Clinical Challenge 1, Norwegian Chiropractors' Association
Publisert av Norsk Kiropraktorforening/Published by Norwegian Chiropractors' Association
QuizMaster: Peter W. Bull DC, MappSc, FICC, FACC
Senior Lecturer
Director of Postgraduate & Professional Studies
Department of Health & Chiropractic
Macquarie University Over thirty years experience in diagnostic & chiropractic radiology. Holds a Doctor of Chiropractic degree. A Masters degree in Medical Imaging – Image Interpretation. Was admitted as a Fellow of the International College of Chiropractors and the Australian College of Chiropractors. Inaugural Fellow of the Australasian College of Chiropractic Is the author of in excess of fifteen scientific papers and book chapters regarding radiology & spinal syndromes. Has presented at numerous National Read moreand International conferences. Is currently the Director for Postgraduate Studies at Macquarie University’s Department of Health & Chiropractic Graduated Student of the Year. Voted Chiropractor of the YearAwarded Life Membership to the Alumni and Gonstead Society
Mer infor her https://www. Chiro. Mq. Edu. Au/Research/Peter%20Bull. Htm
- 1.
Which of the following conditions would not be considered to be a cause of the above radiologic features:
- A.
Marfan’s syndrome
- B.
Neurofibromatosis
- C.
Hodgkin’s disease
- D.
Achondroplasia
Correct Answer
C. Hodgkin’s diseaseExplanation
Hodgkin's disease is a type of lymphoma that affects the lymphatic system. It is not typically associated with radiologic features that would be seen on imaging studies. The radiologic features mentioned in the question are likely referring to specific findings that are commonly seen in conditions such as Marfan's syndrome, neurofibromatosis, and achondroplasia. Therefore, Hodgkin's disease would not be considered a cause of the radiologic features mentioned.Rate this question:
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- 2.
Which USA President was thought to have suffered from Marfan’s syndrome?:
- A.
George Washington
- B.
Abraham Lincoln
- C.
Richard Nixon
- D.
George Bush Snr.
Correct Answer
B. Abraham LincolnExplanation
Abraham Lincoln is thought to have suffered from Marfan's syndrome. Marfan's syndrome is a genetic disorder that affects the connective tissues in the body. Some of the physical characteristics associated with Marfan's syndrome, such as tall stature, long limbs, and a narrow face, were observed in Lincoln. Additionally, Lincoln's documented health issues, including his height, thin frame, and heart problems, further support the speculation that he may have had Marfan's syndrome.Rate this question:
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- 3.
The café-au-lait spots associated with neurofibromatosis are typically:
- A.
One or two large and irregular margined
- B.
Six or more large and irregular margined
- C.
One or two small and smooth margined
- D.
Six or more small and smooth margined
Correct Answer
D. Six or more small and smooth marginedExplanation
The café-au-lait spots associated with neurofibromatosis are typically six or more in number and have small and smooth margins. This means that individuals with neurofibromatosis may have multiple spots on their skin that are small in size and have smooth edges. This characteristic helps in distinguishing these spots from other types of skin markings or lesions.Rate this question:
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- 4.
Which of the following is least likely to produce a solitary ivory vertebra:
- A.
Hodgkin’s disease
- B.
Paget’s disease
- C.
Fluoride poisoning
- D.
Osteoblastic metastasis
Correct Answer
C. Fluoride poisoningExplanation
Fluoride poisoning is least likely to produce a solitary ivory vertebra because it primarily affects the teeth and bones, causing fluorosis. It is unlikely to cause a solitary ivory vertebra, which is a rare condition characterized by a single bone becoming excessively dense and ivory-like. On the other hand, Hodgkin's disease, Paget's disease, and osteoblastic metastasis are all conditions that can lead to the development of a solitary ivory vertebra, as they involve abnormal bone growth and remodeling.Rate this question:
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- 5.
A major concern for the chiropractor associated with the treatment of an achondroplastic patient is:
- A.
Scoliosis
- B.
Spinal stenosis
- C.
Osteoporosis
- D.
No specific contraindications
Correct Answer
B. Spinal stenosisExplanation
The correct answer is spinal stenosis. Achondroplasia is a genetic disorder that causes abnormal bone growth, particularly in the limbs and spine. Spinal stenosis is a common complication of achondroplasia, where the spinal canal narrows, putting pressure on the spinal cord and nerves. This can lead to symptoms such as back pain, numbness, and difficulty walking. Therefore, a chiropractor treating an achondroplastic patient should be particularly concerned about spinal stenosis and its potential impact on the patient's overall health and well-being.Rate this question:
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- 6.
