The anterior portion of the vertebral column serves the following functions, except:
D) Protection of the spinal cord
Protection of the spinal cord is a function of the posterior portion of the vertebral column.
The posterior portion of the vertebral column serve the following functions, except:
B) Mobility in all directions
Mobility in all directions is a function of the anterior portion of the vertebral column.
True or False: At birth, the vertebral column is a single curve that is concave posteriorly.
False
At birth, the vertebral column is a single curve that is convex posteriorly (kyphosis; primary curve).
Which of the following is incorrect about the curves of the vertebral column?
A) There are three curvatures in the adult spine: cervical (concave posteriorly); thoracic (convex posteriorly); and lumbar (concave posteriorly).
There are four curvatures in the adult spine: cervical (concave posteriorly); thoracic (convex posteriorly); lumbar (concave posteriorly); and sacral (convex posteriorly).
True or False: Because the spine is originally convex posteriorly (kyphotic), this curve is referred to as the primary vertebral curve.
True
Because the spine is originally convex posteriorly (kyphotic), this curve is referred to as the primary vertebral curve whereas the anterior convex curves (lordotic) that develop later in the cervical and lumbar regions are secondary curves.
For clinical orientation and palpation, the following landmarks may be used to identify level of specific vertebrae, except:
D) C4 and C5 - thyroid gland
It should be C4 and C5 - thyroid cartilage.
Other landmarks and their corresponding vertebral levels are:
1. C6 - cricoid cartilage
2. T7 - inferior angle of the scapula
3. T10 - tip of the xiphoid process
4. S2 - posterior superior iliac spines
True or False: The axis has a transverse process that protrudes more laterally than do those of the other vertebrae in this region.
True
The atlas has a transverse process that protrudes more laterally than do those of the other vertebrae in this region. This process may be palpated and is found just below the tip of the mastoid process.
Cervical vertebra which can be identified easily on most individuals
C) C7
C7, also known as vertebra prominence, can be easily identified in most individuals because of its prominent spinous process, which is longer and sturdier than those of the other cervical vertebrae.
True or False: In the thoracic region, the spinous processes are directed downward and overlap each other, so that the spinous process of one vertebra is located approximately at the height of the body of the next lower one.
True
Meanwhile, spinous processes in the lumbar region are large and directed horizontally, so that the height of the spinous process more nearly represents the height of its body.
True or False: The two lowest thoracic vertebrae resemble the lumbar vertebra.
True
The two lowest thoracic vertebrae resemble the lumbar vertebra, having rather horizontally directed spinous process that are approximately at the height of the intervertebral disc between its own body and the body of the next lower vertebra.
How many degrees of motion occur in most vertebral joints?
D) 3
These osteokinematic motions include flexion and extension in the sagittal plane, left and right side bending (lateral flexion) in the frontal plane, and left and right rotation in the transverse plane.
All of the following comprise an intervertebral disc, except:
A) Sharpey's fibers
Each intervertebral disc is composed of three parts: the annulus fibrosus, the nucleus pulposus, and the vertebral end plates.
True or False: Annulus fibrosus is a series of hyaline cartilaginous rings that enclose the nucleus pulposus.
False
Annulus fibrosus is a series of fibroelastic cartilaginous rings that enclose the nucleus pulposus.
True or False: Vertebral end plates are hyaline cartilaginous plates which separate the nucleus and the annulus from the vertebral bodies.
True
Intervertebral discs are connected to their adjacent vertebral bodies via:
B) Vertebral end plates
True or False: The fibers in the annulus fibrosus run obliquely from the superior edge of the upper vertebrae to the inferior margin of the lower vertebrae.
False
The fibers in the annulus fibrosus run obliquely from the inferior edge of the upper vertebrae to the superior margin of the lower vertebrae.
True or False: Fiber direction of the annulus fibrosus is opposite in alternate layers, forming crossing patterns.
True
Fiber direction in annulus fibrosus is opposite in alternate layers, forming crossing patterns so that motions in opposite directions can be restrained.
True or False: The circumference of the intervertebral disc is basically the same as the vertebral bodies, but the height is greater in the cervical area.
False
The height is greater in the lumbar area.
In total, the intervertebral discs account for approximately ____% of the length of the vertebral column.
C) 25
In most loading situations, the force is not applied in the center but rather on the anterior, posterior, or lateral parts of the vertebral body. This produces compression of the annulus on its side near the force and tension on the opposite side, with each mechanism serving to limit vertebral compression.
D) Both statements are true.
Since the nucleus pulposus is composed largely of water, it is hydrophilic. Compression forces produced by standing and walking throughout the day causes the nucleus to lose large quantities of water.
A) Only the first statement is true.
Compression forces produced by standing and walking throughout the day causes the nucleus to lose small quantities of water. Fluid levels within the nucleus are restored during sleep and recumbency when pressure inside the nucleus is reduced.
As the supply of blood vessels to the intervertebral disc disappears in the ____ decade of life, the ability of the nucleus pulposus to restore lost water also begins to decrease.
B) Second
This broad and strong ligament attaches to the annulus fibrosus and the edge of each vertebral body.
B) Anterior longitudinal ligament
This ligament limits backward bending, and in the lumbosacral area supports the anterior convexity.
D) Anterior longitudinal ligament
This ligament attaches to the annulus fibrosus and the superior margin of the vertebral body, but covers a plexus of arteries, veins, and lymphatics, as well as the nutrient foramina through which these vessels pass to the cancellous bone of the body.
B) Posterior longitudinal ligament
True or False: Forward flexion is somewhat restrained by the ligamentum flavum but its leverage is poor, and its tensile strength is relatively low.
False
Forward flexion is somewhat restrained by the posterior longitudinal ligament but its leverage is poor, and its tensile strength is relatively low.
With forward flexion, this ligament becomes taut to close the nutrient foraemina and trap fluid in the cancellous vertebral body.
C) Posterior longitudinal ligament
This mechanism is thought to increase the vertebral body's ability to withstand compression forces
True or False: The width of the posterior longitudinal ligament increases as the ligament descends from the cervical to lumbar spines.
False
The width of the posterior longitudinal ligament decreases as the ligament descends from the cervical to lumbar spines. Given this progressive narrowing, the PLL likely offers greater stabilization to the intervertebral disc in the cervical rather than lumbar spine.
Which of the following is not true about intervertebral discs?
C) The bilateral facet joints can support one-fourth of the imposed load.
The bilateral facet joints can support one-fifth of the imposed load.
These joints are formed by the inferior articulating process of one vertebra with the superior articulating process of the vertebra below.
B) All of these
All of the following are functions of facet joints, except:
C) None of these
Which of the following is not true about ligamenta flava?
D) These are a series of 23 intrasegmental ligaments that connect the lamina of two adjacent vertebrae from C2 to sacrum.
These are a series of 23 intersegmental ligaments that connect the lamina of two adjacent vertebrae from C2 to sacrum.
The ligamenta flava are continuous with the interspinous ligaments, which attach between adjacent spinous processes. The interspinous ligaments are continuous with the supraspinous ligament, a strong, fibrous cord attaching to the tips of spinous processes and continuous with the thoracodorsal fascia.
D) Both statements are true.
True or False: The interspinous and supraspinous ligaments resist motions of forward bending very effectively.
True
This ligamentous system is attached farther from the vertebral bodies than some of the spinal muscles so it has a leverage advantage.
Which of the following is not true about the coupling motions of the spine?
C) It has been traditionally viewed that coupling is influenced by the position the spine assumes in the frontal plane.
It has been traditionally viewed that coupling is influenced by the position the spine assumes in the sagittal plane. When the spine is in neutral position, rotation and side bending occur contralaterally. However, when the spine is either flexed or extended, rotation and side bending occur ipsilaterally. More recently, however, these views have been questioned.
These bones form the craniovertebral area, except:
B) None of these
Here the facet joints are specialized, two or three degrees of freedom exits, and the planes of motion are nearly horizontal.
Movement of the head at the atlanto-occipital joint is mainly a nodding movement in the sagittal plane around a medial-lateral axis the passes through the two occipital condyles. Small rotating movements of the atlanto-occipital joint are also possible, but these motions are quite limited.
D) Only the first statement is true.
Small lateral bending movements of the atlanto-occipital joint are also possible, but these motions are quite limited.
The atlanto-axial joint is formed by the following articulation/s:
B) Both of these
Approximately how many percent of the rotation in the cervical area occurs in the atlanto-axial joint?
B) 50
True or False: In the typical cervical vertebral articulations (C2-C3 through C6-C7), the articulating surfaces of the facet joints change from horizontal to a 60° angle between the horizontal and frontal planes.
False
In the typical cervical vertebral articulations (C2-C3 through C6-C7), the articulating surfaces of the facet joints change from horizontal to a 45° angle between the horizontal and frontal planes.
Which of the following is not true about the movement of the articular facets in the cervical region?
B) In side bending to the left, the left superior facet moves superiorly and anteriorly while the right superior facet moves inferiorly and posteriorly.
In side bending to the right, the left superior facet moves superiorly and anteriorly while the right superior facet moves inferiorly and posteriorly, producing a rotation of the vertebral body to the right and the spinous process to the left.
Which of the following is not true about the normal ranges of cervical motion?
A) Flexion: 60°
It should be flexion: 50°.
All of the following are functions of the thoracic vertebrae, except:
A) Supply articulations for ventilation
It should be to supply articulations for respiration.
Which of the following is not true about motions in the thoracic vertebrae?
D) Intervertebral motions of the thoracic spine as a whole more resemble cervical motions, with increased flexion-extension and side bending and less rotation.
Intervertebral motions of the thoracic spine as a whole more resemble lumbar motions, with increased flexion-extension and side bending and less rotation. Active range of motion for the thoracic region is reported in conjunction with the lumbar spine range of motion as the two regions are difficult to dissociate.
