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6. Spine MCQs

Practice Set 50 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 981

Topic: 6. Spine

A patient presents with an L1 burst fracture and paraplegia. Examination reveals loss of motor function, pain, and temperature sensation below the umbilicus, but preserved proprioception and vibratory sense. Which vascular territory is most likely compromised?

. Posterior spinal arteries
. Anterior spinal artery
. Artery of Adamkiewicz
. Radicular arteries
. Vertebral arteries

Correct Answer & Explanation

. Anterior spinal artery

Explanation

Anterior cord syndrome involves damage to the anterior two-thirds of the spinal cord, which is supplied by the anterior spinal artery. It results in loss of motor function and pain/temperature sensation while preserving dorsal column function.

Question 982

Topic: Thoracolumbar Spine & Deformity

A 19-year-old male presents after a lap-belt only motor vehicle collision. Radiographs show a horizontal fracture through the spinous process, pedicles, and vertebral body of T12. Which associated injury must be actively ruled out in this patient?

. Aortic dissection
. Diaphragmatic rupture
. Bowel perforation
. Renal laceration
. Splenic rupture

Correct Answer & Explanation

. Bowel perforation

Explanation

Chance fractures are flexion-distraction injuries commonly associated with seatbelt use. They have a high association (up to 40%) with intra-abdominal injuries, particularly hollow viscus perforations.

Question 983

Topic: 6. Spine

When applying a halo vest for cervical spine immobilization, what is the anatomic safe zone for anterior pin placement to avoid neurovascular injury?

. Medial to the supraorbital nerve
. Lateral to the outer two-thirds of the orbit
. Just above the medial eyebrow
. 1 cm superior to the lateral one-third of the eyebrow
. Directly on the squamosal suture

Correct Answer & Explanation

. 1 cm superior to the lateral one-third of the eyebrow

Explanation

Anterior halo pins should be placed 1 cm superior to the lateral third of the eyebrow. This avoids the supraorbital and supratrochlear nerves medially and the temporalis muscle and fossa laterally.

Question 984

Topic: Cervical Spine

An 82-year-old male sustains a Type II odontoid fracture with 3 mm of posterior displacement. He has significant medical comorbidities. What is the most appropriate initial management?

. Rigid cervical collar
. Halo vest immobilization
. Anterior odontoid screw fixation
. Posterior C1-C2 fusion
. C1-C2 transarticular screws

Correct Answer & Explanation

. Rigid cervical collar

Explanation

In elderly patients with significant comorbidities, a rigid cervical collar is often preferred for Type II odontoid fractures. This is due to the high morbidity and mortality associated with halo vests and surgical intervention in this specific population.

Question 985

Topic: 6. Spine

A 28-year-old man sustains a C1 burst fracture after diving into a shallow pool. On the open-mouth odontoid radiograph, the combined lateral mass overhang is 8 mm. This finding suggests disruption of which of the following structures?

. Alar ligament
. Transverse atlantal ligament
. Apical ligament
. Posterior longitudinal ligament
. Tectorial membrane

Correct Answer & Explanation

. Transverse atlantal ligament

Explanation

The Rule of Spence dictates that a combined lateral mass overhang of C1 on C2 greater than 6.9 mm on an AP open-mouth radiograph indicates a rupture of the transverse atlantal ligament.

Question 986

Topic: 6. Spine

A trauma patient with a complete C5 spinal cord injury presents with a blood pressure of 80/50 mmHg and a heart rate of 50 bpm. His extremities are warm and well-perfused. Which of the following is the most likely cause of his hemodynamic status?

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

Correct Answer & Explanation

. Neurogenic shock

Explanation

Neurogenic shock is characterized by hypotension and bradycardia due to the loss of sympathetic tone following a high spinal cord injury. Warm, well-perfused extremities distinguish it from hypovolemic shock.

Question 987

Topic: 6. Spine

A trauma patient is being evaluated for a complete T10 spinal cord injury. The return of the bulbocavernosus reflex signifies which of the following?

. Transition from complete to incomplete spinal cord injury
. End of spinal shock
. Regeneration of the descending corticospinal tracts
. Resolution of neurogenic shock
. Permanent flaccid paralysis

Correct Answer & Explanation

. End of spinal shock

Explanation

The return of the bulbocavernosus reflex indicates the end of spinal shock. It confirms that the spinal cord circuitry below the level of injury is intact, allowing for accurate ASIA classification.

