Case Studies of the Back - D'Antoni

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. Lumbosacral E. Sacral

A. Cervical

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- fracture B. Spondylolisthesis (if shifting occurred) C. Herniation of intervertebral disc D. Lordosis E. Scoliosis

A. Spondylolysis

A 39 year old man presents with 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

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 showed the figure below. Which of the following was most likely injured? A. Anterior arch of the atlas B. Posterior tubercle of the atlas C. Atlatalocciptial joint D. Inferior articular process joint of the axis E. Interior 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-year-old 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 (most anterior) B. Posterior longitudinal ligament C. Ligamentum flavum D. Intervertebral disc E. Supraspinous ligament

A. Anterior longitudinal ligament (most anterior)

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

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 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 (listening to lungs by stethoscope) 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 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

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 (3 joints R,M,L). 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 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. Thoracodorsal nerve C. Axillary nerve D. Subscapular nerve E.Suprascapular nerve and thoracodorsal nerve

A. Suprascapular nerve

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 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 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 (curvature) 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. Hyper Kyphosis C. Spinal stenosis D. Lordosis E. Herniated disc

B. Hyper Kyphosis

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-year-old 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 (extremities) B. Lateral flexion C. Abduction (extremities) D. Adduction (extremities) E. Inversion (movement of the ankle)

B. Lateral flexion

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

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 (normally does not fracture) (Figure) What is the proper name of this condition? A. Spondylolysis and spondylolisthesis (fracture of pedicle or laminae) B. Spondylolisthesis C. Crush vertebral fracture D. Intervertebral disc herniation E. Klippel-Feil syndrome

B. Spondylolisthesis

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 (fracture) can lead to dislocation B. Spondylolisthesis (slippage/dislocation of vertebral body) C. Herniation of intervertebral disc D. Lordosis E. Scoliosis

B. Spondylolisthesis (slippage/dislocation of vertebral body)

An 18 year old woman passenger injured in a rollover car crash was rushed to the ER. 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 (spinal accessory, innervates trapezius). 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

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 the scapulae B. The highest points of the iliac crests C. The lowest pair of ribs bilaterally D. The sacral hiatus E. The posterior inferior iliac spines

B. The highest points of the iliac crests

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 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 (cruciform larger group of ligaments) C. Interspinous ligament D. Supraspinous ligament E. Nuchal ligament

B. Transverse ligament of the atlas

A 25 year old male race 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 (C3) 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 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 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

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 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 arrived at the scene it is determined that the most likely cause of death was spinal cord injury. Upon confirmation by autopsy, the medical examiner officially reports that the patients cause of death was fracture of the pedicles of the axis (C2) - "Hangman's Fracture". 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 (Bone to bone attachment) B. Tentorium cerebelli (dural fold in the brain) C. Denticulate ligaments D. Ligamentum flavum E. Nuchal ligament (no attachment to spinal cord)

C. Denticulate ligaments

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. Epiphyseal E. Elastic and fibrous

C. Fibrous

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. Denticulate C. Ligamentum flavum D. Nuchal E. Cruciate

C. Ligamentum flavum

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 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 artery B. Segmental medullary artery C. Vertebral artery D. Segmental spinal artery E. Posterior spinal

C. Vertebral artery

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 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 inter costovertebral joints

D. Between inferior and superior vertebral notches

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 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

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/extradurl E. Lumbar cistern

D. Epidural space/extradurl

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 3-year-old boy is brought by his mother to the emergency department with severe headache, high fever, malaise, and confusion. Radiologic and physical examinations reveal that the patient suffers from meningitis. A lumbar puncture is ordered to confirm the diagnosis. Which vertebral level is the most appropriate location for the lumbar puncture? 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 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 (Fig. 1-3). Which nerve was most probably affected? A. L3 B. L4 C. L2 D. L5 E. S1

D. L5

A 32-year-old construction worker falls from a scaffold and is brought to the emergency department with severe lower back pain. Radiographs (x-ray) 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. Posteroanterio 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 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 (production of red blood cells) cells are seen. Which of the following ligaments was most likely penetrated by the needle? A. Supraspinous B. Denticulate C. Anterior longitudinal D. Posterior longitudinal E. Nuchal ligament

D. Posterior longitudinal

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 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.

A 26-year-old man painting his house slipped 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 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 the 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

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

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. Ligamenta flava