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6. Spine MCQs

Practice Set 25 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 481

Topic: 6. Spine

A patient with a fracture dislocation of the spine has a sensory level at the umbilicus. Which of the following nerve root levels indicates this finding:

. T2
. T4
. T7
. T10
. T12

Correct Answer & Explanation

. T10

Explanation

The skin of the umbilicus is innervated by the T10 nerve root.br> In addition to knowing the innervation of selected muscles and the deep tendon reflexes, the clinician should also know the sensory levels to localize pathologic processes. T4 Nipple line T7 Xiphoid process T10 Umbilicus T12 Groin

Question 482

Topic: 6. Spine

Which of the following statements regarding the presentation of thoracic disk herniations is false:

. Pain is the principal symptom.
. Radicular pain may be present.
. Mechanical axial back pain may be present.
. Myelopathic pain may be present.
. Bowel and bladder symptoms occur in more than 50% of affected patients.

Correct Answer & Explanation

. Bowel and bladder symptoms occur in more than 50% of affected patients.

Explanation

Patients with thoracic disk herniations may present with mechanical axial back pain, radicular pain, or myelopathy, but pain is the principal symptom. Bowel and bladder symptoms occur in 10% to 20% of affected patients.

Question 483

Topic: 6. Spine

Which of the following is the only accepted pharmacological agent for the acute treatment of a spinal cord injury:

. GM-1 ganglioside
. Tirilazad (lipid peroxidation inhibitor)
. Nimodipine (calcium channel blocker)
. Naloxone (opoid antagonist)
. Methylprednisolone

Correct Answer & Explanation

. Methylprednisolone

Explanation

Methylprednisolone is currently the only accepted pharmacologic agent for the treatment of spinal cord injury. The North American Spinal C ord Injury Studies (NASC IS) found significant motor and sensory improvement in patients who were treated within 8 hours of injury with a methylprednisolone bolus of 30 mg/kg, followed by an infusion of 5.4 mg per hour for 24 hours. Other agents have been studied in animal experiments but have not been promising in clinical trials.

Question 484

Topic: 6. Spine

A 40-year-old woman has severe neck pain following a motor vehicle accident. Her plain lateral radiograph of the spine is shown (Slide). A sagittal magnetic resonance scan is shown (Slide). The most likely diagnosis is:

. Pseudosubluxation of C 5 on C 6
. C ompression fracture of C 5
. Unilateral facet dislocation
. Bilateral facet dislocation
. Degenerative sponylolisthesis C 5 on C 6

Correct Answer & Explanation

. Bilateral facet dislocation

Explanation

There is significant subluxation of C 5 on C 6 on the plain radiograph. The facets of C 5 and C 6 have lost their normal relationship. This patient has a bilateral facet dislocation. There is compression and significant changes within the spinal cord. This patient should be treated with reduction and fusion.

Question 485

Topic: 6. Spine

A 40-year-old woman has severe neck pain following a motor vehicle accident. Her plain lateral radiograph of the spine is shown (Slide). A sagittal magnetic resonance is shown (Slide). The most appropriate treatment would be:

. Observation
. Neck collar and physical therapy
. Reduction and collar immobilization
. Reduction and halo immobilization
. Reduction and fusion

Correct Answer & Explanation

. Reduction and fusion

Explanation

There is significant subluxation of C 5 on C 6 on the plain radiograph. The facets of C 5 and C 6 have lost their normal relationship. This patient has a bilateral facet dislocation. There is compression and significant changes within the spinal cord. This patient should be treated with reduction and fusion. This is a ligamentous injury so reduction and immobilization will not result in satisfactory healing.

Question 486

Topic: 6. Spine

Plain radiographs of the lumbosacral spine are useful for:

. Detecting marrow changes
. Far lateral herniated intervertebral disks
. Distinction between disk material and the dural sac
. Lateral recess stenosis
. Instability patterns

Correct Answer & Explanation

. Instability patterns

Explanation

Plain radiographs are useful for assessing the alignment of the spine, bone destruction by tumors and infections, and instability patterns. The radiographs also will show degenerative intervertebral disks. Plain radiographs are not sensitive for detecting marrow changes, herniated disks, and neural compression secondary to degenerative changes.

Question 487

Topic: 6. Spine

A 35-year-old construction worker has left leg pain and difficulty walking. His examination is normal except for decreased sensation to the lateral border of the left foot, the inability to walk on the toes of the left foot, and a positive stretch test producing left heel and lateral foot pain. A magnetic resonance image shows a large posterolateral herniated nucleus pulposus on the left side at L5-S1. The gait abnormality is most likely due to:

. Cauda equina syndrome
. L5 radiculopathy and gastrocsoleus muscle complex denervation
. L5 radiculopathy and extensor hallucis longus weakness
. S1 radiculopathy and gastrocsoleus muscle complex denervation
. S2 denervation and extensor hallucis longus weakness

Correct Answer & Explanation

. S1 radiculopathy and gastrocsoleus muscle complex denervation

Explanation

In the lumbar spine, direct posterior and posterolateral disk herniations typically compress the traversing nerve root. In this patient, the herniated disk at the L5-S1 level compresses the shoulder of the S1 nerve root as it comes off the dural sac. The S1 nerve root supplies sensation to the posterior calf and lateral border of the foot, and motor chiefly to the gastrocsoleus muscle complex.

