Gray's CH 1: Back

A 40-year-old woman survived a car crash in which her neck was hyperextended when her vehicle was struck from behind. At the emergency department a plain radiograph of her cervical spine is shown below (Fig. 1-5). Which of the following was also most likely injured? A) Anterior arch of the atlas B) Posterior tubercle of the atlas C) Atlanto-occipital joint D) Inferior articular process of the axis E) Anterior tubercle of the atlas

A) Anterior arch of the atlas

A 40-year-old woman survived a car crash in which her neck was hyperextended when her vehicle was struck from behind. At the emergency department, a plain radiograph of her cervical spine revealed a fracture of the odontoid process (dens). Which of the following was also most likely injured? A) Anterior arch of the atlas B) Posterior tubercle of the atlas C) Atlanto-occipital joint D) Inferior articular process of the axis E) Anterior tubercle of the atlas

A) Anterior arch of the atlas

Idling at a stoplight in his vintage car without headrests, a 71-year-old-man's car is struck from behind by a truck. The man is brought to the emergency department suffering from a severe hyperextension neck injury due to the crash. The T2-weighted MRI shows a rupture of the anterior anulus fibrosus of the C4 to C5 intervertebral disc and a prevertebral hematoma which compromised his airway and required intubation. Which of the following ligaments is most likely disrupted in this injury? A) Anterior longitudinal ligament B) Posterior longitudinal ligament C) Ligamentum flavum D) Interspinous ligament E) Intertransverse ligament

A) Anterior longitudinal ligament

While waiting in his car at a stop sign, a 28-yearold man was rear-ended by a van, resulting in neck hyperextension. He was admitted to the emergency department and a whiplash injury was diagnosed. The next day his neck was stiff and painful. Which structure was most likely damaged to cause the pain? A) Anterior longitudinal ligament B) Posterior longitudinal ligament C) Ligamentum flavum D) Intervertebral disc E) Supraspinous ligament

A) Anterior longitudinal ligament

A 39-year-old man presents with severe neck pain after a whiplash injury, sustained when his car was struck from behind. Radiologic studies reveal trauma to the ligament lying on the anterior surface of the cervical vertebral bodies. Which ligament is most likely disrupted? A) Anterior longitudinal ligament B) Ligamentum flavum C) Nuchal ligament D) Posterior longitudinal ligament E) Transverse cervical ligament

A) Anterior longitudinal ligament; Lies anterior to the vertebral bodies along the vertebral column.

A 24-year-old woman presents with severe headache, photophobia, and stiffness of her back. Physical examination reveals positive signs for meningitis. The attending physician decides to perform a lumbar puncture to determine if a pathogen is in the cerebrospinal fluid (CSF). What is the last structure the needle will penetrate before reaching the lumbar cistern? A) Arachnoid mater B) Dura mater C) Pia mater D) Ligamentum flavum E) Posterior longitudinal ligament

A) Arachnoid mater

The following statement is written in the radiology report of an MRI scan of the cervical spine: "A large osteophyte is emanating from the posterolateral area of the vertebral body of the vertebra immediately above the C3 nerve root and is severely compressing the C3 nerve root." The osteophyte is most likely emanating from which of the following vertebrae? A) C2 B) C3 C) C4 D) C5 E) C1

A) C2

A 65-year-old man is injured when a vehicle traveling at a high rate of speed hits his car from behind. Radiologic examination reveals that two of his articular processes are now locked together, a condition known as "jumped facets." In which region of the spine is this injury most likely to occur? A) Cervical B) Thoracic C) Lumbar D) Lumbrosacral E) Sacral

A) Cervical

A 7-year-old boy is undergoing a surgery to remove a tumor from his spinal cord. During surgery of the spinal cord, which of the following structures is used as a landmark to identify anterior rootlets from posterior rootlets? A) Denticulate ligament B) Filum terminale C) Conus medullaris D) Posterior longitudinal ligament E) Ligamenta flava

A) Denticulate ligament

A 38-year-old man is admitted to the emergency department after a car collision. During physical examination several lacerations to the back are discovered. Pain from lacerations or irritations of the skin of the back is conveyed to the central nervous system by which of the following? A) Dorsal primary rami B) Communicating rami C) Ventral primary rami D) Ventral roots E) Intercostal nerves

A) Dorsal primary rami

A 72-year-old woman presented to her primary care physician after sustaining a fall in her bathroom. Her vital signs were normal and routine blood work was obtained for analysis. As part of her work up, a radiograph of her vertebral column was performed and revealed a wedge fracture at the fourth thoracic vertebra and thin cortical bone showing signs of osteoporotic changes. What will be the most likely type of abnormal spinal curvature in such a patient? A)Hyperkyphosis B) Scoliosis C) Hyperlordosis D) Normal E) Primary

A) Hyperkyphosis

A 22-year-old pregnant woman underwent epidural anesthesia in anticipation of labor. After delivery she developed back pain and right lower extremity weakness. Imaging revealed a hematoma in the epidural space resulting in compression of the nerve that exits at the level of L2 to L3. Which of the following vessels is most likely responsible for the hematoma? A) Internal vertebral plexus B) Great radicular artery (of Adamkiewicz) C) Anterior spinal artery D) Posterior spinal artery E) External vertebral plexus

A) Internal vertebral plexus

A 2-month-old infant is admitted to the emergency department with symptoms of meningitis. A lumbar puncture is performed in order to examine the CSF to confirm the diagnosis. The needle is inserted into the lumbar cistern (dural sac). At which vertebral level will the conus medullaris typically be found in this patient? A) L3 B) L4 C) L5 D) S1 E) S2

A) L3

A 6-year-old boy is admitted to the hospital with coughing and dyspnea. During taking of the history, he complains that it feels like there is glass in his lungs. Auscultation reveals abnormal lung sounds. The abnormal lung sounds are heard most clearly during inhalation with the scapulae protracted. Which of the following form the borders of a triangular space where one should place the stethoscope in order to best hear the lung sounds? A) Latissimus dorsi, trapezius, medial border of scapula B) Deltoid, levator scapulae, trapezius C) Latissimus dorsi, external abdominal oblique, iliac crest D) Quadratus lumborum, internal abdominal oblique, inferior border of the twelfth rib E) Rectus abdominis, inguinal ligament, inferior epigastric vessels

A) Latissimus dorsi trapezius, medial border of scapula

An anesthesiologist administers epidural anesthetic immediately lateral to the spinous processes of vertebrae L3 and L4 of a pregnant woman in labor. During this procedure, what would be the last ligament perforated by the needle in order to access the epidural space? A) Ligamentum flavum B) Anterior longitudinal ligament C) Posterior longitudinal ligament D) Interspinous ligament E) Intertransverse ligament

A) Ligamentum flavum

A 35-year-old man is admitted to the emergency department after a severe car crash. After examining the patient the emergency medicine physician concludes that the serratus anterior muscle is damaged. Which of the following nerves innervates the serratus anterior muscle? A) Long Thoracic B) Axillary C) Spinal accessory D) Dorsal scapular E) Thoracodorsal

A) Long Thoracic; Long thoracic is the only nerve that innervates the serratus anterior.