Which of the following is not true about thoracolumbar ranges of motion?
D) Rotation to the left: 40°
It should be rotation to the left: 30°.
All of the following ribs articulate with the adjacent body, the body, above, and the disc between the two bodies to form the costovertebral joint, except:
D) 1st rib
The typical ribs 2 through 9 articulate with the adjacent body, the body above, and the disc between the two bodies to form the costovertebral joint. The exception to this arrangement are the atypical ribs 1, 10, 11, and 12 that articulate only with the corresponding body.
All of the following ribs articulate with their same-level transverse process to form the costotransverse joints, except:
D) 11th rib
Ribs 1 through 10 articulate with their same-level transverse process to form costotransverse joints.
Anteriorly, the cartilages of ribs _______ form synovial joints with the sternum.
B) 2 through 7
The costal cartilages of ribs 8 through 10 articulate with the cartilage above and the lateral end of ribs 11 and 12 are free, or floating.
Which of the following is not true about the ribs?
D) None of these
All of the following organs are protected by the ribs, except:
A) Stomach
Organs such as the kidneys, lungs, spleen, and liver are protected by the ribs. Meanwhile, the heart is protected by the ribs and sternum.
In the lumbar facet joints, the proportion of sagittal surface is greatest at T11 to L1. This facet alignment progressively changes to a more frontal-plane orientation at L5 to S1.
B) Only the second statement is true.
In the lumbar facet joints, the proportion of sagittal surface is greatest at T12 to L1.
True or False: The near frontal plane orientation of the L5 to S1 facet joints prevents excessive anterior shear of the fifth lumbar vertebra.
True
Anatomuc variations that weaken the lumbosacral junction may permit the lumbar vertebra to slide forward on the sacrum, leading to spondyloslisthesis.
This is a strong, complex structure that acts like a huge ligament to connect the ribs, vertebrae, and sacrum; the posterior intervertebral ligamentous system; and three trunk muscles.
A) Both of these
This fascial system provides humans with the unique ability to lift heavy weights overhead as well as stabilize the trunk for throwing objects at high velocities.
Which layer of the thoracolumbar fascia attaches to the transverse processes of the lumbar vertebrae to cover the quadratus lumborum?
A) Anterior layer
Thoracolumbar fascia is also known as thoracodorsal fascia.
Which layer of the thoracolumbar fascia is composed of strong, transverse fibers, attaching to the lumbar transverse processes medially, the 12th rib, and the transverse abdominis muscle at the lateral raphe?
D) Middle layer
Thoracolumbar fascia is also known as thoracodorsal fascia.
Medially, the posterior layer of the thoracolumbar fascia attaches to the following structures, except:
A) Interspinous ligament
The posterior layer of the thoracolumbar (thoracodorsal) fascia covers the back and attaches to the spinous processes and the supraspinous ligament medially.
Laterally, the posterior layer of the thoracolumbar fascia attaches to the following structures, except:
C) Lateral raphe with the external abdominal oblique muscle
It should be lateral raphe with the internal abdominal oblique muscle.
All of the following muscles are attached to the thoracolumbar fascia, except:
C) Gluteus medius
It should be gluteus maximus.
Which layer of the thoracodorsal fascia is further divided into superficial and deep lamina?
A) Posterior layer
The superficial lamina of the posterior layer of the thoracolumbar fascia is the broad aponeurosis of which muscle?
B) Latissimus dorsi
The fibers angle inferiorly and medially from the lateral raphe to attach the latissimus muscle to the spinous processes.
This is the link between the axial skeleton and the lower extremities.
B) Sacrum
True or False: Small motions in sacroiliac joints occur only in women.
False
The sacroiliac joint was thought by ancient practitioners to be immobile except for slight motion occurring during pregnancy. In the 20th century, it was established that small motions in these joints occur in both men and women.
Sacroiliac joint is classified as:
A) Diarthrodial
Most authors classify the sacroiliac joint as a freely movable diarthrodial joint. The sacral surface is covered in hyaline cartilage, and the iliac surface is covered in fibrocartilage.
True or False: With aging, the incidence of osteophytes and ankylosis of the sacroiliac joints is high, especially in women.
False
With aging, the incidence of osteophytes and ankylosis of the sacroiliac joints is high, especially in men.
How many degrees of freedom does the sacroiliac joint have?
B) 3
The sacroiliac joint has three degrees of motion. These motions include: 1) anterior-posterior rotation around a medial-lateral axis in the sagittal plane; 2) abduction-adduction around an anterior-posterior axis in frontal plane; and 3) medial-lateral rotation around a vertical axis in transverse plane.
Which of the following is not true about nutation?
C) It causes the pelvic outlet to become smaller.
Nutation causes the pelvic outlet to become larger.
Which of the following is not true about counternutation?
C) The iliac crest approximate, and the ischial tuberosities move apart.
The iliac crests move apart, and the ischial tuberosities approximate.
Secretion of the hormone relaxin during pregnancy causes ligamentous laxity and increases the magnitude of motion of which structure/s?
D) Both of these
This, the pelvic inlet becomes larger to accommodate the fetus, and the pelvic outlet becomes larger at birth. This excessive ligamentous laxity, however, can produce severe pain and sometimes spontaneous dislocation of the sacroiliac joints and symphysis pubis.
Ligament/s which have excellent leverage to hold the distal aspect of the sacrum in place against the anterior weight-bearing forces that cause the sacral promontory to tilt anteriorly and inferiorly
C) Both of these
The sacrotuberous and the sacrospinous ligaments are broad, long ligaments connecting the lower aspect of the sacrum to the tuberosity and spine of the ischium respectively.
True or False: The length of the sacrotuberous and the sacrospinous ligaments controls the amount of counternutation possible.
False
The length of the sacrotuberous and the sacrospinous ligaments controls the amount of nutation possible.
This completes the closure of the ring of the pelvic articulations of the sacrum and the innominate bones.
B) Symphysis pubis
The sacrococcygeal and the intercoccygeal joints are classified as:
D) Synarthrodial
Synarthrodial joints are defined as a line of fusion between bones that are separated in early development then later totally fuse.
The sacrococcygeal joint is highly congruent, having a fibrocartilaginous disc and is completely surrounded by several small strong ligaments. There is a slight amount of passive medial-lateral motion available that occurs only during defecation and labor at the time of childbirth.
D) Only the first statement is true.
There is a slight amount of passive anterior-posterior motion available that occurs only during defecation and labor at the time of childbirth.
The intercoccygeal joints are small articulations between the distal four vertebrae. These are typically fused by adulthood and no motion occurs there.
B) Only the second statement is true.
The intercoccygeal joints are small articulations between the distal three vertebrae.
True or False: The sacrum is part of the pelvis.
True
The rigid sacrum, firmly connected with the ilia, is part of the pelvis.
All of the following structures pass between the scalenus anterior and the scalenus medius and above the first rib, except:
D) Dorsal roots of C5-T1 spinal nerves
Anatomic variation, hypertrophy, or spasm of scalene muscles can cause compression of the vessels or nerve roots, resulting in thoracic outlet syndrome.
The most superficial of the anterior neck muscles
A) Sternocleidomastoid
True or False: In the absence of the synergistic contractions of the vertebral muscles to stabilize the cervical spine, isolated bilateral contraction of the sternocleidomastoid process causes extension of the head and an increase in the cervical lordotic curve.
True
Normal unilateral contraction of the SCM causes:
A) Ipsilateral side bending and contralateral rotation
Because of the sternocleidomastoid's attachments on the sternoclavicular joint, the left and right SCM are considered accessory muscles of inspiration. Persons with attacks of asthma or other respiratory distress exhibit contractions of the SCM and other accessory muscles on inspiration.
A) Both statements are true.
All of the following are transversospinal muscles, except:
C) Semispinalis thoracis
It should be semispinalis cervicis.
These muscles are continuous from the sacrum to the occiput, and their combined action is vertebral extension.
A) Erector spinae
Erector spinae is also known as sacrospinalis.
Medially-to-laterally from the spinous processes, the alignment of the erector spinae is:
A) Spinales, longissimus, and iliocostalis
Which of the following is not true about erector spinae muscles?
C) All erector spinae muscles occur in each of the vertebral segments.
Not all erector spinae muscles occur in each of the vertebral segments.
The most superficial of the cervical erector spinae
D) Splenius capitis and cervicis
These muscles have very small cross-sectional area and poor leverage because their attachments are near the axis of motion, so it seems unlikely that these muscles provide sufficient forces or torques that are required for trunk movement or stabilization.
A) Intertransversarii and interspinalis
This transversopinal muscle protects the capsules of the facet joints from being nipped during movement.
B) Multifidus
The deep fasciculi of the multifidus attach to the capsule of the facet joints; this capsular attachment allows the multifidus to protect the capsule from being nipped in movement.
When an individual stands in an erect position and laterally flexes the trunk to the left or right side, the trunk lowering movement occurs from an concentric contraction of the contralateral quadratus lumborum. Meanwhile, the return movement to the upright position is the result of a eccentric contraction of the same muscle.
D) Both statements are false.
When an individual stands in an erect position and laterally flexes the trunk to the left or right side, the trunk lowering movement occurs from an eccentric contraction of the contralateral quadratus lumborum. Meanwhile, the return movement to the upright position is the result of a concentric contraction of the same muscle.
If the humerus is stabilized, this muscle may also assist in hip hiking.
D) Latissimus dorsi
The linea alba is a fibrous band in the median line of the abdominal region, extending from the xiphoid process above to the umbilicus below. This line unites the aponeuroses of the muscles of the right and left sides.