Question 488

Topic: 6. Spine

Which of the following types of neural dysfunction is present with a cervical fracture-dislocation, resulting in a Brown-Sequard neurological injury:

. Ipsilateral loss of pain, temperature recognition, and contralateral loss of motor function
. Ipsilateral loss of motor and contralateral loss of pain/temperature
. Bilateral loss of pain/temperature and unilateral loss of motor
. Bilateral loss of motor and unilateral loss of pain/temperature
. Bilateral upper extremity loss of motor and unilateral lower extremity loss of pain/temperature

Correct Answer & Explanation

. Ipsilateral loss of motor and contralateral loss of pain/temperature

Explanation

A Brown-Sequard injury causes damage to half of the spinal cord. Brown- Sequard injuries produce ipsilateral proprioceptive and motor loss and contralateral loss of sensitivity to pain and temperature. Proprioceptive sensory fibers enter the spinal cord, travel in the dorsal columns and lateral and ventral spinothalmic tracts, and decussate high in the thalamus. Motor efferent nerves cross in the medulla and travel down in the lateral corticospinal tracts.Spinthalamic fibers enter and decussate in the spinal cord. Hence, cord hemi-section produces contralateral pain and temperature (spinothalamic) loss, and ipsilateral motor (corticospinal) and, proprioceptive (dorsal columns) deficit. Often due to penetrating injuries, Brown-Sequard injuries have the best prognosis of the cord injury complexes.

Question 489

Topic: 6. Spine

The axial computed tomography scan depicts a patient with spinal stenosis (Slide). The primary source of neural compression is impingement on the traversing nerve root by the:

. Superior facet of the level below
. Inferior facet of the level above
. Redundant ligamentum flavum
. Overgrown medial pedicle
. Herniated nucleus pulposus

Correct Answer & Explanation

. Superior facet of the level below

Explanation

Spinal stenosis involves narrowing of the spinal canal by a combination of factors. Degeneration of the disk with dehydration allows loss of disk height and bulging posteriorly into the canal. The ligamentum flavum becomes redundant at the segment due to loss of the disk height and buckling of the ligament. C hief among the sources of compression, however, is the overgrowth of the facet joint, which acts to autostabilize the motion segment. The facets are oriented in an oblique plane, depending on the level involved. The superior facet of the subjacent vertebral body lies anterior and lateral to its counterpart from the level above, forming a shingle configuration. The superior articular process, therefore, lies adjacent to the shoulder of the traversing nerve root and is a significant source of lateral recess stenosis.

Question 490

Topic: 6. Spine

A 32-year-old male sustains a stab wound to the back.

Neurological examination reveals right-sided paralysis and loss of vibration sense, along with left-sided loss of pain and temperature sensation below the T8 level. Which of the following best describes this syndrome?

. Anterior cord syndrome
. Central cord syndrome
. Brown-Sequard syndrome
. Posterior cord syndrome
. Conus medullaris syndrome

Correct Answer & Explanation

. Brown-Sequard syndrome

Explanation

Brown-Sequard syndrome is caused by a hemisection of the spinal cord. It presents with ipsilateral motor and proprioceptive loss and contralateral pain and temperature loss.

Question 491

Topic: 6. Spine

A patient with a suspected spinal fracture is found to have sensory loss up to the level of the nipples. Which dermatomal nerve root level corresponds to this finding?

. T2
. T4
. T6
. T8
. T10

Correct Answer & Explanation

. T4

Explanation

The T4 dermatome corresponds to the nipple line. Other critical landmarks include the umbilicus at T10 and the xiphoid process at T7.

Question 492

Topic: 6. Spine

During the evaluation of a patient with a spinal cord injury, the examiner notes that the patient has intact proprioception and vibration sense, but complete loss of motor function, pain, and temperature sensation below the level of the lesion. What is the most likely diagnosis?

. Anterior cord syndrome
. Central cord syndrome
. Brown-Sequard syndrome
. Posterior cord syndrome
. Spinal shock

Correct Answer & Explanation

. Anterior cord syndrome

Explanation

Anterior cord syndrome typically results from flexion injuries or anterior spinal artery compromise. It spares the dorsal columns, maintaining proprioception and vibration sense while affecting the corticospinal and spinothalamic tracts.