A 22-year-old woman is diagnosed with Raynaud's disease. In such a case, the patient suffers chronic vasospasm in response to cold. This can lead to arterial constriction and painful ischemia, especially in the fingers or toes. Relief from the symptoms in the hands would require surgical division of which of the following neural elements? A) Lower cervical and upper thoracic sympathetic fibers B) Lower cervical an upper thoracic ventral roots C) Lower cervical and upper thoracic dorsal roots D) Lower cervical and upper thoracic spinal nerves E) Bilateral spinal accessory nerves

A) Lower cervical and upper thoracic sympathetic fibers

Which of the following muscles is most likely located immediately deep to the semispinalis muscles, pass from a lateral point of origin in a superomedial direction to attach to spinous processes, and cross between 2 and 4 vertebrae? A) Multifidus B) Rotatores C) Longissimus D) Iliocostalis E) Spinalis

A) Multifidus

A 26-year-old competitive football player has been complaining of pain, weakness, numbness, and tingling for the past 2 months in his upper limb. Imaging studies reveal a cervical disc herniation compressing the nerve roots and a portion of the spinal cord. An ACDF surgery is performed. The intervertebral disc is examined upon removal and the nucleus and anulus and nucleus pulposus are severely damaged posterolaterally. What is the embryologic origin of the anulus fibrosus and nucleus pulposus, respectively? A) Notochord and neural crest cells B) Neural crest cells and ectoderm C) Sclerotome and myotome D) Mesenchymal cells from sclerotome and neural crest cells E) Mesenchymal cells from sclerotome and notochord

A) Notochord and neural crest cells

A 35-year-old man underwent a laminectomy of the T8 to T9 vertebrae. During the surgery, the neurosurgeon observed that the posterior roots were compressed at that level due to a space-occupying lesion. Which of the following arteries was most likely directly compressed by the lesion? A) Radicular B) Segmental spinal C) Segmental medullary D) Anterior spinal E) Posterior spinal

A) Radicular

Examination of a 3-day-old male infant reveals a large cystic of approximately 15 cm × 10 cm in the sacrococcygeal region. The mass was removed and histopathological studies identified tissue from all three embryological germ layers. Which of the following embryonic tissues is most likely responsible for this condition? A) Remnants of the primitive streak B) Chorionic villi C) Neural folds D) Intraembryonic coelom E) Neural crest

A) Remnants of the primitive streak

A 22-year-old male soccer player is forced to leave the game following a head-to-head collision with another player. He is admitted to the hospital, and radiologic examination reveals slight dislocation of the atlantoaxial joint. As a result, he experiences decreased range of motion at that joint. What movement of the head would most likely be severely affected? A) Rotation B) Flexion C) Abduction D) Extension E) Adduction

A) Rotation

A young resident complains of an itch on his back that appears to be caused by an insect bite. Which nerve fibers carry the sensation of a mosquito bite on the back, just lateral to the spinous process of the T4 vertebra? A) Somatic afferent B) Somatic efferent C) Visceral afferent D) Visceral efferent E) Somatic efferent and visceral afferent

A) Somatic afferent

During a gross anatomy laboratory session, a professor demonstrates a large back muscle that inserts onto the floor of the intertubercular sulcus of the humerus. Which of the following structures is most likely the vertebral origin of the muscle that the professor is demonstrating? A) Spinous processes of T7 to L5 B) Spinous processes of C7 to T12 C) Transverse processes of C1 to C4 D) Spinous processes of T2 to T5 E) Spinous processes of C7 and T1

A) Spinous processes of T7 to L5

A 53-year-old man is admitted to the emergency department with severe back pain. MRI examination reveals fracture of the pars interarticularis and normal alignment of the body of the L5 vertebra upon the sacrum. What is the most likely diagnosis? A) Spondylolysis B) Spondylolisthesis C) Herniation of intervertebral disc D) Lordosis E) Scoliosis

A) Spondylolysis

A 62-year-old woman is admitted to the hospital because of her severe back pain. Radiologic examination reveals that the L4 vertebral body has slipped anteriorly, with fracture of the zygapophysial joint. What is the proper name of this condition? A) Spondylolysis and spondylolisthesis B) Spondylolisthesis C) Crush vertebral fracture D) Intervertebral disc herniation E) Klippel-Feil syndrome

A) Spondylolysis and spondylolisthesis

A 22-year-old man is brought into the emergency department following a brawl in a tavern. He has severe pain radiating across his back and down his left upper limb. He supports his left upper limb with his right hand, holding it close to his body. Any attempt to move the left upper limb greatly increases the pain. A radiograph is ordered and reveals an unusual sagittal fracture through the spine of the left scapula. The fracture extends superiorly toward the suprascapular notch. Which nerve is most likely affected? A) Suprascapular nerve B) horacodorsal nerve C) Axillary nerve D) Subscapular nerve E) Suprascapular nerve and thoracodorsal nerve

A) Suprascapular nerve

A 12-year-old child was brought to the emergency department by his parents because he has been suffering from a very high fever and severe stiffness in his back. The initial diagnosis is meningitis. The attending physician orders a lumbar puncture to confirm the diagnosis. Upon microscopic examination of the cerebrospinal fluid, hematopoietic cells are seen. Which of the following ligaments was most likely penetrated by the needle? A) Supraspinous B) Deniculate C) Anterior longitudinal D) Posterior longitudinal E) Nuchal ligament

A) Supraspinous

A 48-year-old man underwent suboccipital surgery whereby the surgeon made a midline incision through the ligamentum nuchae that began 1-cm inferior to the external occipital protuberance and ended at the level of the C2 vertebra. The surgeon then placed self-retaining retractors into the incision to forcibly separate the tissue so that an adequate surgical field existed for the duration of the surgery which lasted for 3 hours. During recovery, the patient complained of severe occipital pain and was diagnosed with postsurgical occipital neuralgia. Which of the following nerves was most likely directly stretched by the retractors during the surgery and resulted in this patient's post-surgical pain? A) Third occipital B) Suboccipital C) Greater occipital D) Lesser occipital E) Spinal accessory

A) Third occipital

A 27-year-old man is admitted to the emergency department after a car crash. Physical examination reveals weakness during medial rotation and adduction of the humerus. Which of the following nerves was most probably injured? A) Thoracodorsal B) Axillary C) Dorsal scapular D) Spinal accessory E) Radial

A) Thoracodorsal; The thoracodorsal nerve innervates the latissimus dorsi, one of major muscles that adduct and medially rotate the humerus.

