6. Spine MCQs

A 55-year-old male presents with neck pain radiating down his right arm, associated with weakness in elbow extension and wrist flexion, and a diminished triceps reflex. Which cervical nerve root is most likely compressed?

A 28-year-old male is evaluated in the trauma bay following a fall from a 20-foot scaffold. He is hypotensive (BP 80/50 mmHg), bradycardic (HR 55 bpm), and has warm, well-perfused extremities. He lacks motor and sensory function below the umbilicus. What is the primary pathophysiologic mechanism for his hemodynamic instability?

A 45-year-old female presents with severe neck pain radiating down her right arm. Neurological examination reveals a diminished brachioradialis reflex, weakness in wrist extension, and decreased sensation over the dorsal aspect of the thumb and index finger. Which cervical nerve root is most likely compressed?

A 45-year-old male presents with acute onset of severe low back pain, bilateral lower extremity weakness, and urinary retention following a heavy lifting event. Perianal numbness is noted on exam. Which of the following is the most critical next step in management?

A 70-year-old male presents with deteriorating handwriting, difficulty buttoning his shirt, and a broad-based, unsteady gait. Physical examination reveals a positive Hoffman's sign and hyperreflexia in the lower extremities. What is the most likely diagnosis?

A 45-year-old male presents to the emergency department with acute onset of severe lower back pain, bilateral sciatica, saddle anesthesia, and urinary retention with overflow incontinence. MRI confirms a massive L4-L5 disc herniation compressing the cauda equina. What is the most critical factor in maximizing the likelihood of neurological recovery?

Figure below depicts the radiograph obtained from a 30-year-old woman who began having more right

than left hip pain during a recent pregnancy. Physical examination reveals increased range of motion with positive flexion abduction and external rotation and flexion adduction and internal rotation as well as pain with external logroll. Assessment of Figure below reveals

A 65-year-old male presents with progressive hand clumsiness, gait instability, and bilateral lower extremity hyperreflexia. Physical examination reveals a positive inverted brachioradialis reflex (striking the brachioradialis tendon produces paradoxical finger flexion rather than elbow flexion). What spinal cord level is most likely compressed to produce this highly specific finding?

A 35-year-old male sustains an L1 burst fracture in a motor vehicle collision. He presents with normal neurologic status (ASIA E). A subsequent MRI confirms that the posterior ligamentous complex is completely intact. According to the Thoracolumbar Injury Classification and Severity (TLICS) score, what is his score and the appropriate treatment recommendation?

A 65-year-old male presents with deteriorating fine motor skills, dropping objects, and an unsteady, broad-based gait. Physical examination reveals a positive Hoffmann sign and hyperreflexia in the lower extremities. On preoperative MRI, which of the following findings is the most sensitive indicator of a poor potential for neurologic recovery following surgical decompression?

In a patient with suspected cauda equina syndrome following a traumatic spine injury, which of the following is the most reliable clinical indicator that spinal shock has completely resolved?

A 55-year-old man presents with progressive hand clumsiness and a broad-based gait. Examination reveals a positive Hoffmann sign. Which of the following cervical spine MRI findings would most strongly correlate with a poor potential for neurologic recovery postoperatively?

A 25-year-old man sustains a C5 burst fracture with a complete spinal cord injury. In the trauma bay, his blood pressure is 80/50 mmHg and his heart rate is 50 bpm. His extremities are warm. Which of the following best explains this physiologic state?

In a patient with longstanding rheumatoid arthritis and neck pain, which of the following is the most reliable radiographic predictor of impending neurologic deficit requiring surgical stabilization?

Which specific portion of the ulnar collateral ligament (UCL) complex of the elbow serves as the primary restraint to valgus stress from 30 to 120 degrees of flexion, and what is its anatomic ulnar insertion?

A 4-year-old child with a highly restricted diet presents with petechiae, gingival bleeding, and lower extremity pain. Radiographs reveal a 'white line' at the metaphysis (Frankel's line). The underlying pathogenesis involves a deficiency in the function of which of the following enzymes?

According to the established White and Panjabi criteria, clinical instability of the lower cervical spine on a lateral flexion-extension radiograph is defined by which of the following objective thresholds?

A 35-year-old male is involved in a severe motor vehicle accident and sustains a Levine-Edwards Type II traumatic spondylolisthesis of the axis (Hangman's fracture), demonstrating significant translation and angulation. What is the classic mechanism of injury for this specific fracture subtype?