Question 493

Topic: 6. Spine

Which of the following surgical approaches is strictly contraindicated for the excision of a central calcified thoracic disc herniation?

. Transthoracic approach
. Costotransversectomy
. Transpedicular approach
. Standard posterior laminectomy
. Lateral extracavitary approach

Correct Answer & Explanation

. Standard posterior laminectomy

Explanation

Standard posterior laminectomy is contraindicated for central thoracic disc herniations due to the high risk of catastrophic spinal cord injury. Anterior or lateral approaches must be utilized to safely access the pathology without retracting the cord.

Question 494

Topic: 6. Spine

A 25-year-old male is brought to the emergency department after a high-speed motor vehicle accident. He has a T2 fracture-dislocation. His blood pressure is 80/50 mmHg and heart rate is 50 bpm. His extremities are warm and pink. What is the primary cause of his hemodynamic instability?

. Hypovolemic shock
. Cardiogenic shock
. Spinal shock
. Neurogenic shock
. Septic shock

Correct Answer & Explanation

. Neurogenic shock

Explanation

Neurogenic shock is characterized by hypotension, bradycardia, and warm extremities due to the loss of sympathetic tone following high thoracic or cervical spinal cord injuries. Spinal shock refers to the temporary loss of spinal reflexes, not hemodynamic parameters.

Question 495

Topic: 6. Spine

A 45-year-old female presents with a seatbelt-type flexion-distraction injury (Chance fracture) of the L1 vertebra.

Which of the following associated injuries must be meticulously ruled out?

. Aortic dissection
. Pulmonary contusion
. Hollow viscus injury
. Renal artery thrombosis
. Myocardial contusion

Correct Answer & Explanation

. Hollow viscus injury

Explanation

Chance fractures are highly associated with intra-abdominal injuries, particularly to hollow viscera like the small bowel (up to 50% incidence). Prompt general surgery consultation and abdominal imaging are mandatory.

Question 496

Topic: 6. Spine

A patient with a T4 level complete spinal cord injury suddenly develops a severe pounding headache, diaphoresis above the level of injury, and a blood pressure of 210/110 mmHg. What is the most appropriate initial management?

. Administer intravenous beta-blockers
. Perform immediate intubation
. Check for a kinked Foley catheter or fecal impaction
. Administer broad-spectrum antibiotics
. Place the patient in a Trendelenburg position

Correct Answer & Explanation

. Check for a kinked Foley catheter or fecal impaction

Explanation

The patient is experiencing autonomic dysreflexia, common in injuries above T6, often triggered by a noxious stimulus below the lesion (e.g., distended bladder or bowel). The first step is to remove the inciting stimulus and sit the patient upright.

Question 497

Topic: 6. Spine

A spinal cord injury patient presents with perianal sensation, voluntary anal sphincter contraction, and intact great toe flexion, despite otherwise complete motor and sensory loss below T10. This clinical scenario indicates:

. Complete spinal cord injury
. Spinal shock
. Sacral sparing
. Cauda equina syndrome
. Conus medullaris syndrome

Correct Answer & Explanation

. Sacral sparing

Explanation

Sacral sparing signifies an incomplete spinal cord injury and is defined by the presence of perianal sensation, voluntary rectal sphincter tone, or great toe flexion. It suggests the potential for further neurological recovery.

Question 498

Topic: 6. Spine

The bulbocavernosus reflex is mediated by which of the following nerve roots?

. L2-L4
. L4-S1
. S2-S4
. T12-L1
. S1-S2

Correct Answer & Explanation

. S2-S4

Explanation

The bulbocavernosus reflex is mediated by the S2-S4 nerve roots. Its return clinically signifies the end of the spinal shock phase.

Question 499

Topic: 6. Spine

Thoracic disc herniations most commonly occur at which of the following vertebral levels?

. T2-T4
. T5-T7
. T8-T11
. T1-T2
. T4-T6

Correct Answer & Explanation

. T8-T11

Explanation

Approximately 75% of thoracic disc herniations occur between T8 and T11. They are much less common than cervical or lumbar herniations due to the stabilizing effect of the rib cage.

Question 500

Topic: 6. Spine

A 65-year-old male with long-standing cervical spondylosis sustains a hyperextension injury to his neck. Examination shows marked bilateral weakness in his upper extremities, particularly the hands, with relative sparing of motor function in his lower extremities. What is the most likely diagnosis?

. Anterior cord syndrome
. Central cord syndrome
. Brown-Sequard syndrome
. Cruciate paralysis
. Syringomyelia

Correct Answer & Explanation

. Central cord syndrome

Explanation

Central cord syndrome typically occurs in elderly patients with pre-existing cervical stenosis following a hyperextension injury. It disproportionately affects the upper extremities more than the lower extremities.

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