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6. Spine MCQs

Practice Set 27 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 521

Topic: 6. Spine

A 28-year-old patient with a complete T4 spinal cord injury sustained 6 weeks ago suddenly develops a pounding headache, facial flushing, profuse sweating above the level of injury, and a blood pressure of 190/110 mmHg. Which of the following is the most appropriate initial management step?

. Administer intravenous labetalol
. Check for and relieve bladder or bowel distention
. Perform an emergency brain CT scan
. Administer a bolus of intravenous normal saline
. Start a dopamine infusion

Correct Answer & Explanation

. Check for and relieve bladder or bowel distention

Explanation

The patient is experiencing autonomic dysreflexia, which is common in injuries above T6. The first and most critical step is to remove the offending stimulus, most commonly a distended bladder (e.g., blocked catheter) or bowel impaction.

Question 522

Topic: 6. Spine



A patient is diagnosed with spinal shock following severe trauma. Which of the following clinical signs marks the end of the spinal shock phase?

. Return of voluntary motor function
. Return of the bulbocavernosus reflex
. Normalization of blood pressure and heart rate
. Return of deep tendon reflexes in the upper extremities
. Resolution of lower extremity edema

Correct Answer & Explanation

. Return of the bulbocavernosus reflex

Explanation

Spinal shock is a transient state of physiologic reflex depression of cord function below the level of injury. The return of the bulbocavernosus reflex typically heralds the end of spinal shock, allowing for accurate determination of the SCI extent.

Question 523

Topic: 6. Spine

In a patient presenting with an acute traumatic spinal cord injury, which of the following MRI findings of the spinal cord is associated with the poorest prognosis for neurologic recovery?

. Multilevel cord edema
. Small focal contusion
. Spinal cord hemorrhage
. Epidural hematoma without cord signal change
. Syringomyelia

Correct Answer & Explanation

. Spinal cord hemorrhage

Explanation

The presence of hemorrhage within the spinal cord parenchyma (hematomyelia) on MRI is a strong predictor of poor neurologic recovery compared to edema alone.

Question 524

Topic: 6. Spine

What is the most common anatomical location for a symptomatic thoracic disc herniation?

. T2-T4
. T5-T7
. T8-T11
. T11-T12
. T12-L1

Correct Answer & Explanation

. T11-T12

Explanation

The vast majority of symptomatic thoracic disc herniations occur in the lower third of the thoracic spine, with the T11-T12 level being the most common, likely due to increased mobility transitioning to the lumbar spine.

Question 525

Topic: 6. Spine

A patient with a gunshot wound to the abdomen develops paraplegia. Imaging shows a bullet lodged in the T10 vertebral body with an associated incomplete neurologic deficit. CT scan shows bone fragments in the spinal canal. Which of the following is an absolute indication for surgical decompression and removal of the bullet in this scenario?

. Complete neurologic deficit for > 48 hours
. Bullet lodged strictly within the vertebral body
. Cerebrospinal fluid leak
. Neurologic deterioration with compressive fragments
. Prevention of future lead toxicity

Correct Answer & Explanation

. Neurologic deterioration with compressive fragments

Explanation

Routine removal of bullets from the spine is not indicated. However, progressive neurologic deterioration in the presence of compressive elements (bullet or bone fragments) is a definitive indication for urgent surgical decompression.

Question 526

Topic: 6. Spine

A patient sustains a complete spinal cord injury after a fall. Neurological examination reveals a sensory level at the nipple line. Which of the following nerve root levels indicates this finding?

. T2
. T4
. T6
. T8

Correct Answer & Explanation

. T4

Explanation

The sensory dermatome for the nipple line is T4. The umbilicus is T10, and the xiphoid process is T7.

Question 527

Topic: 6. Spine

A trauma patient presents with a complete spinal cord injury. Pinprick and light touch sensation are absent below the inguinal ligament. Which nerve root level does this specific landmark represent?

. T10
. T12
. L1
. L3

Correct Answer & Explanation

. L1

Explanation

The sensory dermatome for the inguinal ligament corresponds to the L1 nerve root level.

