6. Spine MCQs

A 25-year-old male arrives in the trauma bay after a severe motor vehicle collision. He has a blood pressure of 80/40 mmHg and a heart rate of 55 bpm. Physical examination reveals that his extremities are warm, flushed, and well-perfused. Which of the following is the most likely diagnosis?

A 55-year-old male presents with bilateral hand clumsiness and broad-based gait. Examination reveals a positive Hoffmann's sign and sustained ankle clonus. MRI shows severe cervical stenosis at C5-C6 with T2 hyperintensity in the cord. The pathological progression of this condition is most directly associated with ischemia of which of the following vascular structures?

A 60-year-old male presents with bilateral leg pain and cramping that worsens with walking and prolonged standing, but improves when he leans forward over a shopping cart. MRI shows severe lumbar spinal stenosis at L4-L5. What anatomical structure hypertrophies and buckles into the spinal canal during extension, contributing to his symptoms?

A 68-year-old male complains of bilateral leg pain and cramping that worsens with walking and prolonged standing, but improves when he leans forward on a shopping cart. The symptomatic relief he experiences with forward flexion is primarily due to which of the following anatomic changes in the lumbar spine?

A 50-year-old male presents with right-sided neck pain radiating down his arm, accompanied by numbness in his thumb and index finger. On physical exam, he has weakness in wrist extension and a diminished deep tendon reflex. Which reflex is most likely diminished in this clinical scenario?

A 21-year-old collegiate baseball pitcher presents with medial elbow pain that occurs during the late cocking and early acceleration phases of pitching. On examination, he has pain with the milking maneuver and a positive moving valgus stress test. MRI confirms a full-thickness midsubstance tear of the anterior bundle of the ulnar collateral ligament (UCL). If surgical reconstruction is chosen, which structure is considered the primary isometric restraint to valgus stress at the elbow?

During ulnar collateral ligament (UCL) reconstruction of the elbow in an overhead throwing athlete, the graft is tensioned to recreate the primary valgus stabilizer. Which specific portion of the UCL complex is the primary restraint to valgus stress at 90 degrees of elbow flexion?

A 20-year-old collegiate pitcher undergoes ulnar collateral ligament (UCL) reconstruction utilizing an ipsilateral palmaris longus autograft. Which specific component of the native UCL complex is the primary restraint to valgus stress at 90 degrees of elbow flexion?

A 65-year-old man presents with progressive clumsiness in his hands and difficulty walking. Examination shows positive Hoffmann's sign bilaterally and hyperreflexia in the lower extremities. MRI reveals severe cervical stenosis at C4-C5 and C5-C6. Which physical exam finding would most specifically indicate an upper motor neuron lesion resulting from cervical spine pathology?

A 14-year-old female gymnast presents with an insidious onset of low back pain exacerbated by extension. Radiographs reveal a Grade I isthmic spondylolisthesis at L5-S1. The bilateral pars interarticularis defects are most clearly visualized on which specific radiographic view?

A patient presents with weakness in wrist flexion and finger extension, a diminished triceps reflex, and numbness isolated to the middle finger. Which cervical nerve root is most likely compressed?

A 60-year-old male complains of deteriorating handwriting, dropping objects, and a stiff-legged gait. Physical examination reveals a positive Hoffmann's sign and an inverted supinator reflex. What is the most likely diagnosis?

A 35-year-old male sustains a burst fracture of the atlas (Jefferson fracture) after a diving accident. On the open-mouth odontoid radiograph, the rule of Spence is evaluated. Transverse atlantal ligament rupture is highly suspected if the combined overhang of the C1 lateral masses on C2 exceeds what value?

A 68-year-old female presents with bilateral leg pain that worsens with walking and prolonged standing. She notes that leaning forward on a shopping cart relieves the pain. Which of the following diagnostic findings is most likely to be present?

During a transforaminal endoscopic lumbar discectomy, the surgeon accesses the disc space through Kambin's triangle to avoid nerve root injury. Which of the following structures forms the medial border of Kambin's triangle?

During an anterior approach to the thoracolumbar spine for corpectomy, careful attention is paid to identifying and protecting the artery of Adamkiewicz to prevent anterior spinal cord syndrome. Where does this artery most commonly originate?

During an anterior cervical discectomy and fusion (ACDF), lateral dissection carries the risk of vertebral artery injury. At which cervical level does the vertebral artery typically enter the transverse foramen?

During an anterior (Smith-Robinson) approach to the lower cervical spine, what is the most accurate description of the anatomical relationship and risk to the recurrent laryngeal nerves (RLN)?