B) Only the second statement is true.
The linea alba is a fibrous band in the median line of the abdominal region, extending from the xiphoid process above to the pubis below.
This muscle is commonly referred to as the "six-pack" muscle.
D) Rectus abdominis
Which of the following is not true about rectus abdominis?
C) It is commonly referred to as the "eight-pack" muscle.
It is commonly referred to as the "six-pack" muscle.
Which of the following is not true about external oblique?
C) To activate the muscle on the left side, the trunk is rotated to the left.
To activate the muscle on the left side, the trunk is rotated to the right.
Which of the following is not true about internal oblique?
A) As it fans out from its proximal to distal insertion, the direction of the fibers is continuous with those of the external intercostals.
As it fans out from its proximal to distal insertion, the direction of the fibers is continuous with those of the internal intercostals.
Which of the following is not true about transversus abdominis?
C) It is solely responsible for tension produced when the abdominal wall is tightened.
Transversus abdominis is partly responsible for tension produced when the abdominal wall is tightened. This activity involves all the layers of the abdominal wall.
Which of the following is not true about external and internal intercostals?
A) None of these
Which of the following is not true about diaphragm?
C) When a healthy person breathes in, its peripheral portion descends and puts pressure on the abdominal contents, causing the abdomen to rise outward.
When a healthy person breathes in, its central portion descends and puts pressure on the abdominal contents, causing the abdomen to rise outward.
The diaphragm is perforated by openings, which permit the passage of the following structures, except:
C) Psoas minor
It should be psoas major. The openings in the diaphragm also allow the passage of vena cava.
The following vertebrae consist the cervicoencephalic region, except:
B) C3
The cervical spine is divided by into two areas - the cervicoencephalic for the upper cervical spine and the cervicobrachial for the lower cervical spine.
True or False: During the development, the vertebral body of C1 evolves into the odontoid process.
True
During the development, the vertebral body of C1 evolves into the odontoid process, which is part of C2.
Which of the following is not true about atlanto-occipital joints?
D) They are trochoid and act in unison.
They are ellipsoid and act in unison.
Which of the following is not true about the ligaments of the spine?
B) The tectorial membrane, which is a broad band covering the dens and its ligaments, is found outside the vertebral canal.
The tectorial membrane, which is a broad band covering the dens and its ligaments, is found within the vertebral canal and is a continuation of the posterior longitudinal ligament.
Limit/s flexion and rotation and play/s a major role in stabilizing C1 and C2, especially in rotation
A) Alar ligaments
Constitute the most mobile articulation of the spine
C) C1-C2
The atlanto-axial joints (C1-C2) constitute the most mobile articulation of the spine. Flexion-extension is approximately 10°, and side flexion is approximately 5°. Rotation, which is approximately 50°, is the primary movemen of these joints.
The middle, or median, atlanto-axial joint is classified as plane joint. Meanwhile, the lateral atlanto-axial joints, or facet joints, are classified as pivot (trochoid) joints.
B) Both statements are false.
The middle, or median, atlanto-axial joint is classified as pivot (trochoid) joint. Meanwhile, the lateral atlanto-axial joints, or facet joints, are classified as plane joints.
Which of the following does not describe the transverse ligament of the atlas?
D) It holds the dens of the axis against the posterior arch of the atlas.
It holds the dens of the axis against the anterior arch of the atlas.
The greatest stresses are placed on the vertebral arteries in the following places, except:
A) Where they enter the C7 transverse process
It should be where they enter the C6 transverse process.
Which of the following is not true about the apophyseal joints in the cervical spine?
B) None of these
The greatest flexion-extension of the facet joints in the cervical spine occurs between:
B) C5 and C6
The neutral position of the facet joints in the cervical spine is midway between flexion and extension. Meanwhile, the close packed position is complete extension.
C) Both statements are true.
What is the capsular pattern of the facet joints in the cervical spine?
A) Side flexion and rotation equally limited extension
Which of the following is not true about the joints of Luschka?
A) Extending from the uncus is a "joint" that appears to form because of a weakness in the vertebral end-plate.
Extending from the uncus is a "joint" that appears to form because of a weakness in the annulus fibrosus.
Which of the following is not true about the intervertebral discs in the cervical spine?
C) The intervertebral disc has some innervation on the periphery of the nucleus pulposus.
The intervertebral disc has some innervation on the periphery of the annulus fibrosus.
Which of the following is not true about the structure of the cervical vertebrae?
D) The first palpable vertebra descending from the external occipital protruberance is the spinous process of C3.
The first palpable vertebra descending from the external occipital protruberance is the spinous process of C2 because the spinous process of C1 is absent or at least rudimentary.
In the cervical spine, each nerve root is named for the vertebra below it. As an example, the C5 nerve root exists between the C4 and C5 vertebrae.
B) Both statements are true.
In the rest of the spine, each nerve root is named for the vertebra above. For example, the L4 nerve root exists between the L4 and L5 vertebrae.
Which nerve root passes between the C7 and T1 vertebrae?
C) C8
Although there are seven cervical vertebrae, there are eight cervical nerve roots.
Differential diagnosis of cervical spine conditions: possible instability
B) Spondylosis
Differential diagnosis of cervical spine conditions: increased pain on extension
A) All of these
Vertebral level commonly affected in cervical disc herniation?
B) C5-C6
Differential diagnosis of cervical spine conditions: slow onset
B) Spondylosis and spinal stenosis
Grading of patients suffering from neck pain: 2
B) No signs of major pathology; interference with daily activity
Grading of patients suffering from neck pain: radiculopathy
C) Grade 3
All of the following are warning signs and symptoms of cervical spine fractures, except:
D) None of these
All of the following are warning signs and symptoms of cervical myelopathy, except:
A) Muscle wasting of hand extrinsic muscles
It should be muscle wasting of hand intrinsic muscles.
All of the following are warning signs and symptoms of upper cervical ligamentous instability, except:
B) Severe limitation during neck passive ROM in all directions
It should be severe limitation during neck active ROM in all directions.
All of the following are warning signs and symptoms of vertebral artery insufficiency, except:
B) Dizziness or lightheadedness unrelated to neck movement
It should be dizziness or lightheadedness related to neck movement.
Quebec severity classification of whiplash associated disorders: normal reflexes, dermatomes, and myotomes
C) All of these
Quebec severity classification of whiplash associated disorders: x-ray shows no fracture
D) Grade 3
Quebec severity classification of whiplash associated disorders: neck pain, stiffness or tenderness only
D) Grade 1
All of the following are signs of headaches having a cervical origin, except:
A) Abnormal mobility at C1-C2
It should be abnormal mobility at C0-C1.
Craniovertebral joint dysfunction commonly is accompanied by headaches. Which of the following statements below is not true?
A) None of these
Which of the following is true about the Bakody's sign?
D) None of these
Bakody's sign refers to pain and referred symptoms that are decreased or relieved by placing the hand or arm of the affected side on top of the head. It is usually indicative of problems in the C4 or C5 area.
Differential diagnosis of neurological disorders of the cervical spine and upper limb: (+) pathogical reflex
C) Cervical myelopathy
Differential diagnosis of neurological disorders of the cervical spine and upper limb: arm positions have no effect on pain, except:
C) Cervical radiculopathy
In cervical radiculopathy, pain may be relieved by putting the hand on head, especially if the C5 and C6 nerve roots are affected.
Differential diagnosis of neurological disorders of the cervical spine and upper limb: wide-based gait, drop attacks, ataxia, affected proprioception
C) Cervical myelopathy
In the upper crossed syndrome, all of the following muscles are weak, except:
C) Upper trapezius
It should be lower trapezius.
If the deep neck flexors are weak, which muscle/s will initiate the flexion of the cervical spine?
C) Sternocleidomastoid
If the deep neck flexors are weak, the sternocleidomastoid muscles will initiate the flexion movement, causing the jaw to lead the movement, not the nose, since the sternocleidomastoid muscles will cause the chin to initially elevate before flexion occurs.
Because there is no anatomic block to stop this cervical movement going past normal range, problems often result from whiplash or cervical strain.
B) Extension
Axial rotation in the atlanto-occipital joint
D) Negligible
Lateral flexion in the atlanto-axial joint complex
D) Negligible
Flexion-extension in the intracervical region
C) 105°
Possible cause/s of limitation in side bending in neutral
A) Uncovertebral hypomobility or anomaly
All of the following muscles are responsible for the forward flexion of the head, except:
A) Obliquus capitis inferior
It should be obliquus capitis superior. Obliquus capitis inferior is responsible for extension of the head.
All of the following muscles are responsible for the extension of the head, except:
A) Rectus capitis lateralis
Rectus capitis lateralis is responsible for forward flexion of the head.
All of the following muscles are responsible for ipsilateral rotation of the head, except:
C) Trapezius
Trapezius and sternocleidomastoid are responsible for contralateral rotation of the head.
All of the following muscles are responsible for flexion of the neck, except:
A) Splenius cervicis
Splenius cervicis is responsible for extension of the neck.
All of the following muscles are responsible for extension of the neck, except:
C) Longus colli
Longus colli is responsible for flexion of the neck.
Which of the following muscles is responsible for contralateral rotation of the neck?
D) Multifidus
Multifidus, sternocleidomastoid, and scaleni are responsible for contralateral rotation of the neck.
Which of the following is not true about cervical myotomes?
D) Shoulder abduction and medial rotation: C5
It should be shoulder abduction and lateral rotation: C5
Elbow flexion and/or wrist extension
C) C6
C8 myotome
D) Thumb extension
C8 myotome is responsible for thumb extension and ulnar deviation.