A radiology report of a cervical spine MRI scan contains the following statement: "A small 1-cm tumor is located within a muscle on the lateral border of the right suboccipital triangle." The muscle to which the radiologist is most likely referring inserts on which of the following bony features? A) Transverse process of atlas B) Lateral portion of occipital bone below inferior nuchal line C) Occipital bone between superior and inferior nuchal lines D) Medial portion of occipital bone below inferior nuchal line E) Posterior tubercle of atlas

A) Transverse process of atlas

A 34-year-old woman is admitted to the emergency department after a car crash. Radiologic examination reveals a whiplash injury in addition to hyperextension of her cervical spine. Which of the following ligaments will most likely be injured? A) Ligamentum flavum B) Anterior longitudinal ligament C) Posterior longitudinal ligament D) Anulus fibrosus E) Interspinous ligament

B) Anterior longitudinal ligament

A 7-year-old girl who is somewhat obese is brought to the emergency department because of a soft lump above the buttocks. Upon physical examination you note the lump is located just superior to the iliac crest unilaterally on the left side. The protrusion is deep to the skin and pliable to the touch. Which of the following is the most probable diagnosis? A) Tumor of the external abdominal oblique muscle B) Herniation at the lumbar triangle (of Petit) C) Indirect inguinal hernia D) Direct inguinal hernia E) Femoral hernia

B) Herniation at the lumbar triangle (of Petit)

A 79-year-old man, a retired military veteran, presents to the outpatient clinic with an abnormal curvature of the vertebral column. He complains that it has become increasingly painful to walk around town. Upon physical examination, he has an abnormally increased convexity to his thoracic curvature resulting from osteoporosis. Which of the following is the most likely clinical condition of this patient's spine? A) Scoliosis B) Hyperkyphosis C) Spinal stenosis D) Lordosis E) Herniated disc

B) Hyperkyphosis

A 55-year-old man with severe coughing is admitted to the hospital. Radiologic examination is consistent with tuberculosis of the right lung, with extension to the thoracic vertebral bodies of T6 and T7, producing a "gibbus deformity." Which of the following conditions is most likely also to be confirmed by radiologic examination? A)Hyperlordosis B) Hyperkyphosis C) Scoliosis D) Spina bifida E) Osteoarthritis

B) Hyperkyphosis; "Hunch-back" due to an abnormal increase in curvature of the thoracic region of the vertebral column.

A 22-year-old man is thrown through a plate glass wall in a fight. Radiologic examination reveals that the lateral border of his right scapula is shattered. He is admitted to the emergency department, and physical examination reveals difficulty laterally rotating his arm. Which of the following muscles is most probably injured? A) Teres major B) Infraspinatus C) Latissimus dorsi D) Trapezius E) Supraspinatus

B) Infraspinatus

A 58-year-old man in the intensive care ward exhibited little voluntary control of urinary or fecal activity following repair of an abdominal aortic aneurysm. In addition, physical examination revealed widespread paralysis of his lower limbs. These functions were essentially normal prior to admission to the hospital. The most likely cause of this patient's problems is which of the following? A) Injury to the left vertebral artery B) Injury of the great radicular artery (of Adamkiewicz) C) Ligation of the posterior spinal artery D) Transection of the conal segment of the spinal cord E) Division of the thoracic sympathetic chain

B) Injury of the great radicular artery (of Adamkiewicz)

During a routine physical examination, a 65-yearold man is tested for ease and flexibility of the movements of his lumbar region. Which of the following movements is most characteristic of the intervertebral joints in the lumbar region? A) Circumduction B) Lateral flexion C) Abduction D) Adduction E) Inversion

B) Lateral flexion

A 55-year-old woman has suffered from a middle ear infection for the past month. She recently developed right-sided miosis, partial ptosis, anhydrosis, and redness of the conjunctiva. Biopsy examination of which of the following structures would show the cell bodies of neurons affected by this disease? A) Anterior gray horn of the spinal cord B) Lateral gray horn of the spinal cord C) Posterior gray horn of the spinal cord D) Spinal ganglia E) Lateral column of spinal cord white matter

B) Lateral gray horn of the spinal cord

A 65-year-old man complains of severe back pain and the inability to move his left lower limb. Radiologic studies demonstrate compression of nerve elements at the intervertebral foramen between vertebrae L5 and S1. Which structure is most likely responsible for this space-occupying lesion? A) Anulus fibrosus B) Nucleus pulposus C) Posterior longitudinal ligament D) Anterior longitudinal ligament E) Ligamentum flavum

B) Nucleus pulposus; Compression of nerves at the intervertebral foramen indicates a disc herniation. A disc herniation is characterized by protrusion of the nucleus pulposus through the anulus fibrosus posterolaterally into the spinal canal or intervertebral foramen. In general, the ligaments may be affected by the herniation but are not responsible for the compression of the spinal nerve roots.

A 19-year-old man is diagnosed with a herniated disc but he has no symptoms of spinal cord injury. In the event of intervertebral disc herniation in the cervical region, which of the following ligaments is in an anatomic position to protect the spinal cord from direct compression? A) Supraspinous B) Posterior longitudinal C) Anterior longitudinal D) Ligamentum flavum E) Nuchal ligament

B) Posterior longitudinal

A 38-year-old woman with a history of carcinoma of the left breast and who had had a lumpectomy 2 years previously, presents to her surgeon with complaints of a hard mass in the left breast. On ultrasound examination, a 3 cm × 4 cm hard mass is discovered in the upper outer quadrant extending in the axillary tail (of Spence). A radical mastectomy is performed successfully and the tumor is removed. Three weeks postoperatively the patient complains of difficulty raising her left arm above her head. Which of the following is most likely expected to be found during physical examination? A) Protraction of the both scapulae B) Protrusion of the medial border of the left scapula when hands are pushed against the wall C) Weak abduction of the left upper limb in the 15 to 90 degree range D) Weak retraction of the scapula E) Weak adduction of the humerus

B) Protrusion of medial border of left scapula when hands are pushed against the wall

Radiographs of a 12-year-old girl with midback pain reveal a hemivertebra of the lower thoracic spine. Which additional finding would most likely be demonstrated on the radiographs? A) Osteoporosis B) Scoliosis C) Hyperlordosis D) Spondylolisthesis E) Sacralization

B) Scoliosis

A 62-year-old man visits his physician for his annual medical check-up. During physical examination it is noted that the patient has noticeable pulsations on palpation of the lower abdomen. Ultrasound examination reveals a large abdominal aortic aneurysm. The patient is operated on and during the repair his aorta is temporarily clamped. Which of the following arterial anastomoses will most likely prevent ischemia of the spinal cord if the blood pressure drops dangerously low? A) Segmental arteries from the vertebral, intercostals, superficial epigastric, lumbar, and medial sacral arteries B) Segmental arteries from the vertebral, intercostal, lumbar, spinal anterior, and posterior and lateral sacral arteries C) Anterior and posterior spinal arteries D) Radicular arteries of the vertebral, lumbar, intercostal, lateral sacral arteries, and artery of Adamkiewicz E) Segmental arteries from vertebral and intercostals