Question 528

Topic: 6. Spine
A 25-year-old man sustains a stab wound to the right side of his thoracic spine. He presents with loss of motor function and proprioception in his right leg, and loss of pain and temperature sensation in his left leg. This clinical picture is most consistent with:
. Anterior cord syndrome
. Central cord syndrome
. Brown-Séquard syndrome
. Conus medullaris syndrome

Correct Answer & Explanation

. Brown-Séquard syndrome

Explanation

Brown-Séquard syndrome results from hemisection of the spinal cord. It presents with ipsilateral loss of motor function (corticospinal tract) and proprioception (dorsal columns), and contralateral loss of pain and temperature sensation (spinothalamic tract).

Question 529

Topic: 6. Spine

In the ASIA Impairment Scale, how is a patient classified if they have preserved motor function below the neurological level of injury, and more than half of the key muscle functions below that level have a muscle grade less than 3?

. ASIA A
. ASIA B
. ASIA C
. ASIA D

Correct Answer & Explanation

. ASIA C

Explanation

ASIA C denotes an incomplete spinal cord injury where motor function is preserved below the neurological level, but more than half of the key muscles have a grade less than 3 (non-antigravity). ASIA D requires at least half to be grade 3 or greater.

Question 530

Topic: 6. Spine
A patient presents with progressive myelopathy due to a large, calcified central thoracic disc herniation at T8-T9. Which of the following surgical approaches is generally contraindicated due to the high risk of iatrogenic spinal cord injury?
. Costotransversectomy
. Transthoracic anterior approach
. Standard posterior laminectomy
. Lateral extracavitary approach

Correct Answer & Explanation

. Standard posterior laminectomy

Explanation

A standard posterior laminectomy is contraindicated for central thoracic disc herniations. Retracting the thoracic spinal cord to access the anteriorly situated disc carries a very high risk of permanent spinal cord injury.

Question 531

Topic: 6. Spine

According to the Denis three-column theory of spinal stability, a typical burst fracture of the thoracolumbar spine is characterized by failure of which columns?

. Anterior column only
. Anterior and middle columns under compression
. Middle and posterior columns under tension
. Anterior and posterior columns

Correct Answer & Explanation

. Anterior and middle columns under compression

Explanation

A burst fracture involves failure of both the anterior and middle columns under axial compression. This distinguishes it from a simple compression fracture, which only involves the anterior column.

Question 532

Topic: 6. Spine

Which of the following physical examination findings is the most reliable clinical indicator that a patient has emerged from the phase of spinal shock?

. Return of the bulbocavernosus reflex
. Normalization of blood pressure and heart rate
. Return of deep tendon reflexes in the upper extremities
. Resolution of bradycardia

Correct Answer & Explanation

. Return of the bulbocavernosus reflex

Explanation

The return of the bulbocavernosus reflex marks the end of spinal shock. Once this reflex returns, the true extent of the permanent neurological deficit can be accurately assessed.

Question 533

Topic: 6. Spine
Which of the following incomplete spinal cord injury syndromes carries the worst prognosis for functional motor recovery?
. Central cord syndrome
. Brown-Séquard syndrome
. Anterior cord syndrome
. Posterior cord syndrome

Correct Answer & Explanation

. Anterior cord syndrome

Explanation

Anterior cord syndrome typically involves occlusion of the anterior spinal artery and carries the worst prognosis for motor recovery, with only about 10-20% of patients regaining functional motor control.

Question 534

Topic: Thoracolumbar Spine & Deformity

A 12-year-old restrained passenger in a motor vehicle collision presents with a lap-belt injury. Radiographs show a fracture extending horizontally through the spinous process, pedicles, and vertebral body of L2. What associated injury must be specifically ruled out?

. Aortic tear
. Intra-abdominal hollow viscus injury
. Diaphragmatic rupture
. Renal artery thrombosis

Correct Answer & Explanation

. Aortic tear

Explanation

This describes a Chance fracture (flexion-distraction injury), highly associated with lap-belt use. Up to 50% of these patients have concurrent intra-abdominal injuries, most commonly involving hollow viscus organs (bowel perforation).