Functional strength testing of the cervical spine: able to lift the head keeping the chin tucked in for 3 to 5 repetitions
C) Functionally fair
Functional: 6 to 8 repetitions
Functionally poor: 1 to 2 repetitions
Nonfunctional: 0 repetition
Functional strength testing of the cervical spine: able to lift the head backward and hold it for 1 to 9 seconds
A) Functionally poor
Functional: hold 20 to 25 seconds
Functionally fair: hold 10 to 19 seconds
Nonfunctional: hold 0 second
Functional strength testing of the cervical spine: lift head of bed and rotate to one side keeping head off bed or pillow for 10 to 19 seconds
C) Functionally fair
Functional: hold 20 to 25 seconds
Functionally poor: hold 1 to 9 seconds
Nonfunctional: hold 0 second
Abnormalities or tropisms in the shape of the facets commonly occur in which segments of the lumbar spine?
B) L5-S1
Which zone of the annulus fibrosus contains the largest number of cartilage cells?
B) Inner zone
The inner zone of the annulus fibrosus is primarily made up of fibrocartilage and contains the largest number of cartilage cells.
Which zone/s of the annulus fibrosis is/are made up of Sharpey fibers?
D) Outer zone
The outer zone of annulus fibrosus is made up of fibrocartilage (classified as Sharpey fibers) that attaches to the outer or peripheral aspect of the vertebral body and contains increasing numbers of cartilage cells in the fibrous strands with increasing depth.
Which of the following is not true about nucleus pulposus?
B) Degenerative changes begin to occur after the third decade of life.
Degenerative changes begin to occur after the second decade of life.
Which of the following is not true about nucleus pulposus?
B) It lies slightly anterior to the center of rotation of the disc in the lumbar spine.
It lies slightly posterior to the center of rotation of the disc in the lumbar spine.
Which of the following is not true about intervertebral discs?
B) Their remainder receives nutrition by diffusion, primarily through the annulus fibrosus.
Their remainder receives nutrition by diffusion, primarily through the cartilaginous end plate.
Usually, the intervertebral disc has no nerve supply, although the peripheral anterior aspect of the annulus fibrosus may be innervated by a few nerve fibers from the sinuvertebral nerve. The lateral aspects of the disc are innervated peripherally by the branches of the anterior rami and gray rami communicants.
A) Only the second statement is true.
Usually, the intervertebral disc has no nerve supply, although the peripheral posterior aspect of the annulus fibrosus may be innervated by a few nerve fibers from the sinuvertebral nerve.
All of the following are pain-sensitive structures around the intervertebral disc, except:
D) Nerve ramus
It should be nerve root. The posterior longitudinal ligament is also a pain-sensitive structure.
If there is an injury to the intervertebral disc, four problems can result, all of which can cause symptoms. Which of the following statements below is incorrect?
D) There may be sequestration, which is the formation of discal fragments from the annulus fibrosus and nucleus pulposus inside the disc proper.
There may be sequestration, which is the formation of discal fragments from the annulus fibrosus and nucleus pulposus outsidethe disc proper.
All of the following are unfavorable prognostic factors for positive outcome with non-operative care for lumbar disc herniation, except:
D) Presence of crossed SLR
It should be absence of crossed SLR.
All of the following are unfavorable prognostic factors for positive outcome with non-operative care for lumbar disc herniation, except:
B) Educational level >12 years
It should be educational level <12 years.
The L4 nerve root exits between the L4 and L5 vertebrae. Because of the course of the nerve roots as it exits, the L4 disc is more likely to compress the L4 nerve root.
A) Only the first statement is true.
Because of the course of the nerve roots as it exits, the L4 disc only rarely compresses the L4 nerve root and is more likely to compress the L5 nerve root.
The L5-S1 segment is the most common site of problems in the vertebral column because of the following reasons, except:
C) The center of gravity passes directly through this segment.
The center of gravity passes directly through this segment, which is of benefit because it may decrease the shearing stresses to this segment.
Hall broke low back pain into four categories - two of which are back pain dominant and two of which are leg pain dominant. Which of the following statements below are not true regarding such categories?
D) Pattern 3 suggest nerve ramus involvement.
It should be pattern 3 suggest nerve root involvement.
A patient complained of back pain, which is aggravated by flexion and is relieved by extension. Identify the pattern of back pain given the scenario.
C) 1 - disc involvement
A patient complained of back pain, which is aggravated by extension and rotation and is relieved by flexion. Identify the pattern of back pain given the scenario.
D) 2 - facet joint involvement
A patient complained of leg pain, which is aggravated by flexion and is relieved by extension. Identify the pattern of back pain given the scenario.
A) 3 - nerve root involvement
Which of the following is not true about neurogenic intermittent claudication?
D) Pain relieved with walking
In neurogenic intermittent claudication, leg pain is aggravated with walking (extension) and is relieved by rest (sitting) and/or postural change.
All of the following are characteristics of "mechanical" low back pain, except:
B) Pain usually becomes better over the course of the day.
Pain usually becomes worse over the course of the day.
Which of the following is not true about "mechanical" low back pain?
D) Low back pain is seldom referred to the buttocks and thighs.
Low back pain is often referred to the buttocks and thighs.
In back pain, centralization implies the pain is moving toward the lumbar spine. Meanwhile, peripheralization implies the pain is being referred or is moving into the limb.
A) Both statements are true.
The _____ is/are the key to proper back posture.
B) Pelvis
The pelvis is the key to proper back posture, Ideally, an individual should be able to stand with the pelvis in neutral. In this position, the ASISs are one to two finger widths lower than the PSISs.
All of the following are red flags for serious spinal pathology, except:
B) Lumbar pain
It should be thoracic pain.
All of the following are red flags for serious spinal pathology, except:
A) Persisting severe restriction of lumbar extension
It should be persisting severe restriction oflumbar flexion.
All of the following are characteristics of cauda equina syndrome, except:
A) Loss of rectal sphincter tone or fecal incontinence
It should be loss of anal sphincter tone or fecal incontinence.
All of the following are characteristics of ankylosing spondylitis, except:
D) Gradual onset after age 40 years
It should be gradual onset before age 40 years.
True or False: The straight lateral shift is more likely to be caused by mechanical dysfunction and muscle spasm and is likely to disappear on lying down or hanging.
True
Meanwhile, true scoliosis commonly has compensating curves and does not change with hanging or lying down.
All of the following results to functional lengthening of the limb, except:
B) Hip lifting
It should be hip lowering. Hip lifting results to functional shortening of the limb.
All of the following does not result to functional lengthening of the limb, except:
D) Foot supination
Foot supination results to functional lengthening of the limb.
All of the following are true about pelvic crossed syndrome, except:
A) The weak gluteals result in increased activity in the quadriceps and erector spinae as compensation to assist hip extension.
The weak gluteals result in increased activity in the hamstrings and erector spinae as compensation to assist hip extension.
The upper and lumbar crossed syndromes together are called the:
B) Layer syndrome
A step deformity in the lumbar spine may indicate a:
C) Spondylolisthesis
A "step" occurs because the spinous process of one vertebra becomes prominent when either the vertebra above slips forward on the one below.
The greatest motion in the lumbar spine occurs between:
C) Both of these
True or False: If a disc protrusion is lateral to the nerve root, side flexion to the painful side increases the pain and radicular symptoms on that side.
True
If side flexion away from the painful side alters the symptoms, the lesion may be articular or muscular in origin, or it may be a disc protrusion medial to the nerve root.
A patient with a disc herniation lateral to the left L5 nerve root should list towards which side to relieve his leg pain?
A) Right side
In disc herniation lateral to the nerve root, the list is towards the side opposite the sciatica because a list to the same side would elicit pain.
A patient with a disc herniation medial to the left L5 nerve root should not list towards which side to avoid aggravating his leg pain?
C) Right side
In disc herniation medial to the nerve root, the list is toward the side of sciatica because tilting away would irritate the root and cause pain.
A positive Trendelenburg sign is shown by the nonstance side ilium dropping down instead of elevating as it normally would when standing on the leg. A weak gluteus medius or a coxa valga (abnormal shaft-neck angle of the femur) on the stance leg may produce a positive sign.
B) Only the first statement is true.
A weak gluteus medius or a coxa vara (abnormal shaft-neck angle of the femur) on the stance leg may produce a positive sign.
All of the following muscles are responsible for forward flexion of the lumbar spine, except:
C) Psoas minor
It should be psoas major.
All of the following muscles are responsible for extension of the lumbar spine, except:
C) Gluteus medius
It should be gluteus maximus.
All of the following muscles are responsible for side flexion of the lumbar spine, except:
D) Internal abdominal oblique
It should be external abdominal oblique.
