Cervical Spine Anatomy & Pathology: Exam Review, Exams of Radiology

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Radd Quality Final Exam Study Guide Review Questions

with Answers

1. a. Fusion of posterior elements b. Wasp-waist deformity g. Rudimentary disc space: What are the findings on this image? a. Fusion of posterior elements b.Wasp-waist deformity c. Omovertebral bone d.Sprengel's deformity e. Osteophytosis f.Decreased disc space g.Rudimentary disc space
2. Anterior VB concavity: Wasp-Waist deformity AKA
3. Klippel-Feil Syndrome: Wasp-waist deformity, Anterior vertebral body concavity, and fusion of the posterior elements are all seen with what condition?
4. c. Omovertebral bone d. Sprengel's deformity: What are the radiographic findings on this image? What are the findings on this image? a. Fusion of posterior elements b.Wasp-waist deformity c. Omovertebral bone d.Sprengel's deformity e. Osteophytosis f.Decreased disc space g.Schmorl's nodes
5. b. Sprengel's deformity: An undescended scapula is seen in what condition? a. Klippel-Feil syndrome b.Sprengel's deformity c. Spondyloschesis d.Scheuermann's disease
6. b. Yes, Flexion/Extension to evaluate instability: A cervical spine series shows multiple blocked vertebra, anterior body concavity, and rudimentary disc space at C2-C4 and C6-C7. Would you want any other x-rays? a.Yes, dependent on patient's presentation b. Yes, Flexion/Extension to evaluate instability c. No, they're safe to adjust

2 / d.No, they must be referred immediately

7. c. Refer to a neurologist (possibly D after they've been seen): A patient who's been diagnosed with Klip- pel-Feil syndrome is having cape-shawl like pain and paresthesia from their cervical spine into their extremities. What is the proper follow up for this patient? a. Adjust them b.Do a flexion-extension cervical series to evaluate instability c. Refer to a neurologist d.Ask for a MRI to evaluate the syrinx

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c. Disc degeneration d. Osteophytosis f. Occipitalization:** What are the findings in this cervical series? a. Multiple blocked vertebrae b.Posterior element fusion c. Disc degeneration d. Osteophytosis e. Spondyloschesis f.Occipitalization g.Spina bifida occulta

9. a. True (Flexion/Extension): A patient with occipitalization needs additional x- rays. a.True b.False
10. b. False: A patient without neurological symptoms and occipitalization needs follow up imaging and cannot be adjusted. a.True b.False
11. Fuch's view: What view is this?
12. b. Non-union of the base of the dens: Os odontoideum is: a. Fracture of the base of the dens b.Non-union of the base of the dens c. Fracture of the tip of the dens d.Non-union of the tip of the dens
13. a. Posterior ponticus: What finding(s) are seen in this lateral cervical film? a. Posterior ponticus b.Posterior element fusion

3 / c. Os odontoideum d. Osteophytosis e. Spondyloschesis f.Occipitalization g.Spina bifida occulta

14. c. Os odontoideum: What finding(s) are seen in this fuch's view? a. Posterior ponticus

4 / b.Posterior element fusion c. Os odontoideum d. Osteophytosis e. Spondyloschesis f.Occipitalization g.Spina bifida occulta

15. b. no (enlarged already, no need to stress the joint!): Does a patient with an enlarged ADI on a neutral lateral cervical view need flexion/extension views? a. yes b.no
16. c. Flexion/Extension views: What is the proper follow up for a patient with os odontoideum? a. MRI b.Blood work c. Flexion/Extension views d.Referral to a neurosurgeon
17. d. Referral to a neurosurgeon: 25-year-old female with a 6 mm ADI What is the appropriate follow up? a. MRI b.Blood work c. Flexion/Extension views d.Referral to a neurosurgeon
18. c. Flexion/Extension views: What is the proper follow up in a patient with a normal ADI on a lateral cervical film? a. MRI b.Blood work c. Flexion/Extension views d.Referral to a neurosurgeon
19. e. Spondyloschesis: What finding(s) is/are seen in these cervical films? a. Posterior ponticus b.Posterior element fusion c. Os odontoideum d. Osteophytosis e. Spondyloschesis f.Occipitalization g.Agenesis of the posterior arch
20. b. Os odontoideum: Spina bifida occulta at C1 is known as:

5 / a. Posterior ponticus

6 / b.Os odontoideum c. Spondyloschesis d.Agenesis of the posterior arch

21. b. No (spondylolischesis): Any other x-rays needed for this patient? a.Yes b.No
22. b. no (spondylolischesis): Any other images needed for this patient? a. yes b.no
23. Yes (spondylolischesis): Can you adjust this patient? a. yes b.no
24. g. Agenesis of the posterior arch: What are the radiographic finding(s) on this lateral cervical view? a. Posterior ponticus b.Posterior element fusion c. Os odontoideum d. Osteophytosis e. Spondyloschesis f.Occipitalization g.Agenesis of the posterior arch
25. Yes, Flexion/Extension for Instability: Is there additional imaging needed for agenesis of the posterior arch of C1?
26. Cervical rib: What is the radiographic finding on this series?
27. b. Posterior element fusion e. Rudimentary disc spaces g. Anterior body concavity: What are the findings on this image? a. Multiple blocked vertebrae b.Posterior element fusion c. Disc degeneration d. Osteophytosis e. Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity
28. d. Butterfly vertebra (T10): What is the radiographic finding on this film?

7 / a. Multiple blocked vertebrae b.Posterior element fusion c. Disc degeneration d.Butterfly vertebra e. Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity

29. d. Butterfly vertebra (T7): What is the radiographic finding on this film? a. Multiple blocked vertebrae b.Posterior element fusion c. Disc degeneration d.Butterfly vertebra e. Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity
30. d. Butterfly vertebra: What is the radiographic finding on this film? a. Multiple blocked vertebrae b.Posterior element fusion c. Disc degeneration d.Butterfly vertebra e. Rudimentary disc spaces f.Schmorl's nodes g.Anterior body concavity
31. Cervical series (APLC, APOM, Lateral cervical): Mr. Mark is a 42-year-old office manager who's complaining of progressive numbness/weakness in his left upper extremity that has been evolving over the past few weeks. He notes intermittent numbness and tingling in his left arm and hand. The pain is localized to the left shoulder and cervical region. What x-rays would you order?
32. **1. Spondyloschesis
33. Multiple congenital block vertebrae
34. Spina bifida C
35. Omovertebral bone
36. Cervical rib:** What are the most pertinent findings on Mr. Mark's cervical x-rays?
37. Klippel-Feil syndrome: What are the impression's of Mr. Mark's x-rays?

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34. **1. APOM (part of standard cervical series)
35. Flexion/Extension:** Other than the views provided, what additional x- rays would you like for Mr. Mark?
36. b. Klippel-Feil Syndrome: Chiari malformation is a potential outcome of what condition? a. Spondylolischesis b.Klippel-Feil Syndrome c. Sprengel's deformity d.Posterior ponticus
37. d. MRI without contrast: Suspicion of chiari malformation warrants what type of imaging follow up? a. CT b.MRI with contrast c. PET CT d.MRI without contrast
38. **"CRIT"
39. Crystal induced (gout/pseudogout)
40. Rheumatoid
41. Infectious
42. Traumatic:** What are the 4 types of monoarthritis?
43. **1. Osteophytes
44. Decreased joint space
45. Sclerosis
46. Sunchondral cysts
47. Vacuum phenomenon:** What are the main findings of degenerative changes?
48. b. 40%: What percentage of people aged >40 have degenerative changes? a. 25% b.40% c. 75% d. 100%
49. d. 100%: What percentage of people aged >65 have degenerative changes? a. 25% b.40% c. 75% d. 100%
50. a. Primary: Genetics are an example of which type of degenerative

