Multiple Choice Questions
Spine
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125. Which of the following methods is a line drawn along the upper end plate of upper end vertebra and lower end plate of lower end vertebra, perpendiculars drawn from these lines, and the angle of intersection measured?
A) Cobb
B) Mehta
C) Mohrs
D) Risser
D) Stagnara
124. Which of the following statements is TRUE for tuberculosis of the spine?
A) Disc space destruction is an early sign.
B) Most patients will have a normal chest radiograph.
C) Nuclear medicine bone scans are the most useful investigation tool in active TB.
D) The posterior spinal elements are most commonly involved.
E) The thoracolumbar junction is the most common site of involvement.
123. The recommended lateral mass screw postion in posterior cervical plating is:
A) 20° laterally,90° perpendicular to the lateral mass
B) 15° cephalad and 30° laterally
C) 30° laterally and 15° cephalad
D) 15°laterally and 30° cephalad
E) 30° laterally 30° cephalad
122. Hoffman’s reflex is;
A) pathological
B) positive if there is flexion and adduction of the contralateral thumb
C) a deep tendon reflex
D) associated with hypotonia
E) positive in infants
121. In cervical spine stenosis, the risk of neurological deficit increases with a Pavlov-Torn ratio of?
A) <0.8
B) 0.8 – 1.0
C) 1.0 – 1.2
D) 1.2 – 1.4
E) >1.4
120. The lesion indicated in this computed tomography most likely represents:
A) Brodie’s abscess
B) Eosinophilic granuloma
C) Osteosarcoma
D) Osteoid osteoma
E) Osteoma
119. The radiographic line delimiting the foramen magnum that is used in determining basilar invagination is the:
A) McGregor line
B) McRae line
C) Chamberlain line
D) Ranawat line
E) Swischuk line
118. For a patient who has thoracic idiopathic scoliosis of the surgical range, the distance between the thecal sac and the apical thoracic pedicle on the concave side is:
A) Less than 1 mm
B) 2 mm
C) 3 mm
D) 4 mm
(E) 5 mm
117.Which of the following disorders is due to a defect in anterior horn cells:
A) Charcot-Marie-Tooth
B) Duchenne dystrophy
C) Friedreich’s ataxia
D) Spinal muscular atrophy
E) Rett syndrome
116. A magnetic resonance image of a 7-year-old girl shows a line of high-signal intensity within the cord on T2 sequences that parallels the ventral surface of the cord and appears as a syrinx. However, on the axial images and on the T1 sequences, this finding is not evident. The most likely diagnosis is:
A) Collapsing syrinx
B) Gibbs artifact
C) Motion artifact
D) Ependymoma
E) Astrocytoma
115. A posterior spine fusion with segmental hook fixation from T4-L4 is performed for idiopathic scoliosis in a 15-year-old girl. Somatosensory evoked potential monitoring is normal throughout the procedure.
The patient awakens and is unable to move either lower extremity, but she does have some sensation in the lower extremities.
Recommended treatment includes:
A) Removal of instrumentation
B) Myelogram
C) Laminectomy above the conus medullaris
D) Administration of corticosteroids and observation for 6 hours
E) Full heparinization of the patient
114. A 14-year-old girl is examined because of a pain in her left flank.
The radiographs of the lumbar spine show loss of the pedicle with expansion of the lateral wall of the third lumbar vertebral body.
Magnetic resonance imaging shows multiple fluid levels in the vertebral body with no additional areas of involvement.
She is neurologically normal. Recommended treatment includes:
A) Observation
B) Radiation therapy
C) Selective arterial embolization
D) Radical en bloc resection
E) Curettage plus radiation therapy
113. Which of the following is not a specific feature in making the diagnosis of a dystrophic curve in neurofibromatosis 1:
A) Penciling of the ribs
B) Scalloping of the vertebrae
C) Widening of the foramen
D) Thinning of the transverse processes
E) Vertebral rotation
112. Which of the following descriptions is more characteristic of tuberculosis than pyogenic spondylitis:
A) Disc space is narrowed before significant bony changes occur.
B) Involvement of multiple contiguous levels is uncommon.
C) Bony erosions seen on computerized tomography are usually small and focal.
D) Vertebral destruction exceeds disc destruction.
E) Magnetic resonance imaging rarely shows significant soft tissue swelling.
111. Adolescent girls with multiple radiographs for idiopathic scoliosis are statistically at increased risk for which of the following problems later in life:
(A) Lung cancer
(B) Breast cancer
(C) Lymphoma
(D) Leukemia
(E) Squamous carcinoma
110. Forty percent of osteoblastomas involve the axial skeleton.
Which of the following statements is true:
(A) The vertebral body is the most common location
(B) The posterior elements are the most common site
(C) The presence of aneurysmal bone cyst changes within the lesion is rare
(D) Neurologic symptoms are unusual
(E) Patients are generally over 50 years of age
Correct Answer : B
commonly occur in the spine. The lesions involve the posterior elements, may cause neurologic symptoms, and
commonly occur in young patients.
