
The major pathophysiologic effect of severe kyphoscoliosis are restrictive lung disease and ventillation perfusion imbalance resulting in chronic hypoventilation, hypoxic vasoconstriction pulmonary artery hypertension and cor pulmonale.
Pulmonary function test shows a decrease in vital capacity and total lung capacity and an increase in residual volume, resulting in an increased residual volume/total lung capacity.
Flow is reduced only in propotion to the reduction in vital capacity.
 
Ref: Pulmonary Function Testing and Cardiopulmonary Stress Testing By Vincent C. Madama, 2nd Edition, Page 102; Chest Medicine: Essentials of Pulmonary and Critical Care Medicine By Ronald B. George, 5th Edition, Pages 440-1

Q. 5

Which type of cerebral palsy is commonly associated with scoliosis and other orthopedic problems ‑

 A

Spastic quadriplegia

 B

Anterior cerebral palsy

 C

Spastic deplegia

 D

Atonic cerebral palsy

Q. 5

Which type of cerebral palsy is commonly associated with scoliosis and other orthopedic problems ‑

 A

Spastic quadriplegia

 B

Anterior cerebral palsy

 C

Spastic deplegia

 D

Atonic cerebral palsy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Spastic quadriplegia

“Scoliosis is common, occuring in 15 to 25 percent of the total body CP (spastic quadriplegia CP)”. — Tachdjian Cerebral palsy (CP)

o Cerebral palsy is defined as a non progressive neuromotor disorder of cerebral origin.

o It has following features ‑

i)      Static (nonprogressive)

ii)     Disorder of movement/motor disorder (but sometimes sensory involvement may occur)

iii)    Cerebral in origin

Etiopathogenesis

o CP is due to an insult of developing brain.

o The insult results in maldevelopment and disorderly anatomic organization of the brain.

o The insult may be prenatal (most of the cases), during delivery or in the postnatal period.

Classification

o CP may be classified into following types –

1) Spastic cerebral palsy                              

2) Hypotonic (Atonic) CP

3) Extrapyramidal CP

4) Mixed type CP

  •  This is the most common type
  •  This includes        

i) Spastic quadriparesis  ii) Spastic diplesia         iii) Spastic hemiplegia


Q. 6

Musculo skeletal abnormality in neurofibromatosis is

 A

Hypertrophy of limb

 B

Scoliosis

 C

Cafe au lait spots

 D

All

Q. 6

Musculo skeletal abnormality in neurofibromatosis is

 A

Hypertrophy of limb

 B

Scoliosis

 C

Cafe au lait spots

 D

All

Ans. D

Explanation:

Ans. is `d’ i.e., All 


Q. 7

The abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes:

 A

Reduced RV and TLC

 B

Reduced FEV1/FVC.

 C

Reduced FEV25-75

 D

Increased FRC

Q. 7

The abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes:

 A

Reduced RV and TLC

 B

Reduced FEV1/FVC.

 C

Reduced FEV25-75

 D

Increased FRC

Ans. A

Explanation:

Answer is A (Reduced RV and TLC):

Kyphoscoliosis is a restrictive lung disease.

  • There is decrease in residual volume and total lung capacity.
  • FEV1 and FVC are proportionately decreased.
  • Hence the ratio of FEV1 to FVC remains normal or is increased.
  • The forced expiratory flow rate (FEF) is normal.
  • Functional residual capacity (FRC) is decreased.

Q. 8

Unilateral elevation of diaphragm is commonly due to:

 A

Obesity

 B

Large liver

 C

Scoliosis

 D

Congenital causes

Q. 8

Unilateral elevation of diaphragm is commonly due to:

 A

Obesity

 B

Large liver

 C

Scoliosis

 D

Congenital causes

Ans. C

Explanation:

Ans. C.)Scoliosis.

Causes of Unilateral Elevation of Diaphragm:

Unilateral elevation of Diaphragm occurs more commonly in left side as compared to right side.

Also,the most common cause is acquired Phrenic nerve palsy.

So,looking to the above discussion,Scoliosis may be the correct answer.


Q. 9

Vertebral rotation in scoliosis is checked in

 A

Forward bending

 B

Backward bending

 C

Sideways

 D

Without bending

Q. 9

Vertebral rotation in scoliosis is checked in

 A

Forward bending

 B

Backward bending

 C

Sideways

 D

Without bending

Ans. A

Explanation:

Ans. is ‘a’ i.e., Forward bending

The forward bending test is very sensitive in demonstrating the vertebral rotation that takes place in a structural scoliotic curve.

  • Quantification of the rotation is done by measuring the rib hump by use of inclinometer or scoliometer.
  • Severity of the curve in scoliosis is measured by cobb’s angle, i.e. an angle between line passing through the margins of vertebra at ends of curve. To use the cobb method, one must first decide which vertebrae are the end-vertebrae of the curve. These end vertebrae are the vertebrae at the upper and lower limits of curve which tilt most severely toward the conavity of the curve. Other method used to measure scoliosis angle is Ferguson’s method.

Q. 10

Milwalkee brace is used in treatment of ‑

 A

Scoliosis

 B

Kyphosis

 C

Cubitus varus

 D

Genu varum

Q. 10

Milwalkee brace is used in treatment of ‑

 A

Scoliosis

 B

Kyphosis

 C

Cubitus varus

 D

Genu varum

Ans. A

Explanation:

Ans. is ‘a’ i.e., Scoliosis

The Milwaukee brace is principally a thoracic support consisting of a pelvic corset connected by adjustable steel supports to a cervical ring carrying occipital and chin pads.

Its purpose is to reduce the lumbar lordosis and encourage active stretching and straightening of the thoracic spine.

It is used in the conservative management of idiopathic scoliosis.


Q. 11

Turn-buckle cast is used for ‑

 A

Fracture shaft humerus

 B

Fracture shaft femur

 C

Scoliosis

 D

Cervical spine injury

Q. 11

Turn-buckle cast is used for ‑

 A

Fracture shaft humerus

 B

Fracture shaft femur

 C

Scoliosis

 D

Cervical spine injury

Ans. C

Explanation:

Ans. is ‘c’ i.e., Scoliosis.

Name of the case                                Use

Minerva cast                               Cervical spine disease

Risser’s cast                               Scoliosis

Turn-buckle cast                         Scoliosis

Shoulder spica                            Shoulder immobilisation

U-slab                                       Fracture of the humerus

Hanging cast                              Fracture of the humerus

Colle’s cast                                Colles’ fracture

Hip spica                                   Fracture of the femur

Cylinder cast                              Fracture of the patella

PTB cast                                    Fracture of the tibia



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