9 / change? a. Primary b.Secondary

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42. b. Secondary: Trauma and abnormal biomechanics are examples of which type of degenerative change? a. Primary b.Secondary
43. c. Gout: Monosodium urate crystals are seen in which condition? a. Pseudogout b.HADD c. Gout d. CPPD
44. a. Pseudogout d. CPPD: Which of the following is most commonly found in the knee? a. Pseudogout b.HADD c. Gout d. CPPD
45. b. HADD: Which of the following is most commonly found in the shoulder? a. Pseudogout b.HADD c. Gout d. CPPD
46. d. Supraspinatus: Which tendon is HADD most common in? a. Infraspinatus b.Teres minor c. Biceps tendon d. Supraspinatus
47. b. HADD: Calcification of the tendon is due to which of the following? a. Pseudogout b.HADD c. Gout d. CPPD
48. c. Chondrocalcinosis: Calcification in the joint is known as: a. Pseudogout b.Hydroxyappetite deposition disease c. Chondrocalcinosis d.Pryophosphate arthropathy
49. d. Pryophosphate arthropathy (Chondrocalcinosis leads to pyrophosphate arthropathy): Which of the follow- ing is a secondary result of calcification in the joint?

11 / a. Pseudogout

12 / b.Hydroxyappetite deposition disease c. Chondrocalcinosis d.Pryophosphate arthropathy

50. **1. Decreased joint space (DIPs)
51. Subchondral sclerosis (DIPs)
52. Osteophytosis (DIPs):** What are the radiographic findings on this radiograph?
53. **1. Decreased joint space
54. Osteophytosis at medial and lateral margins of knee
55. Sclerosis
56. Hardware due to previous trauma:** What are the radiographic findings on this image?
57. **1. IVD
58. Facet
59. Uncinate:** What 3 joints should always be checked in the cervical region?
60. **1. DJD at C3-C4, C5-C6 (Lateral)
61. Facet arthrosis at C4-C5, C5-C6 (APLC):** What are the radiographic findings on these images?
62. e. Adjust them: In a patient with DJD in the cervical region with no other significant findings, what other follow ups are needed? a. Flexion/Extension views b.MRI c. Referral to an orthopedist d.Blood work e. Adjust them
63. a. MRI of the cervical spine (or refer to neurologist): This patient is having canal symptoms and the Pavlov ratio measures 0.76. What follow up would you like for this patient? a. MRI of the cervical spine b.Refer to an endocrinologist c. Arthritic panel d.Flextion/Extension views
64. b. >0.8: A pavlov ratio of or less indicates canal stenosis. a. >0. b.>0. c. 0. d. 1.

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57. Pseudofracture: What is the finding in this patient?
58. c. Uncinate processes: What normal anatomy causes a pseudofracture in the cervical spine?

14 / a. Facets b.Articular pillars c. Uncinate processes d. Lamina

59. Subchondral cysts!: What is the significant finding in this hip series?
60. Orthopedist/PT: A patient with degeneration who has not been progressing with chiropractic care should be referred to a(n): a. Neurologist b.Orthopedist c. Endocrinologi st d.
61. e. Pharmacology: Which of the following answer choices is meant to decrease inflammation? a. Chiropractic adjustments b.Social support c.Weight loss and orthotic use d. Physiotherapy e. Pharmacology
62. c. Weight loss and orthotic use: Which of the following answer choices is meant to protect the joint? a. Chiropractic adjustments b.Social support c.Weight loss and orthotic use d. Physiotherapy e. Pharmacology
63. a. Chiropractic adjustments: Which of the following answer choices is meant to restore joint function? a. Chiropractic adjustments b.Social support c.Weight loss and orthotic use d. Physiotherapy e. Pharmacology
64. d. EOA: Gull-wing deformity is specific to which condition? a. CPPD/Pseudogout b.HADD c. Gout d. EOA e. Pyrophosphate arthropathy

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65. a. PIP c. DIP (Interphalangeal joints): What joints are affected in patients with EOA? a. PIP b.MCP c. DIP e. Wrists
66. c. Post-menopausal women: What population is EOA most commonly seen in? a. Elderly men b. Young women c. Post-menopausal women d.Young men
67. c. Bilateral, symmetric: EOA is and a. Unilateral, symmetric b.Bilateral, asymmetric c. Bilateral, symmetric d.Unilateral, asymmetric
68. d. EOA: What is the most likely diagnosis based on the radiographic findings? a. Rheumatoid arthritis b.Degenerative joint disease c. CPPD d. EOA e. Pyrophosphate arthropathy
69. a. Yes (pain permitting): Can you adjust a patient with EOA? a.Yes b.No
70. d. Arthritic panel: If Rheumatoid Factor is suspected in a patient, what should be ordered to confirm this? a. Metabolic panel b.CBC c. Rheumatoid panel d.Arthritic panel
71. **1. RF
72. ANA
73. C-Reactive Protein (CRP)
74. CBC
75. Comprehensive Metabolic Panel (CMP):** What 5 things does an arthritic

16 / panel test for?