The following statements are true concerning osteoblastomas of the spine:
Neurologic symptoms are common.
Expansion of the posterior elements is common.
Aneurysmal bone cyst-like changes are commonly seen histologically.
The patients are generally young.
Author of the question: Rajesh Bahadur Lakhey
109. The skin of the proximal one-third of the anterior thigh just distal to the inguinal ligament is innervated by which of the following levels
(A) T12
(B) L1
(C) L2
(D) L3
(E) L4
Correct Answer : B
The skin of the proximal one-third of the anterior thigh just distal to the inguinal ligament is
innervated by L1, L2, and L3.
Note:
L1 Thigh, proximal third, anterior
L2 Thigh, middle, anterior
L3 Thigh, distal third, anterior
Author : Rajesh Bahadur Lakhey
108. The Achilles tendon reflex (ankle reflex) is transmitted through which of the following nerve roots
(A) L4
(B) L5
(C) S1
(D) S2
(E) S3
Correct Answer: C
The Achilles tendon reflex is based upon the triceps muscle group (medial and lateral
gastrocnemius muscles and soleus muscle) and is transmitted through the S1 nerve root.
Note the reflexes and the associated nerve roots:
Patellar tendon reflex – L4
Posterior tibial reflex – L5
Achilles tendon reflex – S1
107. The tibialis anterior muscle is principally innervated by which of the following segmental levels
(A) L1
(B) L2
(C) L3
(D) L4
(E) L5
Correct Answer: D
The tibialis anterior muscle is primarily innervated by the L4 nerve root. The tibialis anterior muscle also receives innervation from L5. Patients with a weak or absent tibialis anterior muscle will have a drop foot or a steppage gait. The tibialis anterior muscle causes dorsiflexion and inversion of the foot and ankle.
Author : Rajesh Bahadur Lakhey
106. The patellar tendon reflex is primarily transmitted through which of the following nerve roots:
(A) L1
(B) L2
(C) L3
(D) L4
(E) L5
Correct Answer: D
Although the patellar tendon reflex is primarily transmitted through the L4 nerve root, the L2 and L3 nerve roots also contribute to the fibers. There is a weak reflex if the L4 nerve root is completely cut, even if there are still L2 and L3 fibers.
Patellar tendon reflex is seldom completely absent unless the patient has primary muscle or anterior horn lesions.
Author : Rajesh Bahadur Lakhey
105. A 75-year-old woman presents with low back pain that is worse with motion , and bilateral lower extremity pain that is worse with ambulation. She notes that the pain extends down the posterior aspects of her lower extremities, from the buttocks to her calves. The pain limits her activity , she can only ambulate approximately one block before having to rest. She reports that lumbar flexion, notably leaning over a walker or a shopping cart, considerably diminishes her lower extremity pain. She has a significant past medical history of coronary artery disease, and she has had previous angioplasty of her coronary vessels.
On examination, her lower extremity pulses are easily palpable.
This patient’s magnetic resonance image findings are most indicative of:
A) Central stenosis
B) Lateral recess stenosis
C) Central herniated nucleus pulposis
D) Lateral herniated nucleus pulposis
E) Far lateral herniated nucleus pulposis
104. A 45-year-old man has neck pain following a motor vehicle accident.
His neurologic examination is normal.
His plain radiographs are shown (Slide). The most likely diagnosis is:
A) Cervical strain (whiplash-type injury)
B) Compression fracture of C5
C) Unilateral facet dislocation
D) Bilateral facet dislocation
E) Spinous process fracture
103. All of the following are possible treatments for congenital or acquired torticollis except:
A) No treatment because spontaneous resolution is possible in cases of congenital torticollis
B) Active and passive stretching therapies in patients with congenital torticollis until puberty
C) Holding infants so that chin is rotated toward the affected side
D) Physical therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and use of a soft collar
E) Use botulinum toxin, hard collars, or braces in severe cases
102. Schmorl’s nodes may be seen on radiographic studies in all of the following disorders except:
A) Spina bifida
B) Scheuermann’s kyphosis
C) Degenerative disk disease
D) Trauma
E) Osteoporosis
101. Which of the following statements concerning neck pain is incorrect:
A) Patients with traumatic neck injury and pain must be immoblized and assessed with a full neurologic examination
B) Elderly patients may have symptoms of traumatic neck injury without a history of trauma.
