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Self-Assessment Questions


Rheumatologic Disease in the Spine: Review Questions

Janet Burkholder-Krommes, MD

Dr. Burkholder-Krommes is an Assistant Professor of Medicine, Temple University Hospital, Philadelphia, PA.

Choose the single best answer for each question.

1. A 45-year-old woman sees her physician because of neck pain 1 week after an automobile accident in which her car was rear-ended by a truck. She was evaluated in a local emergency department after the accident, where results of a cervical radiograph were normal. She was advised to use a soft cervical collar for several days and to expect generalized aching. The aching has modestly improved, but she is now experiencing numbness and tingling down her left outer arm to the middle finger, and the sensation is progressing. There is focal tenderness over the distal cervical spine. Which of the following therapeutic interventions should be considered for this patient?
  1. Computed tomography scan of the cervical spine
  2. Initiation of high-dose nonsteroidal anti-inflammatory drug therapy
  3. Referral to physical therapy
  4. Round-the-clock use of a muscle relaxant
  5. Use of a Philadelphia collar to improve cervical support
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2. Which of the following symptoms or signs is most specific for a herniated disc in a patient with severe pain radiating down his left leg when he stands up to walk?

  1. Decreased ankle joint reflex
  2. Development of urinary and bowel incontinence
  3. Pain that is relieved by back flexion
  4. Poor response to a 48-hour trial of bed rest
  5. Radicular pain on a contralateral straight leg test
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3. A 68-year-old man with diabetes mellitus and hypertension reports pain when walking. He states that he feels fine when he starts walking, but after half a block, he develops severe pain in his legs that is relieved only by sitting down. When he pushes a grocery cart, he is able to walk much further. He walks with a wide-based gait. Results of a neurologic examination are nonfocal; pulses are diminished but palpable. Which of the following is the most appropriate first step in this patient’s evaluation?
  1. Instruct the patient in Williams’ flexion exercises
  2. Order magnetic resonance imaging of the lumbosacral spine
  3. Perform a bone density scan
  4. Refer the patient to a vascular surgeon
  5. Start a graduated exercise program for the patient
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4. Which of the following features is suggestive of ankylosing spondylitis in a patient with a 2-year history of progressive back pain?

  1. Basilar fibrosis on chest radiography
  2. Positive rheumatoid factor
  3. Presence of HLA-B27
  4. Prominent morning back stiffness
  5. Recurrent sciatic pain
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5. A 74-year-old man has severe pain in the coccyx area when sitting. Two weeks ago, he slipped and fell on the stairs outside his home. The pain has been progressive and has not been relieved by any over-the-counter medication. Which of the following parts of the physical examination is most important to diagnose this patient’s condition?

  1. Musculoskeletal
  2. Neurologic
  3. Rectal
  4. Skin
  5. Spinal
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