Back

A 21-year-old woman fell from her horse and reportedly struck her head. The patient is unconscious upon arrival with a Glasgow coma scale score of 6. Magnetic resonance imaging would reveal blood in which of the following spaces if the internal vertebral venous plexus was ruptured?

epidural space

What portion of the vertebra serves as the area that provides strength to support the weight of the body?

vertebral body

During a lumbar spinal puncture, penetration of what structure results in a "pop" and sudden decrease in resistance to the needle?

Ligamentum flavum

A 67-year-old man is brought to the emergency department for neck pain after a motor vehicle accident an hour ago. He was sitting in the passenger seat when his car was rear-ended by a truck. He currently reports severe neck pain which is exacerbated by looking up and down. His past medical history includes hypertension, coronary artery disease, and obstructive sleep apnea. His medications include aspirin, carvedilol, and atorvastatin. His temperature is 36.9° C (98.4° F), blood pressure is 139/82 mmHg, heart rate is 130/min, and respiratory rate is 20/min. Physical exam is remarkable for diffuse neck tenderness and mild edema without erythema, reduced active and passive range of motion at the neck, and a negative spurling sign. He otherwise has 5/5 strength in his upper and lower extremities with no loss of sensation. A cervical spine x-ray is pending. What structure was most likely injured during the patient's motor vehicle accident?

Anterior longitudinal ligament

Injury to or occlusion of what artery can result in spinal cord ischemia?

Artery of Adamkiewicz

A 66-year-old man reports dizziness and lightheadedness when he turns his head. He is eventually diagnosed with a large growth on his rectus capitis posterior major muscle. What is the most likely cause of his symptoms?

Compression of the vertebral artery within the suboccipital triangle.

A 52-year-old man was helping a friend lift a piano when he suddenly felt a severe pain in his lower back and buttock that radiated down the posterior aspect of his thigh into his leg, including the dorsum of his foot. Which of the following statements best describes the most likely cause of the man's back pain?

Correct optionAn acute herniated intervertebral (IV) disc between L5 and S1 vertebrae

Following abdominal aortic aneurysm surgery, a 60-year-old patient is noted to have profound weakness in his lower extremities. What most likely caused the patient's paraplegia?

Correct optionOcclusion or transection of the great anterior segmental artery (of Adamkiewicz)

A 22-year-old football player is evaluated by the onsite physician after experiencing head trauma from a head-on tackle. Physical examination is notable for pain in his neck and bilateral arms. Which of the following is the cause of his symptoms?

Correct optionRupture of the intervertebral (IV) disc between the C5 and C6 vertebrae

An 8-year-old girl fell during a gymnastics competition and landed on the back of her neck. Her neck was immobilized, and she was taken to the nearest hospital. Radiographs demonstrate anterior subluxation (incomplete dislocation) of C2 on C3 vertebrae. Which of the following statements is true?

Dislocation of the cervical region of the vertebral column may occur without damage to the spinal cord

A 12-year-old boy is diagnosed with rupture of the transverse ligament of the atlas following a swimming accident. Which of the following statements is most likely?

He has atlanto-axial subluxation

A positive straight leg test is most suggestive of which of the following conditions?

Herniated disc

A 78-year-old man presents to the physician for back pain. He was using a wheelbarrow while doing yard work when he noticed the acute onset of low back pain with some radiation down his legs. Physical examination is notable for focal midline tenderness in the lumbar region with a positive straight leg test. The physician also noted that the lower extremity pain is confined to the L5 dermatome. What is the most likely cause of this patient's presentation?

Herniation of the L4 or L5 disc

Which of the following statements about intervertebral disc herniation is correct?

Herniation of the nucleus pulposus usually occurs posterolaterally

The spinal nerves exit through which structure of the spinal column?

Intervertebral foramina

An 8-month-old female infant is brought to the emergency department for somnolence. She was recently diagnosed with an upper respiratory tract infection but developed a high fever this morning. On examination, the infant is lethargic and grimaces in pain with neck flexion. The physician consents the parents for a lumbar puncture. Which of the following statements best describes this procedure?

It may be safely performed at the L4-L5 vertebral level

At what vertebral level is the conus medullaris typically located?

L1-2

What process causes spina bifida in infants?

Neural tube defect

A 24-year-old male weightlifter presents for back pain after an attempted deadlift exercise. He reports trying to lift greater weight than he had ever performed without the use of his protective belt when he felt severe pain in his lower back. Examination is notable for localized palpable pain in his lower back. A radiograph and computed tomography (CT) demonstrates a fracture of the L1 vertebra without dislocation. Which of the following statements is most likely correct pertaining to this injury?

The injury is a compression fraction of the vertebral body.

A 16-year-old girl who spends 18 hours a week on her gymnastic routine complained of lower back pain. She is examined by a pediatric orthopedist. Physical examination of her back is notable for an abnormal protrusion of the L5 vertebra. A radiograph is obtained and demonstrates a separation of the L5 posterior vertebral arch from the vertebral body. The anterior part of the vertebra (body, pedicles, and superior articular processes) was noted to be anterior relative to the sacrum (see figure). Which of the following statements best describes this abnormality?

This degenerative condition typically results from a fracture of the portion of the vertebra known as the pars interarticularis

In an 87-year-old woman with severe osteoporosis, which of the following would you most likely expect?

Thoracic kyphosis

Which of the following describes the normal curvature of the spine in adults?

Thoracic vertebrae exhibit kyphosis

A 17-year-old woman has neck pain with numbness in her extremities after a motor vehicle accident. Imaging of the cervical spine demonstrates a fracture at the intersection between the odontoid process (dens) and the body of C2 vertebrae. What ligament prevents further displacement of the fractured bone against the spinal cord?

Transverse ligament of the atlas

A 55-year-old woman presents to her primary care physician for back and leg pain. Her pain is worse when she walks long distances, and is only able to walk two blocks. She notes the pain improves when leaning such as on a shopping cart or when going uphill. Physical examination is notable for leg weakness and numbness. Which of the following is likely the cause of this patient's presentation?

Vertebral canal narrowing in the lumbar region

48-year-old woman is diagnosed with a lesion to the posterior primary rami of several thoracic spinal nerves after a skiing injury. What muscle would most likely be affected?

iliocostalis

Which of the following intrinsic back muscles makes up the superficial layer?

splenius

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