A major concern for the chiropractor associated with the treatment of a patient with Marfan’s syndrome is:
- A.
Osteoporosis
- B.
Dural ectasia
- C.
Atlanto-axial instability
- D.
Scoliosis
Correct Answer
C. Atlanto-axial instabilityExplanation
A major concern for the chiropractor associated with the treatment of a patient with Marfan's syndrome is atlanto-axial instability. Marfan's syndrome is a genetic disorder that affects the connective tissues in the body, including those in the spine. Atlanto-axial instability refers to excessive movement or instability between the atlas (the first cervical vertebra) and the axis (the second cervical vertebra). This condition can increase the risk of spinal cord injury and neurological complications. Therefore, it is crucial for the chiropractor to be aware of this instability and take appropriate precautions when treating a patient with Marfan's syndrome.Rate this question:
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- 7.
Focal gigantism is a bizarre feature associated with?:
- A.
Acromegaly
- B.
Marfan’s syndrome
- C.
Neurofibromatosis
- D.
Achondroplasia
Correct Answer
C. NeurofibromatosisExplanation
Focal gigantism is a condition characterized by abnormal growth in a specific area of the body. Neurofibromatosis is a genetic disorder that causes tumors to form on nerve tissue, which can lead to focal gigantism in certain cases. This condition can result in localized overgrowth of bones and tissues, causing abnormal enlargement of body parts. Therefore, neurofibromatosis is associated with focal gigantism. Acromegaly, Marfan's syndrome, and achondroplasia are not specifically linked to focal gigantism.Rate this question:
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- 8.
An 8 year old girl complained of failing vision, and was found to have severely reduced acuity and constricted fields. On examination she had reduced growth, precocious puberty and obesity. Several cafe au lait spots were evident and characteristic changes around the iris. On thin-section axial and coronal CT studies a mass is identified lying in the chiasmatic cistern and interpeduncular fossa. Skeletal changes that may be found in association with this disorder may include :
- A.
Scoliosis with posterior vertebral scalloping
- B.
Multiple osteomas
- C.
Enchondromatosis
- D.
Polyostotic fibrous dysplastic lesions
Correct Answer
A. Scoliosis with posterior vertebral scallopingExplanation
The correct answer is scoliosis with posterior vertebral scalloping. This is because the patient's symptoms and findings are consistent with a diagnosis of neurofibromatosis type 1 (NF1), which is a genetic disorder that causes tumors to form on nerve tissue. Skeletal abnormalities, such as scoliosis and posterior vertebral scalloping, are common in patients with NF1. The other options listed, multiple osteomas, enchondromatosis, and polyostotic fibrous dysplastic lesions, are not typically associated with NF1.Rate this question:
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- 9.
The pain of Hodgkin’s lymphoma to bone is intensified by:
- A.
Bed rest
- B.
Physical activity
- C.
Heat
- D.
Alcohol consumption
Correct Answer
D. Alcohol consumptionExplanation
Alcohol consumption intensifies the pain of Hodgkin's lymphoma to bone. This is because alcohol can have a negative impact on bone health, leading to decreased bone density and increased risk of fractures. Additionally, alcohol can weaken the immune system, making it harder for the body to fight off infections and manage the symptoms of Hodgkin's lymphoma. Therefore, alcohol consumption can exacerbate the pain experienced in the bones for individuals with this condition.Rate this question:
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- 10.
A 25-year old male demonstrates mild bowing of the proximal aspect of the right thigh. Radiographs of the hip and thigh region reveal a coxa vara type bowing deformity of the proximal femur. The femur also demonstrates a large, geographic lucent region, which has a hazy or "ground glass" appearance. The most likely cause for these changes would be:
- A.
Paget's disease
- B.
Fibrous dysplasia
- C.
Neurofibromatosis
- D.
Hodgkin's lymphoma
Correct Answer
B. Fibrous dysplasiaExplanation
The most likely cause for the bowing deformity and the geographic lucent region with a "ground glass" appearance in the proximal femur is fibrous dysplasia. Fibrous dysplasia is a bone disorder characterized by the replacement of normal bone with fibrous tissue. It can cause bone deformities and weaken the affected bone, leading to fractures. The "ground glass" appearance on radiographs is a classic finding in fibrous dysplasia, indicating the presence of fibrous tissue and areas of increased bone density. Other conditions listed, such as Paget's disease, neurofibromatosis, and Hodgkin's lymphoma, do not typically present with these specific radiographic findings.Rate this question:
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