C) Rest, physical therapy, and prolonged immobilization of the neck with a collar are effective in managment
D) Surgery for neck pain may be indicated for patients with a cervical spine fracture with evidence of instability, neoplastic disorders, spinal stenosis, and nerve root compression.
(E) Rest and physical therapy
100. Studies suggest that cervical radiculopathy of which nerve root may partially explain the phenomenon of cervicogenic headaches:
A) C3
B) C4
C) C5
D) C6
E) C7
99. Which of the following spinal fracture types is the most stable fracture:
A) Teardrop fracture
B) Burst fracture
C) Unilateral facet dislocation
D) Hangman’s fracture
E) Clay-shoveler’s fracture
98. To avoid vertebral artery injury during cervical lateral mass screw placement, it is best to:
A) Start at the midpoint and aim the screw laterally
B) Start at the midpoint and aim the screw medially
C) Start medially and aim the screw perpendicular
D) Start medially and aim the screw medially
E) Start laterally and aim the screw medially
97. All of the following are elements of the lateral mass of cervical spinal segments except:
A) Inferior articulating process
B) Superior articulating process
C) Spinous process
D) Transverse process
E) Transverse foramen
96. Which of the following statements is false regarding minimally invasive transperitoneal anterior lumbar interbody
fusion:
A) This technique may be safely performed at all lumbar levels.
B) This technique allows direct access to pathology in the vertebral body.
C) Laparoscopy is of great value in the transperitoneal approach to the anterior lumbar spine.
D) There is a potential risk of injuring the aorta and its bifurcation with this technique.
E) None of the above
95. Which of the following serves as the best landmark for proper screw entry into the lumbar pedicle:
A) The junction of the transverse process and inferior facet
B) The junction of the transverse process and superior facet
C) The articulating interface of the superior and inferior facets
D) The medial border of the superior facet
E) There is no relationship between the nerve root and the superior facet
94. In relation to the lumbar pedicle, the exiting nerve root is found:
A) Immediately superior to the pedicle
B) Immediately inferior to the pedicle
C) At the midpoint between the superior and inferior level pedicles
D) Nerve root has no anatomic relationship to the pedicle
E) None of the above
93. Patients with anterior cord syndrome usually present with:
A) Preservation of motor function, preservation of pain and temperature sensation, and loss of vibration and touch sensation
B) Preservation of motor function, with loss of pain, temperature, vibration, and touch sensation
C) Motor paralysis, loss of pain, temperature, vibration, and touch sensation
D) Motor paralysis, loss of pain and temperature sensation, and preservation of vibration and touch sensation
E) Motor paralysis, loss of vibration and touch sensation, and preservation of pain and temperature sensation
92. In reference to the normal sagittal vertical axis (sagittal plumb line), the axis normally falls from the odontoid process through the C7-T1 intervertebral disk and anterior to the thoracic vertebrae.
This normal axis crosses the spinal column at which of the following levels before crossing at the posterior superior border of the S1 vertebral body:
A) T3-T4 intervertebral disk
B) T6-T7 intervertebral disk
C) T8-T10 intervertebral disk
D) T12-L1 intervertebral disk
E) L3-L4 intervertebral disk
91 The endplates and pedicles of which of the following vertebra are normally parallel to the ground in a standing individual:
A) L1
B) L3
C) S1
D) T1
E) T12
5. The axial computed tomography scan depicts a patient with spinal stenosis
The primary source of neural compression is impingement on the traversing nerve root by the:
A) Superior facet of the level below
B) Inferior facet of the level above
C) Redundant ligamentum flavum
D) Overgrown medial pedicle
E) Herniated nucleus pulposus
4. A 45-year-old man has neck pain following a motor vehicle accident.
His neurologic examination is normal.
His plain radiographs are shown (Slide). The most likely diagnosis is:
A) Cervical strain (whiplash-type injury)
B) Compression fracture of C5
C) Unilateral facet dislocation
D) Bilateral facet dislocation
E) Spinous process fracture
3. Canal compromise in burst fractures is caused by:
A) Lamina fracture and anterior migration
B) Migration of the posteroinferior vertebral body
C) Retropulsion of the posterosuperior vertebral body
D) Narrowing of the interpedicular distance
E) Herniated disk material
2. In this slide of a lumbar burst fracture, which column is disrupted to distinguish it from a compression fracture:
A) Anterior
B) Lateral
C) Posterior
D) Middle
E) Medial
1. A 35-year-old man has neck pain following a motor vehicle accident.
His axial computed tomography scan is shown.
The most appropriate treatment would be:
A) Observation
B) Neck collar and physical therapy
C) Reduction and collar immobilization
D) Reduction and halo vest immobilization
E) Reduction and fusion
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