BRS and Gray's Review Questions Exam 1

A woman with cancer is known to have tumors in the intervertebral foramina between the fourth and fifth cervical vertebrae and between the fourth and fifth thoracic vertebrae. Which of the following spinal nerves may be damaged?

5th cervical nerve & 4th thoracic nerve All cervical spinal nerves exit through the intervertebral foramina above the corresponding vertebrae All other spinal nerves (thoracic and lumbar) exit the intervertebral foramina below the corresponding vertebrae.

A mother brings her young toddler to her pediatrician with new onset of bowel and bladder dysfunction and loss of the lower limb function. Her mother had not taken enough folic acid (to the point of deficiency) during her pregnancy. On examination, the child has protrusion of the spinal cord and meninges and is diagnosed with which of the following conditions?

Meningomyelocele Myelomeningocele is an NTD (neural tube defect) in which the bones of the spine do not completely form. This results in an incomplete spinal canal. The spinal cord and meninges protrude from the child's back.

A crush injury of the vertebral column can cause the spinal cord to swell. Which structure would be trapped between the dura and the vertebral body by a swelling spinal cord?

Posterior longitudinal ligament

A 37-year-old man is brought to the emergency department with a crushed second cervical vertebra (axis) that he suffered after a stack of pallets fell on top of him at work. Which of the following structures would be intact after the accident?

Rectus capitis posterior minor

During a schoolyard fight, a 16-year-old boy suffers a deep stab wound near the superior angle of the scapula near the medial border, which compromises both the dorsal scapular and spinal accessory nerves. Such an injury could result in paralysis of what muscles?

Rhomboid major and trapezius

A 26-year-old heavyweight boxer suffered a punch to his mandible, resulting in a slight subluxation (dislocation) of the atlantoaxial joint. The consequence of the injury was decreased range of motion at that joint. What movement would be most affected?

Rotation (atlas/C1)

A 24-year-old woman comes to the hospital to deliver her baby. Her obstetrician uses a caudal anesthesia during labor and childbirth to block the spinal nerves in the epidural space. Local anesthetic agents are most likely injected via which of the following openings?

Sacral hiatus

In a freak hunting accident, a 17-year-old boy was shot with an arrow that penetrated into his suboccipital triangle, severing the suboccipital nerve between the vertebral artery and the posterior arch of the atlas. Which of the following muscles would be unaffected by such a lesion?

Splenius capitis

A 38-year-old woman with a long history of shoulder pain is admitted to a hospital for surgery. Which of the following muscles becomes ischemic soon after ligation of the superficial or ascending branch of the transverse cervical artery?

Trapezius Latissimus dorsi= receives blood from the thoracodorsal artery Rhomboid major= receives blood from the deep or descending branch of the transverse cervical artery

A 25-year-old soldier suffers a gunshot wound on the lower part of his back and is unable to move his legs. A neurologic examination and MRI scan reveal injury of the cauda equina. Which of the following is most likely damaged?

Ventral roots of the sacral spinal nerves

A middle-aged coal miner injures his back after an accidental explosion. His MRI scan reveals that his spinal cord has shifted to the right because the lateral extensions of the pia mater were torn. The function of which of the following structures is most likely impaired?

denticulate ligament

A jockey falls from her horse and complains of headache, backache, and weakness. Radiologic examination would reveal blood in which of the following spaces if the internal vertebral venous plexus was ruptured?

epidural space: the space b/w the vertebral canal and the dura mater that contains the internal vertebral venous plexus

A 69-year-old man has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is the most likely diagnosis?

kyphosis

An elderly man at a nursing home is known to have degenerative brain disease. When CSF is withdrawn by lumbar puncture for further examination, which of the following structures is most likely penetrated by the needle?

ligamentum flavum

A 25-year-old man with congenital abnormalities at birth has a lesion of the dorsal scapular nerve, making him unable to adduct his scapula. Which of the following muscles is most likely paralyzed?

rhomboid major

Cerebrospinal fluid (CSF) is normally withdrawn from which of the following spaces for a spinal tap?

subarachnoid space

triangle of auscultation borders

trapezius, latissimus dorsi, medial border of scapula

During a snowstorm, a 52-year-old man is brought to the emergency department after a multiple car accident. Which of the following conditions is produced by a force that drives the body forward while the head lags behind in a rear-end automobile collision?

whiplash injury

A 57-year-old woman comes into her physician's office complaining of fever, nausea, vomiting, and the worst headache of her life. Tests and physical examination suggest hydrocephalus (widening ventricles) resulting from a decrease in the absorption of CSF. A decrease of flow in the CSF through which of the following structures would be responsible for these findings?

Arachnoid villi

A 44-year-old woman comes to her physician and complains of headache and backache. On examination, she is found to have fluid accumulation in the spinal epidural space because of damage to blood vessels or meninges. Which of the following structures has most likely ruptured?

Internal vertebral venous plexus

A 27-year-old stuntman is thrown out of his vehicle prematurely when the car used for a particular scene speeds out of control. His spinal cord is crushed at the level of the fourth lumbar spinal segment. Which of the following structures would most likely be spared from destruction?

Lateral horn

After a 26-year-old man's car was broadsided by a large truck, he is brought to the emergency department with multiple fractures of the transverse processes of the cervical and upper thoracic vertebrae. Which of the following muscles might be affected?

Levator scapulae

A woman presents to her primary care physician with back pain from a possible herniated disk. Her magnetic resonance imaging (MRI) scan reveals that the posterolateral protrusion of the intervertebral disk between the L4 and L5 vertebrae would most likely affect nerve roots from which of the following spinal nerves?

Fifth lumbar nerve

A 27-year-old mountain climber falls from a steep rock wall and is brought to the emergency department. His physical examination and computed tomography (CT) scan reveal dislocation fracture of the upper thoracic vertebrae. The fractured body of the T4 vertebra articulates with which of the following parts of the ribs?

Head of the fifth rib

A 34-year-old woman crashes into a tree during a skiing lesson and is brought to a hospital with multiple injuries that impinge the dorsal primary rami of several spinal nerves. Such lesions could affect which of the following muscles?

Iliocostalis The dorsal primary rami of the spinal nerves innervate the deep muscles of the back, including the iliocostalis (erector spinae)