Isometric abdominal test: arms crossed over chest, until scapulae clear the table for 15 to 20 seconds
C) Good (4)
Grade
Description
Normal (5)
Hands behind the neck, until scapulae clear the table for 20 to 30 seconds
Good (4)
Arms crossed over chest, until scapulae clear the table for 15 to 20 seconds
Fair (3)
Arms straight, until scapulae clear the table for 10 to 15 seconds
Poor (2)
Arms extended, toward knees, until top of the scapulae lift from table for 1 to 10 seconds
Trace (1)
Unable to raise more than head off the table
Isometric abdominal test: scapulae clear the table for 10 to 15 seconds
A) Fair (3)
Grade
Description
Normal (5)
Hands behind the neck, until scapulae clear the table for 20 to 30 seconds
Good (4)
Arms crossed over chest, until scapulae clear the table for 15 to 20 seconds
Fair (3)
Arms straight, until scapulae clear the table for 10 to 15 seconds
Poor (2)
Arms extended, toward knees, until top of the scapulae lift from the table for 1 to 10 seconds
Trace (1)
Unable to raise more than head off the table
Isometric extensor test: with hands clasped behind the head, extends the lumbar spine, lifting the head, chest, and ribs from the floor for 20 to 30 seconds
D) Normal (5)
Grade
Description
Normal (5)
With hands clasped behind the head, extends the lumbar spine, lifting the head, chest, and ribs from the floor for 20 to 30 seconds
Good (4)
With hands at the side, extends the lumbar spine, lifting the head, chest, and ribs from the floor for 15 to 20 seconds
Fair (3)
With hands at the side, extends the lumbar spine, lifting the sternum off the floor for 10 to 15 seconds
Poor (2)
With hands at the side, extends the lumbar spine, lifting the head off the floor for 1 to 10 seconds
Trace (1)
Only slight contraction of the muscle with no movement
Isometric extensor test: with hands at the side, extends the lumbar spine, lifting the sternum off the floor for 10 to 15 seconds
C) Fair (3)
Grade
Description
Normal (5)
With hands clasped behind the head, extends the lumbar spine, lifting the head, chest, and ribs from the floor for 20 to 30 seconds
Good (4)
With hands at the side, extends the lumbar spine, lifting the head, chest, and ribs from the floor for 15 to 20 seconds
Fair (3)
With hands at the side, extends the lumbar spine, lifting the sternum off the floor for 10 to 15 seconds
Poor (2)
With hands at the side, extends the lumbar spine, lifting the head off the floor for 1 to 10 seconds
Trace (1)
Only slight contraction of the muscle with no movement
In double straight leg lowering test, a grade of 4 is given if the patient is:
B) Able to reach 16° to 45° from the table before the pelvis tilts
Grade
Description
Normal (5)
Able to reach 0° to 15° from the table before the pelvis tilts
Good (4)
Able to reach 16° to 45° from the table before the pelvis tilts
Fair (3)
Able to reach 46° to 75° from the table before the pelvis tilts
Poor (2)
Able to reach 75° to 90° from the table before the pelvis tilts
Trace (1)
Unable to hold the pelvis in neutral at all
In double straight leg lowering test, a grade of 2 is given if the patient is:
C) Able to reach 75° to 90° from the table before the pelvis tilts
Grade
Description
Normal (5)
Able to reach 0° to 15° from the table before the pelvis tilts
Good (4)
Able to reach 16° to 45° from the table before the pelvis tilts
Fair (3)
Able to reach 46° to 75° from the table before the pelvis tilts
Poor (2)
Able to reach 75° to 90° from the table before the pelvis tilts
Trace (1)
Unable to hold the pelvis in neutral at all
Isometric internal / external abdominal oblique test: unable to flex and rotate fully
B) Grade 2
Grade
Description
Normal (5)
Flexes and rotates the lumbar spine fully with hands behind the head and hold it for 20 to 30 seconds
Good (4)
Flexes and rotates the lumbar spine fully with hands across the chest and hold it for 15 to 20 seconds
Fair (3)
Flexes and rotates the lumbar spine fully with arms reaching forward and hold it for 10 to 15 seconds
Poor (2)
Unable to flex and rotate fully
Trace (1)
Only slight contraction of the muscle with no movement
(0)
No contraction of the muscle
In dynamic horizontal side support test, a grade of 2 is given if the patient is:
B) Unable to lift the pelvis off the examining table
Grade
Description
Normal (5)
Able to lift the pelvis off the examining table and hold the spine straight for 10 to 20 seconds
Good (4)
Able to lift the pelvis off the examining table but has difficulty holding the spine straight for 5 to 10 seconds
Fair (3)
Able to lift the pelvis off the examining table and cannot hold the spine straight for 5 to 10 seconds
Poor (2)
Unable to lift the pelvis off the examining table
Back, over trochanter, groin
D) L1
Inner buttock, outer thigh, inside of leg, dorsum of foot, big toe
D) L4
Psoas and hip adductors
C) L2
All of the following are characteristics of L3 nerve root lesion, except:
B) Weak knee jerk
It should be sluggish knee jerk. Weak knee jerk is associated with L4 nerve root lesion.
All of the following are characteristics of L4 nerve root lesion, except:
A) None of these
Weak knee jerk is also associated with L4 nerve root lesion.
Which of the following is not true about myotomes of the lumbar and sacral spines?
C) S1: Ankle plantarflexion, ankle inversion, hip extension
It should be S1: Ankle plantarflexion, ankle eversion, hip extension.
What is the most rigid part of the spine?
C) Thoracic
The thoracic spine is the most rigid part of the spine because of the associated rib cage.
Which of the following is not true about the costovertebral joints?
B) None of these
Which of the following is not true about costotransverse joints?
B) None of these
True or False: The second through sixth sternocostal joints are synovial.
True
The first costal cartilage is united with the sternum by a synchondrosis.
Which of the following is not true about the facet orientation of thoracic vertebra?
A) None of these
Which of the following is not true about the facet joints?
A) Capsular pattern: rotation and extension equally limited, side flexion
It should be capsular pattern: side flexion and rotation equally limited, extension.
Which thoracic vertebra has the greatest spinous process angulation?
A) T7
True or False: All the thoracic vertebrae have spinous processes that face obliquely downward.
False
The upper three thoracic vertebrae have spinous processes that project directly posteriorly.
Which of the following is not true about spinous processes of thoracic vertebrae?
C) The T11 spinous process is similar to that of T3.
The T11 spinous process is similar to that of T6, in which it is halfway between the two transverse processes of the vertebra. Meanwhile, the spinous process of T12 is similar to that of T3, in which it is in level with the transverse process of the same vertebra.
The ribs, which help stiffen the thoracic spine, articulate with the demifacets on the following vertebrae, except?
A) T1
The ribs, which help stiffen the thoracic spine, articulate with the demifacets on vertebrae T2 to T9. For T1 and T10, there is a whole facet for ribs 1 and 10, respectively.
Which of the following is not true about the ribs?
D) Ribs 8 through 10 join directly with the costocartilage of the rib below and are classified as false ribs.
Ribs 8 through 10 join directly with the costocartilage of the rib above and are classified as false ribs.
Which of the following is not true about the movement of the ribs during respiration?
D) None of these
Which of the following is not true about the movement of the ribs during inspiration?
A) Not true
Which of the following is not a characteristic of the ribs
A) By the 11th rib, the ribs are more vertical than horizontal.
By the 12th rib, the ribs are more vertical than horizontal.
All of the following are considered thoracic spine and rib cage red flags, except:
C) None of these
The medial border of the scapula is parallel to the spine and the approximately how many centimeters lateral to the spinous processes?
B) Five
Hyperkyphosis is a kyphotic angle of greater than ____ commonly meausred by the Cobb method on a lateral x-ray measuring between T4 and T12.
A) 40°
Decreased pelvic inclination (20°) with a thoracolumbar or thoracic kyphosis
D) Round back deformity
To compensate and maintain the body's center of gravity, a structural kyphosis, usually caused by tight soft tissues from prolonged postural change or by a growth disturbance.
Most common structural kyphosis in adolescents but can also occur in adults
D) Scheuermann's disease
The etiology of Scheuermann's disease is unknown.
Which of the following is not true about hump back deformity?
D) The pelvic inclination is usually decreased (20°).
The pelvic inclination is usually normal (30°).
Which of the following is not true about flat back deformity?
D) This kyphotic deformity is similar to hump back, except that the thoracic spine remains mobile and is able to compensate throughout its length for the altered center of gravity.
This kyphotic deformity is similar to round back, except that the thoracic spine remains mobile and is able to compensate throughout its length for the altered center of gravity.
Dowager's hump results from postmenopausal osteoporosis. Because of the osteoporosis, anterior wedge fractures occur to several vertebrae, usually in the middle and lower thoracic spine.
B) Only the first statement is true.
Because of the osteoporosis, anterior wedge fractures occur to several vertebrae, usually in the upper and middle thoracic spine.
All of the following are causes of nonstructural scoliosis, except:
B) None of these
Other causes of nonstructural scoliosis are poor posture, inflammation in the spine area, and hip contracture.
Which of the following is not true about the apex of scoliosis?
D) For a cervicothoracic curve, the apex is at C8 or T1.
For a cervicothoracic curve, the apex is at C7 or T1.
The lumbar curve has an apex between L2 and L4, and a lumbosacral scoliosis has an apex at L5 or S1.
In scoliosis, the involvement of which segment of the spine results in a very poor cosmetic appearance?
A) Thoracic
The involvement of the thoracic spine results in a very poor cosmetic appearance or greater visual defect as a result of deformation of the ribs along with the spine. The deformity can vary from a mild rib hump to a severe rotation of the vertebrae, causing a rib deformity called a razorback spine.
All of the following changes occur in structural scoliosis, except:
A) None of these
Most benign and least deforming of all idiopathic curves
A) Primary lumbar
Progresses more rapidly, becomes more severe, and produces greater clinical deformity than any other pattern
A) Primary thoracic
Poorly disguised because of high shoulder, elevated scapula, and deformed thoracic cage
B) Cervicothoracic
Movement in the thoracic spine is limited by the:
D) Both of these
True or False: With nonstructural scoliosis, the scoliotic curve disappears on forward flexion.
True
With structural scoliosis, the scoliotic curve remains on forward flexion.
The vertebral rotation in scoliosis is most evident if the spine is placed in which position?
D) Flexion
Which of the following is not true when measuring the ROM of the thoracic spine?
D) None of these
The landmarks used are the C7 and T12 spinous processes.
True or False: If the patient shows excessive kyphosis, the kyphotic curvature remains on extension, whether the movement is tested in standing or prone lying.
True
If extension is tested in prone lying, the normal thoracic kyphosis should, for the most part, disappear.
If, on side flexion, the ipsilateral paraspinal muscles tighten or their contracture is evident, which condition should be considered?