B) Segmental arteries from the vertebral, intercostal, lumbar, spinal anterior, and posterior and lateral sacral arteries

A 42-year-old woman complains of pain and stiffness in her neck. She was injured sliding into second base headfirst during her company's softball game. Radiographs reveal no fractures of her spine. However, upon physical examination, her right shoulder is drooping and she has difficulty in elevating that shoulder. If you ordered an MRI, it would most likely reveal soft tissue damage involving which of the following nerves? A) Thoracodorsal nerve B) Spinal accessory nerve C) Dorsal scapular nerve D) Greater occipital nerve E) Axillary nerve

B) Spinal accessory nerve

A 53-year-old man is admitted to the emergency department due to severe back pain. MRI examination reveals anterior dislocation of the body of the L5 vertebra upon the sacrum. Which of the following is the most likely diagnosis? A) Spondylolysis B) Spondylolisthesis C) Herniation of intervertebral disc D) Lordosis E) Scoliosis

B) Spondylolisthesis

An 18-year-old woman passenger injured in a rollover car crash was rushed to the emergency department. After the patient is stabilized, she undergoes physical examination. She demonstrates considerable weakness in her ability to flex her neck, associated with injury to CN XI. Which of the following muscles is most probably affected by nerve trauma? A) Iliocostalis thoracis B) Sternocleidomastoid C) Rhomboid major D) Rhomboid minor E) Teres major

B) Sternocleidomastoid

A 64-year-old man arrived at the clinic with a painful rash and skin eruptions that are localized entirely on one side of his body, closely following the dermatome level of the spinal nerve C7. The patient was diagnosed with the a herpes zoster virus infection known as "shingles." In what structure has the virus most likely proliferated to cause the patient's current condition? A) The sympathetic chain B) The dorsal root ganglion of C7 spinal nerve C) The lateral horn of C7 spinal cord segment D) The posterior cutaneous branch of dorsal primary ramus of C7 E) The ventral horn of C7 spinal cord segment

B) The dorsal root ganglion of C7 spinal nerve; Herpes zoster is a viral disease that remains latent in the dorsal root ganglia of the sensory nerves and when the virus becomes active presents as a painful skin lesion. It is associated only with sensory nerve fibers and has no motor involvement. The only answer choice that is solely responsible for sensory innervation is the dorsal root ganglion.

When a lumbar puncture is performed to sample cerebrospinal fluid, which of the following external landmarks is the most reliable to determine the position of the L4 vertebral spine? A) The inferior angles of scapulae B) The highest points of iliac crests C) The lowest pair of ribs bilaterally D) The sacral hiatus E) The posterior inferior iliac spines

B) The highest points of iliac crests; Used as landmark for locating position of L4 to L5 for lumbar puncture; identified and traced medially toward the vertebral column (Tuffier's line).

A 53-year-old man was in a head-on collision resulting in the dens crushing the spinal cord. Which ligament was most likely torn for the dens to crush the spinal cord? A) Anterior and posterior longitudinal ligaments B) Transverse ligament of the atlas C) Interspinous ligament D) Supraspinous ligament E) Nuchal ligament

B) Transverse ligament of the atlas

A 53-year-old man was in a head-on vehicle collision that resulted in compression of his spinal cord by the dens (odontoid process) of the axis, with resulting quadriplegia. Which of the following ligaments was most probably torn? A) Anterior longitudinal ligament B) Transverse ligament of the atlas C) Ligamentum flavum D) Supraspinous ligament E) Nuchal ligament

B) Transverse ligament of the atlas

A 25-year-old male racing car driver is admitted to the emergency department after a severe car crash. Radiologic studies reveal damage to the tip of the transverse process of the third cervical vertebra, with a significantly large pulsating hematoma. What artery is the most likely to have been damaged? A) Anterior spinal artery B) Vertebral artery C) Ascending cervical artery D) Deep cervical artery E) Posterior spinal arteries

B) Vertebral artery

A drug that preferentially destroys sclerotomes during embryogenesis would most likely result in underdevelopment of which of the following structures? A) Nucleus pulposus of intervertebral disc B) Vertebral bodies C) Dorsal root ganglion D) Spinal cord E) Anulus fibrosus of intervertebral disc

B) Vertebral bodies

A 68-year-old man is admitted to the hospital due to severe back pain. Radiologic examination reveals severe osteoporosis of the vertebral column, with compression fractures to vertebrae L4 and L5. Which of the following parts of the vertebrae are most likely to be fractured in this patient? A) Spinous process B) Vertebral bodies C) Transverse process D) Superior articular process E) Intervertebral disc

B) Vertebral bodies; A crush fracture is characterized by compression of the entire vertebral body. The wedge fracture is similar in that it affects the vertebral bodies, but it involves small fractures around the perimeter of the vertebral body.

A 45-year-old woman is admitted to the outpatient clinic for shoulder pain. During physical examination she presents with weakened shoulder movements. Radiologic examination reveals signs of quadrangular space syndrome, causing weakened shoulder movements. Which of the following nerves is most likely affected? A) Suprascapular B) Subscapular C) Axillary D) Radial E) Ulnar

C) Axillary

The following statement was found in the radiology report of a magnetic resonance imaging scan of the cervical spine: "An acute posterolateral herniation of the most superiorly located intervertebral disc is located within the corresponding intervertebral foramen and compressing the exiting nerve." Which of the following nerves was the radiologist most likely referring to in the report? A) C1 B) C2 C) C3 D) C4 E) C5

C) C3

In a report of a radiograph of the cervical spine the radiologist wrote the following: "Severe narrowing of the C7-T1 intervertebral foramen (IVF) on the left." Which nerve was most likely compressed as a result of this finding? A) C6 B) C7 C) C8 E) T1

C) C8

A male newborn infant is brought to the clinic by his mother and diagnosed with a congenital malformation. MRI studies reveal that the cerebellum and medulla oblongata are protruding inferiorly through the foramen magnum into the vertebral canal. What is this clinical condition called? A) Meningocele B) Klippel-Feil syndrome C) Chiari II malformation D) Hydrocephalus E) Tethered cord syndrome

C) Chiari II malformation

A 37-year-old pregnant woman is given a caudal epidural block to alleviate pain during vaginal delivery. Caudal epidural blocks involve injection of local anesthetic into the sacral canal. Which of the following landmarks is most commonly used for the caudal epidural block? A) Anterior sacral foramina B) Posterior sacral foramina C) Cornua of the sacral hiatus D) Intervertebral foramina E) Median sacral crest