Question 988

Topic: 6. Spine

A 45-year-old man presents to the ER with new-onset bilateral leg weakness, saddle anesthesia, and urinary retention. Post-void residual is 400 mL. What is the most appropriate next step in management?

. Lumbar puncture
. Epidural steroid injection
. Urgent MRI of the lumbar spine
. High-dose IV methylprednisolone
. Non-contrast CT of the lumbar spine

Correct Answer & Explanation

. Urgent MRI of the lumbar spine

Explanation

The patient exhibits classic signs of cauda equina syndrome, an orthopedic emergency. An urgent MRI of the lumbar spine is required to confirm the diagnosis and identify the site of compression prior to urgent surgical decompression.

Question 989

Topic: Cervical Spine

A 34-year-old manual laborer complains of lower neck pain after forcefully shoveling heavy snow. Radiographs reveal an isolated oblique fracture through the spinous process of C7. What is the most appropriate management?

. Anterior cervical discectomy and fusion
. Rigid cervical collar for 6 weeks
. Symptomatic treatment with NSAIDs and early mobilization
. Halo vest immobilization
. Posterior cervical fusion

Correct Answer & Explanation

. Symptomatic treatment with NSAIDs and early mobilization

Explanation

A Clay Shoveler's fracture is a stable avulsion fracture of a lower cervical or upper thoracic spinous process. Treatment is conservative, focusing on symptomatic relief, analgesics, and early mobilization.

Question 990

Topic: 6. Spine

A 25-year-old male sustains a gunshot wound to the abdomen. The bullet traverses the colon and lodges in the L3 spinal canal, causing a cauda equina deficit. What is the primary indication for surgical removal of the bullet in this patient?

. To prevent lead toxicity
. To treat the incomplete neurological deficit
. Because the bullet traversed a hollow viscus
. To prevent a dural tear pseudo-meningocele
. Routine protocol for all retained intracanalicular bullets

Correct Answer & Explanation

. To treat the incomplete neurological deficit

Explanation

Surgical removal of a bullet in the spinal canal is indicated primarily for progressive neurological deficit or an incomplete deficit with persistent compression (e.g., cauda equina syndrome). Transcolonic passage is considered a relative indication, but neurological status drives the acute intervention.

Question 991

Topic: 6. Spine

A 40-year-old male is intubated in the ICU following a severe traumatic brain injury. A high-quality, fine-cut CT scan of the cervical spine is interpreted as normal. According to the latest EAST guidelines, what is the most appropriate next step for cervical spine clearance?

. Keep the patient in a rigid collar until clinically evaluable
. Perform dynamic flexion-extension fluoroscopy
. Perform an MRI of the cervical spine within 48 hours
. Remove the cervical collar
. Obtain upright plain radiographs

Correct Answer & Explanation

. Remove the cervical collar

Explanation

According to updated Eastern Association for the Surgery of Trauma (EAST) guidelines, the cervical collar can be safely removed in an obtunded trauma patient if a high-quality, fine-cut CT scan is completely negative.

Question 992

Topic: Thoracolumbar Spine & Deformity

A patient has a T12 burst fracture. MRI shows indeterminate posterior ligamentous complex (PLC) status. The patient is neurologically intact. What is the total TLICS score, and what is the recommended management?

. Score 2, Non-operative
. Score 4, Surgeon's choice
. Score 5, Operative
. Score 3, Non-operative
. Score 6, Operative

Correct Answer & Explanation

. Score 4, Surgeon's choice

Explanation

The TLICS score is calculated as follows: Burst morphology (2 points), intact neurology (0 points), indeterminate PLC (2 points), yielding a total score of 4. A score of 4 means management can be either operative or non-operative based on surgeon preference.

Question 993

Topic: 6. Spine

A patient with a C6 spinal cord injury has preserved sensation in the S4-S5 sacral segments. Motor function is preserved below the neurological level, but more than half of the key muscles below the neurological level have a muscle grade of less than 3. What is the appropriate ASIA Impairment Scale grade?

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

Correct Answer & Explanation

. ASIA C

Explanation

ASIA C indicates an incomplete spinal cord injury where motor function is preserved below the neurological level, but more than half of the key muscles below that level have a muscle grade less than 3 (non-antigravity).