B) Ankylosing spondylitis
This is known as the Forestier's bowstring sign.
Which joint movement is usually determined by measuring chest expansion?
A) Costovertebral joint
Which of the following is not true when measuring the costovertebral expansion?
B) The examiner places the tape measure around the chest at the level of the sixth intercostal space.
The examiner places the tape measure around the chest at the level of the fourth intercostal space.
Which of the following is incorrect about the landmarks used when measuring the costovertebral expansion?
D) None of these
Which of the following is not true when assessing rib motion?
D) None of these
If a rib stops moving relative to other ribs on exhalation, it is classified as an elevated rib. If an elevated rib is present, it is usually the lowest restricted rib that causes the greatest problem.
All of the following muscles are responsible for approximating the ribs, except:
C) None of these
Diaphragm also approximates the ribs.
All of the following muscles are responsible for depressing the ribs, except:
B) Iliocostalis thoracis
It should be longissimus thoracis. Iliocostalis thoracis approximates the ribs.
Which of the following is not true in muscles responsible for elevating the ribs?
A) The sternocleidomastoid can elevate ribs if the head is fixed, while the pectoralis minor can if the arm is fixed.
The pectoralis major can elevate ribs if the arm is fixed. Meanwhile, the pectoralis minor can also elevate ribs if the scapula is fixed.
Which of the following is not true about erector spinae?
A) None of these
Erector spinae is also known as sacrospinalis and extensor spinae.
The facets of the thoracic spine are oriented in what plane?
B) Frontal
Frontal plane is also known as vertical plane.
The cervical facet joints change from a horizontal to a 45° angle between the ____________ and _____________ planes.
B) Horizontal; frontal
The lumbar facet joints articulate in:
B) Both
Vertical plane is also known as frontal plane.
The bodies of the fifth to ninth thoracic vertebrae are usually asymmetric because of:
D) Presence of pericardium and heart
The presence of mediastinum and its contents (e.g. heart and lungs) made the bodies of T5-T9 asymmetric because the heart is not located perfectly at the center but is pointed towards the left.
The thoracic curvature begins to develop as an infant begins to lift his/her head. An exaggerated posterior curve in the lumbar region is termed lordosis or hyperlordosis.
D) Both statements are false.
The cervical curvature begins to develop as an infant begins to lift his/her head. An exaggerated anterior curve in the lumbar region is termed lordosis or hyperlordosis.
The lamina is situated between the spinous process and the:
C) Foramen transversarium
The lamina is situated between the spinous process and the transverse process. The foramen transversarium can be found in the transverse processes of the cervical vertebrae.
David was on an afternoon hike when he slipped on a rock crossing over a shallow creek. The next day, he was having back pain and some difficulty breathing. A subsequent x-ray at his doctor's office revealed that he had fractured the head of the sixth rib along with the articulating vertebrae. What are these vertebrae?
C) T5 and T6
The sixth rib articulates with the inferior demifacet of T5 and superior demifacet of T6.
A crush injury of the vertebral column can cause the spinal cord to swell. Which structures would be trapped between the dura and the vertebral body by the swelling of the spinal cord?
A) PLL and ligamentum flavum
What is the superior continuation of the posterior longitudinal ligament?
D) Tectorial membrane
Location where vertebra join each other
D) Articular facets
Facet joints are the articulation between the inferior articulating facet of the superior vertebra and the superior articulating facet of the inferior vertebra.
Cervical lordosis starts to develop at the age of:
D) 2-3 months
Cervical lordosis starts to develop when the infant raises his/her head from the prone position.
Superficial muscle of the back
D) Levator scapula
Other superficial muscles of the back are trapezius, latissimus dorsi, and rhomboids major and minor.
The following relationships are true of the low back, except:
B) The length of the hamstrings are positively related to the lumbar curve.
The length of the hamstrings are negatively related to the lumbar curve. The shorter the hamstrings, the less lumbar lordosis.
Which of the following will result to an exaggerated lumbar curve?
C) None of these
An exaggerated lumbar curve results from:
1. Long abdominals
2. Long hamstrings and gluteals
3. Short erector spinae
4. Short hip flexors
The functional unit of the spine is composed of:
C) All of these
The three-joint complex that results is sometimes referred to as the "articular triad".
Which parts of the vertebra are absent in atlas?
D) Body and spinous process
The atlas has no vertebral body, but it has an anterior arch. Also, it has no spinous process, but it has a posterior tubercle.
The height of a specific vertebra may be used to determine the following landmarks, except:
A) C4 and C5 - level with cricoid cartilage
It should be C4 and C5 - level with thyroid cartilage.
The following statements characterize extension in the lumbar spine, except:
D) When testing extension, the examiner must not assist the subject manually by gently pushing on his/her chest.
When testing extension, the examiner may or may not assist the subject manually by gently pushing on his/her chest.
This ligament limits backward bending and supports the anterior convexity in the lumbosacral area.
C) Anterior longitudinal ligament
Structures that pass through the transverse foramen
B) None of these
Structures the pass through the transverse foramen are vertebral veins, vertebral arteries, and sympathetic nerves.
The height of this specific vertebra may be used to determine the corresponding landmark, except:
B) L4 - tubercle of ilium
It should be L5 - tubercle of ilium. L4 corresponds with the highest portion of the iliac crest.
This ligament has the highest content of elastic fiber.
A) Ligamentum flavum
Ligamentum flavum's yellow color reflects its high elastic content, which contributes to the pre-stress of the disc and resistance to forward flexion.
Which sections of the vertebral column curve posteriorly?
C) Thoracic, sacral, and coccygeal
Cervical and lumbar regions of the vertebral column curve anteriorly.
Foward bending is a complex movement of combined lumbar and hip motion, and many of the tasks that occur during everyday activities require trunk flexion. The following statements apply to this movement, except:
B) Stretching short hamstrings will not affect lumbar motion during forward bending.
Stretching short hamstrings may affect lumbar motion during forward bending. Short hamstrings, because of their attachment to the posterior leg and to the ischial tuberosity, may limit hip flexion ROM.
The spine of the scapula corresponds to what vertebral level?
A) T3
The spine of the scapula corresponds to T3 and T4 vertebral levels.
The superior angle of the scapula corresponds to what vertebral level?
C) T2
The inferior angle of the scapula corresponds to what vertebral level?
B) All of these
It varies individually.
The xiphisternal joint corresponds to what vertebral level?
B) T9
The tip of xiphoid process corresponds to T10 vertebral level.
When a ballet dancer extends her low back area, which of the following muscles are involved in this movement?
A) All of these
It is given that both multifidus and spinalis are back extensors, but transversus abdominis also contracts eccentrically to control back extension.
Opening/s through which the spinal cord passes
A) Both
Opening/s through which the spinal nerves pass
D) Neither
Spinal nerves pass through intervertebral foramina.
The vertebral canal is made up of:
D) Vertebral body anteriorly; pedicles laterally; and laminae posteriorly
The vertebral canal is also known as the neural canal.
Which of the following is not true about vertebral end plate?
B) It has a thin layer of cortical bone that attaches to the vertebral body.
It has a thin layer of porous(trabecular/spongy) bone that attaches to the vertebral body.
Soft tissue palpation of the lumbar spine may present the following observation, except:
B) The sacral triangle is a common area of pain due to low back strains of the avulsion of a tendon from the anterior iliac spine.
The sacral triangle is a common area of pain due to low back strains of the avulsion of a tendon from the posterior iliac spine. An equilateral triangle can be drawn to connect the posterior superior iliac spines and the sacral hiatus.
Flexion-extension of the thoracolumbar spine totals how much?
B) 85°
This is based on American Academy of Orthopedic Surgeons (AAOS).
Motion
Cervical
Thoracolumbar
Flexion
50°
60°
Extension
60°
25°
Lateral flexion to right
45°
25°
Lateral flexion to left
45°
25°
Rotation to right
80°
30°
Rotation to left
80°
30°
Flexion-extension of the thoracic spine totals how much?
C) 110°
This is based on American Academy of Orthopedic Surgeons (AAOS).
Motion
Cervical
Thoracolumbar
Flexion
50°
60°
Extension
60°
25°
Lateral flexion to right
45°
25°
Lateral flexion to left
45°
25°
Rotation to right
80°
30°
Rotation to left
80°
30°
Rotation of the thoracolumbar spine totals how much?
A) 60°
This is based on American Academy of Orthopedic Surgeons (AAOS).
Motion
Cervical
Thoracolumbar
Flexion
50°
60°
Extension
60°
25°
Lateral flexion to right
45°
25°
Lateral flexion to left
45°
25°
Rotation to right
80°
30°
Rotation to left
80°
30°
In flexing the hips and knees and dorsiflexing the ankles, objects may be lifted from the floor. The following position/s of the pelvis and vertebrae may be used:
B) Both of these
Vertebrae are best classified as:
A) Irregular bones
The following statements apply to the scalene muscles, except:
B) Decrease cervical lordotic curve with bilateral contraction in the absence of longus colli
Scalenes increase cervical lordotic curve with bilateral contraction in the absence of longus colli.
The neural canal is smallest and circular in the _________ region.
C) Thoracic
The neural canal is largest and triangular in the __________ spine.
B) Cervical
Which of these sections of the vertebral column is matched with its correct number of vertebrae?
D) Coccygeal - 4 vertebrae fused into 1 coccyx
Cervical - 7 vertebrae
Thoracic - 12 vertebrae
Lumbar - 5 vertebrae
Sacral - 5 vertebrae fused into 1 sacrum
Coccygeal - 4 vertebrae fused into 1 coccyx
The following statements characterize flexion in the lumbar spine, except:
B) Flexion in the low back produces kyphosis.