C) Cornua of the sacral hiatus

A 23-year-old man was killed in a high-speed motor vehicle collision after racing his friend on a local highway. When the medical examiner arrives at the scene, it is determined that the most likely cause of death was a spinal cord injury. Upon confirmation by autopsy, the medical examiner officially reports that the patient's cause of death was a fracture of the pedicles of the axis (C2). Breaking of which of the following ligaments would be most likely implicated in this fatal injury? A) Ligamentum flavum B) Nuchal ligament C) Cruciform ligament D) Posterior longitudinal ligament E) Supraspinous ligament

C) Cruciform ligament

A 23-year-old college student is admitted to the emergency department after jumping from a 50-foot high waterfall. The MRI of his back reveals a lateral shift of the spinal cord to the left. Which of the following structures has most likely been torn to cause the deviation? A) Posterior longitudinal ligament B) Tentorium cerebelli C) Denticulate ligaments D) Ligamentum flavum E) Nuchal ligament

C) Denticulate ligaments

A 65-year-old woman who has been otherwise well presents to her physician with complaints of a group of painful blisters over her back in the distribution of the T9 dermatome. She noticed that a few days prior to the eruption of the blisters she experienced an intense burning sensation over her skin. She was diagnosed with herpes zoster (shingles). Where are the neural cell bodies located that are responsible for the pain sensation? A) Dorsal horn B) Lateral horn C) Dorsal root ganglia D) Sympathetic chain ganglia E) White rami communicans

C) Dorsal root ganglia

A 35-year-old man is admitted to the hospital after a severe car crash. Radiologic examination reveals an injury to the dorsal surface of the neck and a fracture of the medial border of the right scapula. During physical examination, the patient presents with the scapula retracted laterally on the affected side. Which of the following nerves has most likely been injured on that side? A) Axillary B) Long thoracic C) Dorsal scapular D) Greater occipital E) Suprascapular

C) Dorsal scapular; The dorsal scapular nerve (from the ventral ramus of C5) is responsible for innervating rhomboids major and minor.

A 28-year-old pregnant woman is admitted to the obstetrics department for delivery. In the final stages of labor, a caudal anesthetic is administered via the sacral hiatus. Into which of the following spaces in the sacral canal is the anesthetic placed? A) Vertebral canal B) Vertebral venous plexus C) Epidural space D) Subarachnoid space E) Subdural space

C) Epidural space

A 26-year-old competitive football player has been complaining of pain, weakness, numbness, and tingling for the past 2 months in his upper limb. Imaging studies reveal a cervical disc herniation compressing the nerve roots and a portion of the spinal cord. An anterior cervical discectomy and fusion (ACDF) surgery is performed. The intervertebral disc is examined upon removal and the anulus fibrosus and nucleus pulposus are severely damaged posterolaterally. What type of cartilage most likely gives the tensile strength of the intervertebral disc? A) Hyaline B) Elastic C)Fibrous D) Epiphysial E) Elastic and fibrous

C) Fibrosis

A 45-year-old man is admitted to the hospital because of severe pain in the back and lower limb. Radiologic examination reveals spinal canal stenosis syndrome. Which of the following conditions is most likely to be confirmed by a magnetic resonance imaging (MRI) examination? A) Hypertrophy of supraspinous ligament B) Hypertrophy of interspinous ligament C) Hypertrophy of ligamentum flavum D) Hypertrophy of anterior longitudinal ligament E) Hypertrophy of nuchal ligament

C) Hypertrophy of ligamentum flavum; The ligamentum flavum connects the laminae of two adjacent vertebrae and forms the posterior wall of the vertebral canal.

In spinal anesthesia, the needle is often inserted between the spinous processes of the L4 and L5 vertebrae to ensure that the spinal cord is not injured. This level is safe because in the adult the spinal cord usually terminates at the disc between which of the following vertebral levels? A) T11 and T12 B) T12 and L1 C) L1 and L2 D) L2 and L3 E) L3 and L4

C) L1 and L2

A 3-day-old girl develops a fever. She is irritable and not feeding. As part of the workup for fever of unknown origin, a lumbar puncture is performed. This puncture must be done below the spinal cord which usually ends at which vertebral level in a patient of this age? A) L1 B) S1 C) L3 D) S3 E) L5

C) L3

A 42-year-old woman is diagnosed with stenosis of the cervical vertebral canal. A laminectomy of two vertebrae is performed. Which of the following ligaments will most likely also be removed? A) Anterior longitudinal B) Deniculate C) Ligamentum flavum D) Nuchal E) Cruciate

C) LIgamentum flavum

A 39-year-old woman complains of an inability to reach the top of her head to brush her hair with her right hand. History reveals that she had undergone a mastectomy procedure of her right breast 2 months earlier. Physical examination demonstrates winging of her right scapula. A) Axillary B) Spinal accessory C) Long thoracic D) Dorsal scapular E) Thoracodorsal

C) Long thoracic; Innervates serratus anterior, responsible for elevation and protraction of scapula beyond the horizontal level while maintaining its position against the thoracic wall.

A mother brought her 15-month-old previously healthy child to the pediatrician and nervously told the physician that her child now had "a curvature in her low back." The mother stated that this curvature was not present previously and that she noticed it when the child started standing and walking. The physician examined the child and then reassured the mother that the spinal curvature was normal. Which curvature did the mother most likely observe? A) Thoracic kyphosis B) Cervical lordosis C) Lumbar lordosis D) Cervical kyphosis E) Thoracic lordosis

C) Lumbar lordosis

A 23-year-old woman is admitted to the hospital due to back pain. Radiologic examination reveals that she suffers from a clinical condition affecting her vertebral column. Her history reveals that she suffered from polio and has a muscular dystrophy. Which of the following conditions of the vertebral column will most likely be present in this patient? A) Hyperlordosis B) Hyperkyphosis C) Scoliosis D) Spina bifida E) Osteoarthritis

C) Scoliosis

A 32-year-old mother complains of serious pain in the coccygeal area some days after giving birth. To determine whether the coccyx is involved, a local anesthetic is first injected in the region of the coccyx and then dynamic MRI studies are performed. Physical examination reveals pain with palpation to the region of the coccyx. The local anesthetic is used to interrupt which of the following nerve pathways? A) Visceral afferents B) Somatic efferent C) Somatic afferent D) Sympathetic preganglionic E) Parasympathetic preganglionic

C) Somatic afferent

A maternal serum sample with high alphafetoprotein alerted the obstetrician to a possible neural tube defect. Ultrasound diagnosis revealed a myelomeningocele protruding from the back of the child. Which of the following is the most likely diagnosis of this congenital anomaly? A) Cranium bifida B) Spina bifida occulata C) Spina bifida cystica D) Hemothorax E) Caudal regression syndrome

C) Spina bifida cystica

A 1-year-old girl is brought to the clinic for a routine checkup. The child appears normal except for a dimpling of the skin in the midline of the lumbar region with a tuft of hair growing over the dimple. What is this relatively common condition that results from incomplete embryologic development? A) Meningomyelocele B) Meningocele C) Spina bifida occulata D) Spina bifida cystica E) Rachischisis

C) Spina bifida occulata; Development condition resulting from incomplete fusion of the vertebral arches within the lumbar region.