Question 535

Topic: Cervical Spine

A 35-year-old sustains a Type II odontoid fracture with a reverse obliquity fracture line (sloping from anterior-inferior to posterior-superior). Which fixation method is contraindicated?

. Anterior odontoid screw fixation
. Posterior C1-C2 transarticular screws
. Posterior C1-C2 Harms technique
. Halo vest immobilization

Correct Answer & Explanation

. Anterior odontoid screw fixation

Explanation

Anterior odontoid screw fixation is contraindicated in reverse obliquity Type II fractures because the lag screw trajectory will cause the fracture to shear and displace rather than compress.

Question 536

Topic: 6. Spine

Which of the following is an established indication for emergent surgical decompression following a gunshot wound to the spine?

. Complete spinal cord injury at T6 with a retained bullet in the canal
. Bullet trajectory through the colon prior to entering the spine without neurological deficit
. Incomplete spinal cord injury with progressive neurological deterioration and cord compression
. Any retained bullet in the intervertebral disc space to prevent lead toxicity

Correct Answer & Explanation

. Complete spinal cord injury at T6 with a retained bullet in the canal

Explanation

Most gunshot wounds to the spine are managed non-operatively. Surgery is indicated for progressive neurological deficit with an incomplete injury, or severe cauda equina compression with ongoing deficit.

Question 537

Topic: 6. Spine

A 30-year-old presents with a unilateral jumped facet at C5-C6 following a hyperflexion-rotation injury. He is neurologically intact. Pre-reduction MRI demonstrates a large, uncontained C5-C6 disc herniation compressing the cord. What is the most appropriate management?

. Closed reduction with cranial traction in the awake patient
. Anterior cervical discectomy and fusion (ACDF) prior to reduction
. Posterior open reduction and fusion followed by observation
. Stand-alone posterior cervical wiring

Correct Answer & Explanation

. Closed reduction with cranial traction in the awake patient

Explanation

If an MRI reveals a large extruded disc herniation in the setting of a facet dislocation, an anterior discectomy should be performed prior to reduction. Closed or posterior reduction first could force the disc further into the canal, causing a catastrophic spinal cord injury.

Question 538

Topic: 6. Spine

A 55-year-old diabetic male presents with worsening back pain, fever, and new-onset lower extremity weakness. Laboratory tests show elevated CRP and ESR. MRI with contrast reveals a rim-enhancing fluid collection in the dorsal epidural space. What is the most likely causative organism?

. Streptococcus pneumoniae
. Staphylococcus aureus
. Pseudomonas aeruginosa
. Mycobacterium tuberculosis

Correct Answer & Explanation

. Streptococcus pneumoniae

Explanation

The clinical picture describes a spinal epidural abscess. Staphylococcus aureus is by far the most common causative organism, responsible for over 60% of cases.

Question 539

Topic: 6. Spine

A patient arrives at the trauma bay after a high-speed motorcycle crash. He has flaccid paralysis below T2. His blood pressure is 80/50 mmHg, and his heart rate is 55 bpm. His extremities are warm and well-perfused. What is the primary pathophysiological mechanism for his hemodynamic state?

. Severe hypovolemia from occult bleeding
. Loss of sympathetic tone causing vasodilation
. Parasympathetic blockade causing bradycardia
. Acute myocardial contusion

Correct Answer & Explanation

. Severe hypovolemia from occult bleeding

Explanation

Neurogenic shock occurs with cervical or high thoracic spinal cord injuries. It is caused by the loss of sympathetic outflow, resulting in unopposed parasympathetic tone, profound vasodilation (warm extremities), hypotension, and bradycardia.

Question 540

Topic: Thoracolumbar Spine & Deformity
A lateral lumbar radiograph of a 14-year-old gymnast shows forward slippage of L5 on S1 by 60%. According to the Meyerding classification, what grade of spondylolisthesis does this represent?
. Grade II
. Grade III
. Grade IV
. Grade V

Correct Answer & Explanation

. Grade III

Explanation

The Meyerding classification grades spondylolisthesis based on the percentage of slip: Grade I (0-25%), Grade II (26-50%), Grade III (51-75%), Grade IV (76-100%), and Grade V (>100%, spondyloptosis). A 60% slip is Grade III.

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