Practice Set 26 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.
A patient with a suspected spinal injury demonstrates a sensory level exactly at the umbilicus.
Which dermatome correlates to this landmark?
. T10
A 28-year-old male sustains a thoracic spine injury.
Radiographs reveal a bony Chance fracture. Which of the following mechanisms of injury is most classically associated with this fracture pattern?
. Flexion-distraction
In a patient presenting with a traumatic spinal cord injury, the physical examination demonstrates a sensory level isolated to the nipple line. Which of the following dermatomal nerve root levels corresponds directly to this finding?
. T4
A 65-year-old male with a history of severe cervical spondylosis falls forward, striking his chin. He presents with severe weakness in his upper extremities but is able to move his lower extremities against gravity. What is the pathophysiological mechanism responsible for this specific neurological pattern?
. Hyperextension causing central gray matter damage
A 40-year-old female presents with severe myelopathy and imaging confirms a large, central, calcified disc herniation at the T8-T9 level. Which of the following surgical approaches is explicitly contraindicated due to a high risk of iatrogenic neurological deterioration?
. Standard posterior laminectomy
A 22-year-old male sustains a severe spinal cord injury. On examination, he has flaccid paralysis, absent reflexes below the level of injury, and absent perianal sensation. The bulbocavernosus reflex is absent. This clinical picture most accurately represents:
. Spinal shock
A trauma patient presents with a cervical spine injury.
Imaging reveals bilateral fractures through the pars interarticularis of C2. Which of the following is the primary mechanism resulting in this specific injury?
. Hyperextension and axial loading
Which of the following associated injuries has the highest incidence in patients diagnosed with a bony Chance fracture of the thoracolumbar junction?
. Hollow viscus intestinal injuries
A patient presents with a traumatic cervical spine injury.
A Type II odontoid fracture is identified. Which of the following factors contributes most significantly to the high nonunion rate of this specific fracture type?
. Interruption of the watershed blood supply at the base of the dens
A 35-year-old paraplegic male with a known complete spinal cord injury at T4 suddenly develops severe headache, profuse sweating above the nipple line, and profound hypertension (BP 210/110 mmHg). What is the most appropriate immediate intervention?
. Check for and relieve a distended bladder or bowel impaction
A cervical radiograph of a trauma patient demonstrates anterior translation of C5 over C6 by approximately 25% of the vertebral body width.
What is the most likely diagnosis?
. Unilateral facet dislocation
According to the ASIA (American Spinal Injury Association) Impairment Scale, a patient who has preserved motor function below the neurological level, with more than half of the key muscles demonstrating a muscle grade less than 3, is classified as:
. ASIA C
Which of the following clinical findings best differentiates a Conus Medullaris syndrome from a Cauda Equina syndrome?
. Presence of mixed upper and lower motor neuron signs
During a left-sided transthoracic approach for a T10-T11 disc herniation, the surgeon is cautious of a major radiculomedullary artery that supplies the anterior lower two-thirds of the spinal cord. This artery typically arises from the left side between which spinal levels?
. T9 and L2
A patient with long-standing Ankylosing Spondylitis sustains a minor ground-level fall and complains of back pain. Which of the following statements regarding spinal fractures in this patient population is most accurate?
. They act like long-bone fractures and are highly unstable
A Jefferson fracture is defined as a burst fracture of the C1 ring. If the sum of the lateral mass displacement over the C2 articular facets on an open-mouth odontoid radiograph exceeds 7 mm, which critical structure is presumed completely disrupted?
. Transverse atlantal ligament
A 35-year-old male sustains a severe flexion-distraction injury to the T12 vertebra in a motor vehicle collision. Which of the following concurrent injuries is most likely to be present and requires urgent evaluation?
. Hollow viscus injury
A patient with a traumatic spinal fracture is noted to have a sensory level localizing to the inguinal ligament. What is the corresponding nerve root level for this dermatome?
. L1
Which of the following is considered an absolute contraindication for a standard posterior laminectomy in the surgical management of a central, calcified thoracic disc herniation?
. Direct mechanical trauma to the spinal cord
Regarding the Thoracolumbar Injury Classification and Severity Score (TLICS), a patient presents with a T11-T12 burst fracture, indeterminate posterior ligamentous complex (PLC) status on MRI, and intact neurologic function. What is the total TLICS score and the recommended management?
. Score 4, either operative or non-operative