Question 994

Topic: 6. Spine
A 29-year-old male is stabbed in the back. Examination reveals loss of motor function and proprioception on the right lower extremity, and loss of pain and temperature sensation on the left lower extremity. Where is the anatomical lesion located?
. Left hemisection of the spinal cord
. Right hemisection of the spinal cord
. Anterior two-thirds of the spinal cord
. Posterior columns bilaterally
. Central gray matter of the spinal cord

Correct Answer & Explanation

. Right hemisection of the spinal cord

Explanation

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

Question 995

Topic: 6. Spine

A 65-year-old man sustains a hyperextension injury to his cervical spine during a fall. On examination, he has 2/5 motor strength in his upper extremities and 4/5 motor strength in his lower extremities. Which of the following best describes this neurologic syndrome?

. Motor loss in legs greater than arms
. Loss of proprioception primarily
. Motor loss in arms greater than legs
. Contralateral pain and temperature loss
. Ipsilateral motor loss

Correct Answer & Explanation

. Motor loss in arms greater than legs

Explanation

Central cord syndrome is characterized by disproportionally greater motor impairment in the upper extremities compared to the lower extremities. It typically occurs in older patients with pre-existing cervical spondylosis who sustain a hyperextension injury.

Question 996

Topic: 6. Spine

A 24-year-old man is brought to the emergency department after a motorcycle accident with a T6 burst fracture and flaccid paralysis of his lower extremities. Which of the following clinical findings indicates the end of spinal shock?

. Return of deep tendon reflexes
. Return of the bulbocavernosus reflex
. Normalization of blood pressure
. Return of voluntary toe movement
. Resolution of bradycardia

Correct Answer & Explanation

. Return of the bulbocavernosus reflex

Explanation

Spinal shock is a temporary physiologic concussion of the spinal cord resulting in flaccid paralysis and areflexia. The return of the bulbocavernosus reflex marks the end of spinal shock, allowing for accurate determination of whether the cord injury is complete or incomplete.

Question 997

Topic: Cervical Spine

A patient sustains a Levine-Edwards Type IIA Hangman's fracture, which is characterized by severe angulation and minimal translation. What is the most appropriate initial management?

. Hard cervical collar for 6 weeks
. Halo vest immobilization applied in extension
. Halo vest immobilization applied in compression
. Anterior cervical discectomy and fusion
. Posterior C1-C2 transarticular screw fixation

Correct Answer & Explanation

. Halo vest immobilization applied in compression

Explanation

A Type IIA Hangman's fracture involves severe angulation with distraction, typically due to a flexion-distraction injury. Traction is contraindicated as it exacerbates the deformity; therefore, it is managed with a halo vest applied in slight compression.

Question 998

Topic: Cervical Spine

An open-mouth odontoid radiograph of a patient with a suspected Jefferson fracture shows lateral displacement of the C1 lateral masses relative to C2. According to the Rule of Spence, what total combined overhang indicates a likely rupture of the transverse ligament?

. Greater than 3 mm
. Greater than 5 mm
. Greater than 6.9 mm
. Greater than 9 mm
. Greater than 11 mm

Correct Answer & Explanation

. Greater than 6.9 mm

Explanation

The Rule of Spence dictates that a combined overhang of the C1 lateral masses on C2 of 6.9 mm or greater on an AP open-mouth radiograph indicates a highly probable transverse ligament rupture. This renders the C1 ring highly unstable, often necessitating surgical stabilization.

Question 999

Topic: Thoracolumbar Spine & Deformity

A 12-year-old child wearing a lap belt sustains an L2 Chance fracture during a motor vehicle collision. Which of the following associated injuries is most commonly seen with this specific fracture pattern?

. Hepatic laceration
. Splenic rupture
. Hollow viscus injury
. Renal contusion
. Bladder rupture

Correct Answer & Explanation

. Hollow viscus injury

Explanation

Chance fractures are flexion-distraction injuries highly associated with seatbelt use. Due to the mechanism of sudden abdominal compression, there is a high incidence (up to 50%) of associated intra-abdominal hollow viscus injuries, such as bowel perforations.

Question 1000

Topic: 6. Spine

A 55-year-old man with advanced ankylosing spondylitis sustains a minor ground-level fall. Initial examination shows no neurologic deficits, but 6 hours later he rapidly develops paraplegia. What is the most likely cause of his deterioration?

. Spinal cord infarction
. Epidural hematoma
. Post-traumatic syringomyelia
. Progressive kyphotic deformity
. Diskitis

Correct Answer & Explanation

. Epidural hematoma

Explanation

Patients with ankylosing spondylitis have a rigid, brittle spine prone to highly unstable fractures even with minor trauma. Due to the altered epidural space and bleeding from fractured ossified structures, they are at exceptionally high risk for delayed epidural hematomas requiring urgent decompression.

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