Flexion in the low back does not produce kyphosis. There is no reversal of the lumbar lordosis during flexion, instead the lumbar spine merely flattens out.
Weight-bearing portion/s of a vertebra:
A) Vertebral body and intervertebral disc
The vertebral body and intervertebral disc consist the anterior joint elements. Their functions include weight-bearing, shock absorption, and mobility in all directions.
The primary muscle/s responsible for elevating the ribs during inspiration is/are:
B) External intercostals
The levatores costarum also elevates the ribs during inspiration.
The strongest extensor of the lumbar spine from forward flexed position
B) Multifidus
Back extensor/s which provide/s proprioceptive feedback and input due to high muscle spindle density
A) Multifidus
Unilateral action: ipsilateral side bending and contralateral rotation
B) Both
C7 is characterized by having:
A) Both of these
Structure/s which pass/es through the foramen transversarium of the seventh cervical vertebra
A) Vertebral vein
The foramen transversarium of the seventh cervical vertebra is either absent or small.
Vertebra prominens
B) C7
Epistropheus
A) C2
Which of the following is not a function of an intervertebral disc?
C) Increases shock in a joint and adjusts bony articulating surfaces of different shapes to one another
An intervertebral disc decreases shock in a joint and adjusts bony articulating surfaces of different shapes to one another.
Intervertebral disc are located between vertebral bodies, except:
A) C1-C2
How many intervertebral discs are there in the spinal colum?
D) 23
This ligament connects the apex of the dens to the anterior margin of the foramen magnum.
B) Apical ligament
The apical ligament is a small ligament that joins the apex of the dens of C2 to the anterior margin (basion) of the foramen magnum.
This ligament is a weak, fibrous remnant of the notochord which does not contribute significantly to the vertebral column's stability.
D) Apical ligament
Attach between adjacent spinous processes
B) Interspinous ligaments
The supraspinous ligament is a strong, fibrous cord attaching to the tips of the spinous processes.
Upon viewing the x-ray, scotty dog with collar can be most seen in:
D) Oblique view: spondylolysis
Upon viewing the x-ray, scotty dog decapitated can be most seen in:
A) Lateral view: spondylolisthesis
Scottie dog's nose
B) Transverse process
Scottie dog's front leg
A) Inferior articular process of same side
Scottie dog's eye
A) Pedicle
Scottie dog's tail
B) Superior articular process of opposite side
Your patient complained of low back pain with radiculopathy. Her symptoms now include bilateral leg pain that has worsened; it has continued to worsen in the last six months. She has very little relief from pain, and the severity and consistency of her symptoms have limited all her activities of daily living. The physician diagnosed her with severe spinal stenosis and grade 1 spondylolisthesis at L4-L5. What manifestations can be seen in this diagnosis?
B) All of these
Most common type of spondylolisthesis according to Wiltse's classification
B) Isthmic
Isthmic spondylolisthesis is a stress fracture involving the pars interarticularis.
Wiltse's classification: acute pars interarticularis fracture
A) IIC
IIA - fatigue (stress) fracture of pars
IIB - elongated but intact pars (due to repetitive healed microfractures)
Wiltse's classification: type I
B) Dysplastic
Isthmic: type II
Degenerative: type III
Traumatic: type IV
Pathologic: type V
Meyerding's classification: spondyloptosis
A) Grade V
Grade I: 1° to 25°
Grade II: 26° to 50°
Grade III: 51° to 75°
Grade IV: 76° to 100°
Grade V: >100° (spondyloptosis)
Meyerding's classification: 40°
C) Grade II
Grade I: 1° to 25°
Grade II: 26° to 50°
Grade III: 51° to 75°
Grade IV: 76° to 100°
Grade V: >100° (spondyloptosis)
What causes osteoporosis?
A) All of these
Upon administering Schober's test on the patient, it revealed an increase of 7cm from the landmarks. The patient has:
B) None of these
Normal spinal flexion is an increase more than 5 cm, but less than 10 cm. An increase of less than 5 cm indicates ankylosing spondylitis, whereas an increase of more than 10 cm indicates spinal hypermobility.
The Schober's test measures which spinal motion?
A) Flexion
Positive Dowager's hump is seen in:
B) Gibbus deformity
A Dowager's hump is usually caused by vertebral fractures or collapse, and such cases are gibbus deformity secondary to osteoporosis. Osteoporosis does not always lead to vertebral fractures.
A woman suffered from whiplash injury in a car accident. A day after the accident, she was admitted to the hospital after showing signs of stroke. How might the two be related to each other?
D) Whiplash injury to the cervical spine affected the intervertebral foramina, leading to blockage of vertebral arteries.
Which anatomic feature of the vertebra is the best reference when assessing rotation?
B) Pedicle
The use of spinous process or transverse process to determine vertebral rotation is unreliable, due to frequent, normal asymmetry.
This type of torticollis can be caused by blunt trauma to head and neck or merely sleeping in an awkward position.
A) Acute
The recommended treatment program for spondylolysis is usually a combination of the following, except:
B) For terminal defects: a brief period of activity reduction after starting stabilization exercises
For terminal defects, there should be a brief period of activity reduction before starting stabilization exercises.
Hemivertebra
D) Both of these
Block vertebra
A) Type of vertebral anomaly which results from failure of two or more adjacent vertebra bodies to separate
Congenital bony bar is a type of vertebral anomaly which results from failure of one side of two or more adjacent vertebral bodies to separate.
Type of vertebral anomaly which is likely to progress
D) Congenital bony bar
Cobb's method
B) Both of these
Orthopedic gold standard for measuring the degree of spinal curvature in scoliosis
D) Cobb's method
Congenital muscular torticollis is musculoskeletal anomaly with the following characteristics, except:
A) None of these
What is the classic triad of Klippel-Feil syndrome?
A) Low posterior hairline, short neck, restricted cervical ROM
After suffering multiple cervical fractures, a man was given a choice of which vertebrae to fuse together - that is, he could eave only one articulation unfused. He decided to choose the fusion which would allow him to shake his head "no". His choice was to leave the _____________ unfused.
D) Articulation between atlas and axis
If the man chose the fusion which would allow him to nod his head "yes", the articulation between the atlas and occipital condyles will be left unfused.
Which of the following is not true about coccygodynia?
C) None of these
Coccygodynia is also known as coccyalgia.
The most appropriate statement regarding degenerative disc disease (DDD) is:
D) DDD occurs principally as a result of the aging process.
MRI can show damaged discs, but it alone cannot confirm the diagnosis of DDD. If DDD is present, the spaces between the vertebral bodies are narrow, indicating the discs has become very thin or has collapsed.
An axial CT bone window section through L4 at the pedicle level reveals bilateral lucent defects with sclerotic margins. What is the most likely diagnosis?
D) Sponydylolysis
When considering trauma as a cause for sclerotic lesions, remember to check and see if the areas involved are the areas in the typical distribution of stress fracture.
The patient suffered head-on collision. The x-ray revealed a ligamentous tear in the lateral view. Which of these ligaments are most likely to be affected?
D) Ligamentum flavum
A head-on collision is when two vehicles come into contact with the front end of each pointing towards each other. This sudden, jerking motion of the head and neck is known as whiplash.
If excessive tightness of hip ligaments, muscles, or fasciae prevents the complete extension of the hip joints, an individual commonly compensates for this limitation by:
C) Accentuating the anterior pelvic tilt and lumbar lordosis
A 70-year old man is suffering from bilateral lower extremity weakness. He has history of ligamentous hypertrophy and disc herniation. MRI revealed that his vertebral canal's diameter is 10 mm. The man is suffering from:
B) Relative spinal stenosis
A vertebral canal diameter of less than 12 mm indicates relative spinal stenosis, where a diameter of less than 10 mm indicates absolute spinal stenosis.
What diameter/s of the neural canal are being measured in order to determine the severity of spinal stenosis?
D) Anteroposterior
A patient with a left posterolateral herniation on the lumbar area should avoid listing to the:
C) Right
Listing or lateral bending on the right side will push the intervertebral disc towards the left. This will aggravate the neurological symptoms experienced by the patient as the herniation will hit the axilla of the nerve root.
A patient presents with high left shoulder and high right pelvis. What is your impression?
A) C-curve; levoscoliosis
A patient complains of low back pain. Upon your evaluation and assessment, she complains of unilateral pain below L5 during sit-to-stand. What is your PT impression?
B) The patient may be suffering from a painful sacroiliac joint.
According to Goodman, midline lumbar pain, especially if present when rising from sitting, often comes from a diskogenic source. Patients with unilateral pain below L5 when rising from sitting are more likely to have a painful sacroiliac joint.
The following are causes of spinal stenosis, except:
A) None of these
Ligamentous hypertrophy can also cause spinal stenosis.
The following are true about spina bifida, except:
C) Spina bifida is a congenital disability involving the spine that occurs when a baby's neural tube, or fetal spinal cord, does not completely open in the early stages of development during the first months of a mother's pregnancy.
Spina bifida is a congenital disability involving the spine that occurs when a baby's neural tube, or fetal spinal cord, does not completely close in the early stages of development during the first months of a mother's pregnancy.
Which two types of degenerative disease most commonly lead to compromise of the intervertebral foramina in the cervical spine?
B) Uncinate arthrosis, facet arthrosis
The uncinate processes form part of the intervertebral foramina's anterior border, whereas the facets form part of the IVF's posterior border. When these structures hypertrophy with a degenerative disease, they grow into the IVF.
The combination of facet and uncinate arthroses leads to characteristic ____________ appearance of an impinged cervical intervertebral foramina.