A 22-year-old man has suffered from headaches and some muscle weakness to his upper muscles of the back for the last 6 months. An MRI shows a large tumor compressing the suboccipital and greater occipital nerves. Which of the following muscles will most likely still be functioning normally? A) Rectus capitis posterior major and minor B) Semispinalis capitis C) Splenius capitis D) Obliquus capitis superior E) Obliquus capitis inferior and lateral

C) Splenius capitis

A 19-year-old presents at the emergency department with high fever, severe headache, nausea, and stiff neck that have persisted for 3 days. The attending physician suspects meningitis and obtains a sample of CSF using a lumbar puncture. From which of the following spaces was the CSF collected? A) Epidural space B) Subdural space C) Subarachnoid space D) Pretracheal space E) Central canal of the spinal cord

C) Subarachnoid space

An orthopedic surgeon was teaching two residents during a workshop. For the purpose of learning, one resident acted as the patient and the other as the clinician. The surgeon asked the resident-clinician to use a marker and draw a horizontal line connecting the highest points of the iliac crests on the skin of the resident-patient. The surgeon then asked the residentclinician to palpate the midline area on the skin where the subarachnoid space terminates inferiorly. Which of the following most likely represents the area on the skin where the resident-physician palpated? A) Three spinous processes superior to the horizontal line B) Two spinous processes inferior to the horizontal line C) Three spinous processes inferior to the horizontal line D) Two spinous processes superior to the horizontal line E) The spinous process bisected by the horizontal line

C) Three spinous processes inferior to the horizontal line

An MRI scan of the thoracic spine of a 68-year-old man with acute midback pain revealed a large tumor arising from the anterior median fissure of the spinal cord at the level of the T3 vertebra. The artery compressed by the tumor is most likely formed superiorly by direct branches from which of the following arteries? A) Ascending cervical B) Segmental medullary C) Vertebral D) Segmental spinal E) Posterior spinal

C) Vertebral

A 22-year-old woman is diagnosed with the presence of a chondroma at her index finger. Which of the following structures are sharing the same embryologic with the tumor? A) Denticulate ligament B) Dentate ligament C) Nucleus pulposus D) Apical ligament of the atlas E) Alar ligament

D) Apical ligament of the atlas

A 54-year-old woman is admitted to the emergency department due to increasing back pain over the preceding year. MRI reveals that her intervertebral discs have been compressed. It is common for the discs to decrease in size in people older than 40, and this can result in spinal stenosis and disc herniation. At which locations are the spinal nerves most likely to be compressed? A) Between the denticulate ligaments B) As they pass through the vertebral foramen C) Between the superior and inferior articular facets D) Between inferior and superior vertebral notches E) Between the superior and inferior intercostovertebral joints

D) Between inferior and superior vertebral notches

A 38-year-old man presents to the emergency department with complaints of lower back pain during the past 5 days. Examination revealed tenderness of the spine over the L5 vertebra with an obvious "step-off" defect at that level. There was some weakness of the limbs. An MRI examination revealed an anterior displacement of the L5 vertebral body and narrowing of the vertebral canal. This pathology will most likely be associated with which of the following? A) Compression of the spinal cord and bilateral lower limb weakness B) Compression of the spinal cord and unilateral lower limb weakness C) Compression of the spinal nerve roots and L5 with unilateral lower limb weakness D) Compression of the cauda equina and bilateral lower limb weakness E) Compression of the cauda equina and low back pain only

D) Compression of the cauda equina and bilateral lower limb weakness

A 69-year-old woman visits her physician due to severe neck pain. Radiologic studies reveal bony growths (osteophytes) in the intervertebral foramen between vertebrae C2 and C3. Which of the following muscles would be most likely affected by this condition? A) Rhomboideus major B) Serratus anterior C) Supraspinatus D) Diaphragm E) Latissimus dorsi

D) Diaphragm

A 60-year-old man has been feeling sharp pains over his left lower chest and back for several days. A rash of red erupted vesicles is seen at the left border of the sternum just at the level of the xiphoid process. Antiviral treatment is given for herpes zoster. Which of the following locations will contain the neural cell bodies responsible for the painful sensation? A) Ventral horn of T6 spinal cord segment B) Lateral horn of T6 spinal cord segment C) Dorsal root ganglion of T4 spinal nerve D) Dorsal root ganglion of T6 spinal nerve E) Dorsal root ganglion of T10 spinal nerve

D) Dorsal root ganglion of T6 spinal nerve

A 42-year-old man is struck in the back, rupturing the internal vertebral venous plexus (of Batson). Radiologic studies reveal a hematoma causing compression of the spinal cord. When aspirating the excess blood, the physician performing the procedure should stop the needle just before puncturing which of the following structures? A) Spinal cord B) Pia mater C) Arachnoid mater D) Dura mater E) Ligamentum flavum

D) Dura mater

A 25-year-old male bodybuilder complains of difficulty moving his right shoulder for the past 2 weeks. Upon physical examination, the muscles of the left upper back and shoulder were notably larger than the right side. There was a notable decrease of muscle power on his right sided upper back and shoulder muscles when he was asked to pull the shoulder blades toward the middle of his back against resistance. Nerve conduction examination confirmed neurapraxia of the nerves supplying the rhomboid major and minor muscles. In which of the following functions will the bodybuilder most likely also demonstrate weakness? A) Abduction of the right arm above the horizontal level and protraction of the scapula B) Medial rotation and adduction of the right arm C) Extensions, adduction, and medial rotation of the right arm D) Elevation of the scapula and inferior rotation of the right shoulder E) Abduction of the right arm from 0 to 15 degrees

D) Elevation of the scapula and inferior rotation of right shoulder

Following a car crash, a 47-year-old woman complains of severe headache and back pain. Radiologic examination reveals bleeding of the internal vertebral venous plexus (of Batson), resulting in a large hematoma. In what space has the blood most likely accumulated? A) Subarachnoid space B) Subdural space C) Central canal D) Epidural space E) Lumbar cistern

D) Epidural space

A 45-year-old man was injured in a motor vehicle crash and brought to the emergency department. Radiographs of the upper cervical spine revealed a type III dens fracture demonstrated by a horizontal radiolucent line on the superior half of the posterior aspect of the C2 vertebral body. Which of the following ligaments most likely has direct attachment to the bony area where the fracture was located? A) Apical ligament of dens B) Superior longitudinal band of cruciform ligament C) Transverse ligament of atlas D) Inferior longitudinal band of cruciform ligament E) Ligamenta flava

D) Inferior longitudinal band of cruciform ligament

A 45-year-old woman states that she has experienced moderate pain for 2 years over her left lower back; pain that radiates to her left lower limb. She states that after lifting a case of soft drinks, the pain suddenly became intense. She was admitted to the emergency department. Radiologic examination revealed intervertebral disc herniation between vertebral levels L4 and L5. Which of the following nerves was most likely affected by the disc herniation? A) T12 to L1 B) L1 to L2 C) L2 to L3 D) L4 to L5 E) L5 to S1

D) L4 to L5; A lumbar puncture is performed by taking a sample of CSF from the lumbar cistern (the subarachnoid space below the spinal cord) between vertebrae L4 and L5 or sometimes between L3 and L4. It is the safest place to do the procedure because it lies between these areas and the risk of injuring the spinal cord is minimized.