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72. d. Gout: A lumpy bumpy overhanging margin sign is seen with what condition? a. CPPD b.Pyrophosphate arthropathy c. Chondrocalcinosis d. Gout e. HADD
73. d. Gout: Erosions are pathognomonic for which of the following crystal deposi- tion disease? a. CPPD b.Pyrophosphate arthropathy c. Chondrocalcinosis d. Gout e. HADD
74. d. Gout: This AP foot and spot projection demonstrates what condition? a. CPPD b.Pyrophosphate arthropathy c. Chondrocalcinosis d. Gout e. HADD
75. c. Blood work (for uric acid): What would be the proper follow up for this patient? a. MRI b.Surgery c. Blood work d. Adjustment
76. d. Elevated Uric Acid levels: What lab value(s) would you expect to find in this patient? a. RF+ b.ANA c. Elevated CRP levels d.Elevated Uric Acid levels e. Elevated A1C levels
77. a. Primary care provider: Who should a patient with gout be referred to? a. Primary care provider b.Rheumatologist c. Orthopedist d. Podiatrist

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78. a. CPPD: Linear calcification paralleling the articular surface is seen in which condition?

19 / a. CPPD b.Pyrophosphate arthropathy c. Chondrocalcinosis d. Gout e. HADD

79. c. CPPD "CPPD IN KNEE": This linear calcification that parallels the articular surface indi- cates which of the following? a. HADD b.Chondrocalcinosis c. CPPD d.Pyrophosphate arthropathy
80. a. yes: Can you adjust a patient with CPPD? a. yes b.no
81. c. HADD: Globular or ovoid calcification is seen with which condition? a. Chondrocalcinosis b.CPPD c. HADD d. Pseudogout
82. c. Ossification of the ALL: What is the most significant finding on this patient? a. Spondylolischesis b.Decreased disc height with osteophytosis c. Ossification of the ALL d.Ossification of the PLL
83. OPLL: What condition is associated with DISH but has a much more sinister outcome?
84. e. Elevated A1C levels: What lab value(s) would you expect to find in this patient? a. RF+ b.ANA c. Elevated CRP levels d.Elevated Uric Acid levels e. Elevated A1C levels
85. HLA-B8 (and A1C levels): What blood work findings might be found in a patient with DISH?
86. b. False (Low force): You can adjust a patient with DISH HVLA.

20 / a.True b.False

87. d. Erosions: What is the main characteristic finding for inflammatory arthritis? a. Decreased joint space b.Subchondral sclerosis c.Vacuum phenomenon d. Erosions e. Osteophytes
88. **PEAR
89. Psoriatic arthritis
90. Enteropathic arthritis
91. Ankylosing spondylitis
92. Reactive arthritis:** What are the Seronegative Spondyloarthropathies?
93. c. Ankylosing spondylitis: What is the most common seronegative inflamma- tory spondyloarthropathy? a. Psoriatic arthritis b.Rheumatoid arthritis c. Ankylosing spondylitis d.Enteropathic arthritis e. Scleroderma f.SLE
94. b. Seropositive: Which is RF +? a. Seronegative b.Seropositive
95. d. Rheumatoid arthritis: What is the most common seropositive spondy- loarthropathy? a. Juvenile RA b.SLE c. Ankylosing spondylitis d.Rheumatoid arthritis e. Reactive arthritis f.Scleroderma
96. RF+, ANA+, CRP, and ESR: What lab value(s) are likely seen in a patient with Rheumatoid Arthritis?
97. f. Inflamatory arthritis: Focal indentations into the articular surface are charac- teristic for which kind of conditions? a. Degenerative arthritis b.Congenital variants