A 29-year-old female elite athlete was lifting heavy weights during an intense training session. The athlete felt severe pain radiate suddenly to the posterior aspect of her right thigh and leg. The patient was taken to the hospital where an MRI was performed. Which nerve was most probably affected? A) L3 B) L4 C) L2 D) L5 E) S1

D) L5

A 32-year-old man was lifting heavy weights during an intense training session. He felt severe pain radiating to the posterior aspect of his right thigh and leg. He was taken to hospital where an MRI scan (see Fig. 1-3) revealed a ruptured intervertebral disc. Which of the following nerves was most likely affected? A) L2 B) L3 C) L4 D) L5 E) S1

D) L5

A 32-year-old man, an elite athlete, was lifting heavy weights during an intense training session. The athlete felt severe pain radiating to the posterior aspect of his right thigh and leg. The patient was taken to the hospital where MRI revealed a ruptured L4/L5 intervertebral disc. Which nerve is most probably affected? A) L3 B) L4 C) L2 D) L5 E) S1

D) L5

A 43-year-old male construction worker survived a fall from a two-story building but lost all sensation in his lower limbs and was admitted to the hospital for examination and treatment. Radiologic studies revealed that he crushed his spinal cord at vertebral level C6. Which of the following muscles will most likely be paralyzed? A) Sternocleidomastoid B) Trapezius C) Diaphragm D) Latissimus dorsi E) Deltoid

D) Latissimus dorsi

A 32-year-old construction worker falls from a scaffold and is brought to the emergency department with severe lower back pain. Radiographs of the lumbar spine reveal bilateral pars interarticularis fractures of the L5 vertebra. Which of the following radiographic views would most likely reveal these fractures? A) Anteroposterior B) Lateral C) Posteroanterior D) Oblique E) Anteroposterior open mouth

D) Oblique

A 38-year-old man who is a professional golfer complains of chronic lower back pain with radiating pain to the heel. The pain is so debilitating that he now has trouble ambulating. MRI of the lower back reveals severe narrowing of an intervertebral foramen (IVF), which has caused compression of the exiting nerve root. Surgery is required to correct the problem. During surgery the neurosurgeon carefully accesses the IVF using a lateral approach and shaves bone off the superior margin (roof) of the IVF to decompress the exiting nerve root. Which of the following vertebral bony features is the neurosurgeon most likely shaving off? A) Superior articular process B) Lamina C) Inferior articular process D) Pedicle E) Spinous process

D) Pedicle

A 36-year-old man was found guilty of first-degree murder and sentenced to death by judicial hanging. The radiological image below shows the vertebra that is fractured as a result of the hanging. The mechanism of injury resulting in death is forcible hyperextension resulting in a fracture of which of the following structures? A) Odontoid process B) Transverse process C) Lateral mass D) Pedicle (pars articularis) E) Spinous process

D) Pedicle (pars articularis)

A 35-year-old man is admitted to the emergency department after a severe car crash. After examining the patient the emergency medicine physician concludes that the serratus anterior muscle is damaged. Which of the following functions will the patient most likely be unable to perform? A) Retraction of scapula B) Elevation of scapula C) Depression of scapula D) Protraction of scapula E) Medial rotation of scapula

D) Protraction of scapula; The serratus anterior muscle pulls the scapula forward (protraction) over the thoracic wall

A 45-year-old male driver involved in a motor vehicle crash was taken to the emergency department and MRI revealed a complete tear of the right alar ligament. None of the other ligaments of the upper cervical spine were torn. Upon physical examination, which of the following cervical spine movements will be most likely increased as a result of the tear? A) Flexion B) Extension C) Lateral flexion D) Rotation E) Abduction

D) Rotation

A 34-year-old pregnant woman in the maternity ward was experiencing considerable pain during labor. Her obstetrician decided to perform a caudal epidural block. What are the most important bony landmarks used for the administration of such anesthesia? A) Ischial tuberosities B) Ischial spines C) Posterior superior iliac spines D) Sacral cornua E) Coccyx

D) Sacral cornua

A 62-year-old man is admitted to the emergency department after a severe car crash resulting in a whiplash injury. MRI examination reveals several hairline vertebral fractures in the cervical region impinging the dorsal primary rami of the same levels. Two months after the injury the patient recovered well, however, there is still some weakness in the function of a muscle. Which of the following muscles is most likely affected? A) Rhomboid major B) Levator scapulae C) Rhomboid minor D) Semispinalis capitis E) Latissimus dorsi

D) Semispinalis capitis

Examination of a 3-day-old male infant reveals protrusion of his spinal cord and meninges from a defect in the lower back. Which of the following describes this congenital anomaly? A) Avulsion of meninges B) Meningitis C) Spina bifida occulta D) Spina bifida with myelomeningocele E) Spina bifida with meningocele

D) Spina bifida with myelomeningocele

A 19-year-old man is brought to the emergency department after dislocating his shoulder while playing football. Following treatment of the dislocation, he cannot initiate abduction of his arm. An MRI of the affected shoulder shows a torn muscle. Which muscle was most likely damaged by the injury? A) Coracobrachialis B) Long head of triceps brachii C) Pectoralis minor D) Supraspinatus E) Teres major

D) Supraspinatus; The rotator cuff muscles are common sites of damage during shoulder injuries; supraspinatus, teres minor, infraspinatus, subscapularis. The initiation of abduction (first 15 degrees) is performed by the supraspinatus, followed by deltoid (15 to 90 degrees), and above the horizontal the scapula is rotated by the trapezius and serratus anterior, causing the glenoid fossa to turn superiorly and allowing humerus to move above 90 degrees.

A 66-year-old woman had been diagnosed with a tumor on her spine. She has started to retain urine and is experiencing rectal incontinence. Both of these symptoms are signs of conus medullaris syndrome. At which of the following vertebral levels is the tumor probably located? A) L3/L4 B) L3 C) L4 D) T12 to L2 E) T11

D) T12 to L2

A 72-year-old man with cancer of the prostate gland presents with loss of consciousness and seizures. A CT scan is performed and a brain tumor is diagnosed. The tumor spread to the brain from the pelvis via the internal vertebral venous plexus (of Batson). What feature of the plexus allows this to happen? A) The internal venous plexus contains the longest veins in the body. B) The internal venous plexus has valves that ensure one-way movement of blood. C) The internal venous plexus is located in the subarachnoid space. D) The internal venous plexus is, in general, valveless. E) The internal venous plexus is located in the subdural space.

D) The internal venous plexus is, in general, valveless

During a surgical procedure to debride an abscess involving the erector spinae muscle at vertebral level T8, the nerve branch supplying the skin and this muscle is unavoidably severed. What are the anatomical locations of the cell bodies of the nerve fibers normally found in this branch? A) Ventral horn and dorsal horn B) Ventral horn, dorsal horn, and lateral horn C) Ventral horn, dorsal root ganglion, and lateral horn D) Ventral horn, dorsal root ganglion, and sympathetic paravertebral ganglion E) Ventral horn, dorsal horn, and dorsal root ganglion

D) Ventral horn, dorsal root ganglion, and sympathetic paravertebral ganglion

A 26-year-old man painting his house slipped and fell from the ladder, landing on the pavement below. After initial examination in the emergency department, the patient is sent to the radiology department. Radiographs reveal that the portion of his left scapula that forms the tip, or point, of the shoulder has been fractured. Which part of the bone was fractured? A) Coracoid process B) Superior angle of the scapula C) Glenoid D) Spine of the scapula E) Acromion

E) Acromion

A 14-year-old girl accidentally flipped her bicycle off a curb, fell, and landed on her face. Although she was wearing a helmet, she landed in such a way that her neck was forced into hyperextension. Which of the following ligaments of the cervical spine was stretched to the greatest degree during her injury? A) Posterior longitudinal ligament B) Ligamentum nuchae C) Ligamenta flava D) Supraspinous ligament E) Anterior longitudinal ligament

E) Anterior longitudinal ligament

A 70-year-old man with prostate cancer is experiencing sharp shooting pains radiating from his neck into the upper limb. An MRI of his spine demonstrates a small metastatic mass in the cervical region extending into the left intervertebral foramen between C6 and C7. The intervertebral discs appear normal. Which neural structure is most likely being compressed by the metastatic mass to account for the pain? A. C8 spinal nerve B. Dorsal horn of C6 spinal cord segment C. C6 spinal nerve D. Dorsal horn of C7 spinal nerve E. C7 spinal nerve

E) C7 spinal nerve

A 35-year-old man pedestrian is crossing a busy intersection and is hit by a truck. He is admitted to the emergency department, and a CT scan reveals a dislocation of the fourth thoracic vertebra. Which of the following costal structures is most likely also involved in the injury? A) Head of the fourth rib B) Neck of the fourth rib C) Head of the third rib D) Tubercle of the third rib E) Head of the fifth rib

E) Head of the fifth rib

A 15-year-old woman was suspected of having meningitis. To obtain a sample of cerebrospinal fluid by spinal tap in the lumbar region (lumbar puncture), the tip of the needle must be placed in which of the following locations? A) In the epidural space B) Between anterior and posterior longitudinal ligaments C) Superficial to ligamentum flavum D) Between arachnoid mater and dura mater E) In the subarachnoid space

E) In the subarachnoid space

A 5-year-old boy is admitted to the hospital because of pain in the upper back. Radiologic examination reveals abnormal fusion of the C5 and C6 vertebrae and a high-riding scapula. Which of the following is the most likely diagnosis? A) Lordosis B) Kyphosis C) Scoliosis D) Spina bifida E) Klippel-Feil syndrome

E) Klippel-Feil syndrome

Radiographs of the lumbar spine of a 68-year-old woman with lower back pain were taken and in the radiology report the following was written: "The anteroposterior view demonstrates marked bilateral enlargement of the transverse processes of a single vertebra. The length and width of both transverse processes of this single vertebra are enlarged and the inferior aspects of these bony features appear to be articulating with the bone immediately below it, so much so that the single vertebra appears to have morphologic characteristics similar to the bone immediately below it." The single vertebra referred to by the radiologist in the report is most likely which of the following? A) L1 vertebra B) L4 vertebra C) S2 vertebra D) S1 vertebra E) L5 vertebra

E) L5 vertebra

A 45-year-old woman states that she has experienced moderate pain for 2 years over her left lower back; pain that radiates to her left lower limb. She states that after lifting a case of soft drinks, the pain suddenly became intense. She was admitted to the emergency department. Radiologic examination revealed intervertebral disc herniation between vertebral levels L4 and L5. Which of the following nerves was most likely affected by the disc herniation? A) L1 B) L2 C) L3 D) L4 E) L5

E) L5; Disc herniation in the lumbar region between L4 and L5 affects the L5 spinal nerve roots. Even though the L4 spinal nerve root lies directly between the L4 and L5 vertebrae, it exits from the spinal canal superior to the intervertebral disc, whereas the L5 spinal nerve root lies directly posterior to the disc.

A 38-year-old woman has been in labor for 14 hours and has agreed to have an epidural anesthetic injection for pain control. Which of the following structures is most likely to be the last penetrated by the needle before it reaches the epidural space? A) Supraspinous ligament B) Interspinous ligament C) Anterior longitudinal ligament D) Posterior longitudinal ligament E) Ligamenta flava

E) Ligamental flava

A 24-year-old patient suffered a lower back strain after a severe fall while skiing. MRI studies reveal injury to the muscles responsible for extending and laterally bending the trunk. What arteries provide blood supply for these muscles? A) Subscapular B) Thoracodorsal C) Anterior intercostal D) Suprascapular E) Posterior intercostal

E) Posterior intercostal

A 16-year-old girl is sent for a presports physical examination prior to the beginning of her school year. She has no medical complaints or any clinical past history. On physical examination, the physician notices one shoulder is higher than the other. The student is then asked to bend forward at the waist to touch her toes. This maneuver results in a posterior bulging of the ribs on the right side. Which one of the following is most likely diagnosis? A) Kyphosis B) Spondylosis C) Lordosis D) Spondylolisthesis E) Scoliosis

E) Scoliosis

A 20-year-old male hiker suffers a deep puncture wound during a fall. Physical examination reveals a lesion between the trapezius and latissimus dorsi muscles on the right lateral side of his back. Upon admission to the hospital, physical examination reveals weak adduction and medial rotation of his arm. Which of the following muscles is most probably injured? A) Teres minor B) Triceps brachii C) Supraspinatus D) Infraspinatus E) Teres major

E) Teres major

An 8-year-old girl was brought to a pediatrician for a routine physical examination. The figure associated with this question is a photograph of the child. Which of the following best describes the embryologic basis for this child's condition? A) Underdevelopment of the secondary ossification center in the vertebral arch B) Underdevelopment of the primary ossification center in the spinous process C) Underdevelopment of the primary ossification center in the vertebral body D) Underdevelopment of the secondary ossification center in the vertebral body E) Underdevelopment of the primary ossification center in the vertebral arch

E) Underdevelopment of the primary ossification center in the vertebral arch