21 / c.Traumatic injuries

22 / d.Hematological disorders e. Spondylo discitis f.Inflamatory arthritis

94. Erosions: "Focal indentations into the articular surface" is describing:
95. c. Ankylosing spondilitis g. Enteropathic arthritis: Which seronegative inflammatory arthropathies are bilat- erally symmetric? a. Rheumatoid arthritis b.Psoriatic arthritis c. Ankylosing spondilitis d. SLE e. Reactive arthritis f.Scleroderma g.Enteropathic arthritis
96. b. Psoriatic arthritis e. Reactive arthritis: Which seronegative inflammatory arthropathies are bilaterally asymmetric? a. Rheumatoid arthritis b.Psoriatic arthritis c. Ankylosing spondilitis d. SLE e. Reactive arthritis f.Scleroderma g.Enteropathic arthritis
97. d. AS and Enteropathic: Which seronegative inflammatory arthropathies can- not be differentiated radiographically (have identical appearance)? a. AS and Psoriatic b.Psoriatic and Enteropathic c. Enteropathic and Reactive d.AS and Enteropathic e. AS and Reactive
98. a. True (90%) (BUT don't have RF): Seronegative inflammatory arthropathies are typically HLA-B 27+ a.True b.False
99. c. Sclerosis d. Symmetrical loss of joint space

23 / e. Erosions

24 / g. Syndesmophytes h. Periostitis: Select all the radiographic findings for inflammatory arthritis: a. Osteophytes b.Asymmetrical loss of joint space c. Sclerosis d.Symmetrical loss of joint space e. Erosions f.Subchondral cysts g. Syndesmophytes h. Periostitis

100. d. Bilateral sclerosis with erosions (Sacroiliitis): Based on this image, what are the radiographic findings? a. Unilateral sclerosis with erosion b.Bilateral sclerosis with consequent "ghost sign" c. Unilateral sclerosis with well defined densities adjacent to it d.Bilateral sclerosis with erosions
101. c. Sacroiliitis: This image demonstrates: a. Ghost sign b.Bone islands c. Sacroiliitis d.Bilateral destruction
102. b. Psoriatic arthritis: Focal indentations into the articular surface seen at the metatarsal heads are characteristic of: a. Rheumatoid arthritis b.Psoriatic arthritis c. Ankylosing spondilitis d. SLE e. Reactive arthritis f.CPPD g. Gout
103. d. Psoriatic arthritis e. Reactive arthritis: Erosions of the articular surface in the metatarsal heads is characteristic of: a. Gout b.CPPD c. DJD d.Psoriatic arthritis e. Reactive arthritis

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104. a. Sacroiliitis: This image demonstrates: a. Sacroiliitis b.Bone islands c. Ghost sign d.Bilateral destruction
105. b. Symmetrical loss of joint space d. Erosions at metatarsal heads 3-5: What are the significant radiographic findings on this medial oblique foot image? a. Erosions at the DIP b.Symmetrical loss of joint space c. Sesamoid bone at the first metatarsal head d.Erosions at metatarsal heads 3- 5
106. b. Psoriatic arthritis: Using this AP and Medial oblique foot, what is the most likely diagnosis? a. Ankylosing spondylitis b.Psoriatic arthritis c. Degenerative Joint Disease d.Rheumatoid arthritis e. Pyrophosphate arthropathy
107. d. RF- and HLA B27 (Psoriatic): What lab value(s) would you expect to see in this patient? a. RF+ and ANA b.RF- and ANA c. RF+ and HLA B27 d.RF- and HLA B27 e. RF+ and CRP
108. d. Flexion/Extension view of cervical spine: Anyone suspected of having inflammatory arthropathies must have what type of follow up? a. MRI/other imaging b.Adjustments c. Referral to an orthopedist d.Flexion/Extension view of cervical spine
109. d. RF- and HLA B27 (Psoriatic b/c asymmetrical erosions): What lab value(s) would you expect to see in this patient? a. RF+ and ANA b.RF- and ANA c. RF+ and HLA B27