D) Figure of 8
Spondylolysis occurs in 6-10% of the general population and is as high as 25-60% of the athletic community. It is essentially common in young athletes under age 18 who participate in sports that involve twisting or backward bending motions of the spine. The following are considered to be consequences of injury, except:
C) None of these
Patients with cervical radiculopathy should avoid:
D) Cervical extension
Patients should avoid extension and lateral flexion on the same side of affectation. With these motions, the diameter of the neural foramen decreases, aggravating the symptoms of radiculopathy.
What is the most common type of motor vehicular accident that happens in whiplash?
B) Rear-end collision
What is the leading cause of spondylosis?
C) Aging
Aging is the predominant cause of spondylosis, which is also known as the arthritis of the spine.
The following are clinical manifestations of spinal stenosis, except:
A) Some patients also have ataxia from compression of spinothalamic tracts.
Some patients also have ataxia from compression of spinocerebellar tracts.
The following are clinical manifestations of torticollis, except:
C) The eyes will voluntarily look upward, while the tongue will involuntary stick out.
The eyes will involuntarily look upward (oculogyric crisis), and the tongue will involuntarily stick out (buccolingual crisis).
Interspinous fusion is seen in:
B) All of these
Which ligament typically fuse in ankylosing spondylitis?
B) Interspinous and supraspinous ligaments
Abdominal muscle exercises during pregnancy and at least 8 weeks postpartum should be chosen with care because of the following reasons, except:
D) There is no reversal in rectus abdominis muscle separation 4 weeks post birth
There is reversal in rectus abdominis muscle separation 4 weeks post birth.
The lumbar lordosis begins to develop at the age of:
B) 10-12 months
The lumbar lordosis develops when the child starts to stand and walk.
Widest intervertebral foramina in transverse view
B) L5
Narrowest intervertebral foramina in transverse view
D) T4
Widest intervertebral foramina in sagittal view
C) T11
Narrowest intervertebral foramina in sagittal view
B) T1
The costal facet of T1 vertebra is found in the _________ edge of the vertebral body.
D) Superior
All of the following thoracic vertebrae have almost horizontal spinous processes, except:
D) T1
T1 vertebra has a horizontal spinous process.
All of the following thoracic vertebrae have tubercles on their bodies, except:
A) T8
This thoracic vertebra has a costal facet on the lateral edge of its body.
B) T10
Typical vertebrae, except:
A) T4-T8
It should be T5-T8.
Hoop's stretch is generated by:
A) Annulus fibrosus
How many uncinate joints are there in the spine?
D) 12
Uncinate joints, also known as joints of Luschka or neurocentral joints, are only found in C3 through C7 vertebra.
The jugular notch is found at the level of:
C) T2
Jugular notch is also known as sternal notch.
The vertebral end plate connects the:
D) Nucleus pulposus and inner annulus fibrosus to vertebral body
Meanwhile, Sharpey's fibers connect the outer annulus fibrosus to vertebral body.
Which of the following does not occur in the vertebra column during spinal flexion?
B) The facet joints close.
The facet joints, which are found in the posterior aspect of the vertebral column, open during flexion. The opposite occurs during extension.
Which of the following does not occur in the vertebra column when side bending to the right?
A) The spinous processes approximate.
No changes occur in the spinous processes during side bending.
The intervertebral discs are weakest during this spinal motion.
A) Rotation
All of the following are intersegmental ligaments of the spine, except:
A) Ligamentum flavum
Ligamentum flavum is an intrasegmental ligament, which connects adjacent lamina.
This ligament is incised to obtain cerebrospinal fluid during lumbar puncture.
C) Ligamentum flavum
The intertransverse ligaments limit:
C) Flexion
The intertransverse ligaments limit flexion and contralateral side bending.
This ligament assists the alar ligament in rotation of occiput and atlas on axis.
A) Both
The anterior atlanto-occipital membrane runs from:
A) C0-C2
The anterior atlanto-occipital membrane is the superior continuation of anterior longitudinal ligament.
What is the superior continuation of ligamentum flavum?
D) Posterior atlanto-occipital membrane
The posterior atlanto-occipital membrane runs from occiput to atlas (C0-C2).
The ligamentum nuchae is the superior continuation of supraspinous ligament and runs from:
A) C0-C7
Shawl muscle
D) Trapezius
Crutch-walking muscle
A) Latissimus dorsi
This muscle inserts on the medial border of the scapula at the level of the superior angle.
D) Levator scapula
Rhomboid minor also inserts on the medial border of the scapula, but at the level of the spine. Meanwhile, the rhomboid major inserts at the level of the inferior angle.
Bandage muscle
B) Splenius
Transversospinalis consists of:
A) Semispinalis, multifidus, and rotatores
Transversospinalis muscle with the largest fascicles
A) Semispinalis
Meanwhile, rotatores has the smallest fascicles.
Deepest transversospinalis
A) Rotatores
The posterior longitudinal ligament tapers at which vertebral level?
D) L2
The intervertebral disc commonly herniates in which direction?
B) Posterolateral
What is the narrowest part of the neural arch?
C) Isthmus
Isthmus is also known as pars interarticularis.
Most commonly involved vertebral levels in spondylosis
B) C5-C6
C5-C6 are the most mobile segments of the spine, making them susceptible to wear and tear over time.
Painful and inflamed costochondral joints
B) Both
In the presence of torticollis, what is the correct sequence of stretching the SCM?
D) (1) Extension, (2) ipsilateral rotation, (3) contralateral side bending
All of the following are characteristics of forward head posture, except:
C) Madibular protrusion
It should be mandibular retrusion.
All of the following are characteristics of flat neck posture, except:
D) Atlanto-occipital and upper cervical extension
It should be atlanto-occipital and upper cervical flexion.
Scheuermann's disease
C) All of these
Scheuermann's disease is common in boys aged 12 to 16 years.
Most commonly involved vertebral levels in juvenile kyphosis
B) T10-L2
Juvenile kyphosis is also known as Scheuermann's disease.
Scheuermann's disease is characterized by anterior wedging of at least ___° of ____ consecutive vertebrae.
C) 5; 3
All of the following characterize swayback deformity, except:
B) Increased hip flexion
It should be increased hip extension.
All of the following characterize flatback deformity, except:
A) Increased lumbosacral angle
It should be decreased lumbosacral angle.
Most common form of idiopathic scoliosis
D) Adolescence
Infantile: 1-3 years old
Juvenile: 4-9 years old
Adolescence: 10-16 years old
Most rotated vertebra in scoliosis
D) Apical vertebra
Meanwhile, end vertebra is the most tilted.
Vertebra which is farthest from the midline in scoliosis
D) Apical vertebra
Easiest method of determining the degree of spinal curvature in scoliosis
B) Risser-Ferguson method
In Risser-Ferguson method, the degree of scoliotic curvature is determined by the angle formed by the intersection of two lines at the center of the apical vertebra: the first line originating at the center of the upper end vertebra, and the other at the center of the lower end vertebra.
Lippmann-Cobb classification of scoliotic curvature: 51°-75°
A) Group IV
Group
Angle of Curvature
I
<20°
II
21°-30°
III
31°-50°
IV
51°-75°
V
76°-100°
VI
101°-125°
VII
>125°
Lippmann-Cobb classification of scoliotic curvature: 125°
A) Group VI
Group
Angle of Curvature
I
<20°
II
21°-30°
III
31°-50°
IV
51°-75°
V
76°-100°
VI
101°-125°
VII
>125°
This method uses the spinous process to determine the amount of vertebral rotation in scoliosis.
C) Cobb's method
In Cobb's method, the vertebra is divided into six equal parts. Normally, the spinous process appears at the center. Its migration to certain points toward the convexity of the curve marks the degree of rotation.
Vertebra with the most severe wedging in scoliosis
D) Apical vertebra
Nash-Moe pedicle method: grade 2+
B) Both of these
Grade
Description
0
Pedicles are symmetrically positioned at the lateral border of the vertebral body.
+1
One pedicle is going to midline (1/3).
+2
One pedicle is going to midline (2/3), while the other pedicle is almost out of view.
+3
Only one pedicle is seen, positioned at the center of the vertebral body.
+4
Only one pedicle is seen, positioned lateral to the center of the vertebral body.
Nash-Moe pedicle method: only one pedicle is seen
C) All except +2
Grade
Description
0
Pedicles are symmetrically positioned at the lateral border of the vertebral body.
+1
One pedicle is going to midline (1/3).
+2
One pedicle is going to midline (2/3), while the other pedicle is almost out of view.
+3
Only one pedicle is seen, positioned at the center of the vertebral body.
+4
Only one pedicle is seen, positioned lateral to the center of the vertebral body.
Which of the following is not true about clinical manifestations of scoliosis?
A) Anterior rib bump on convex side
It should be anterior rib bump on concave side. Posterior rib hump is found on convex side.
Orthosis for scoliosis with apex at T8
C) All of these
Orthosis for scoliosis with apex at T6
A) Milwaukee
Miami orthosis is used for scoliosis with apex at T7.
Degree of curvature in scoliosis associated with degenerative joint disease of the spine
C) 50°-60°
Degree of curvature in scoliosis associated with cardiopulmonary manifestations
A) 70°-80°
Deepest muscle in the posterior trunk
D) Both
Which of the following does not describe the 7th rib?
D) Most oblique rib
The 9th rib is the most oblique rib.
A patient is exercising on lying position. She crossed her right leg on top of her left knee and supported her head with her left hand. She crunched and brought her left elbow across her body towards her right knee. What muscles produced this movement?
C) Right internal oblique and left external oblique
The patient rotated her trunk towards the right. The external oblique rotates the trunk towards the opposite side, whereas the internal oblique rotates the trunk towards the same side.
This ligament is one of the proximal attachments of the trapezius.
A) Ligamentum nuchae
Ligamentum nuchae is the superior continuation of the supraspinous ligament.
Patients with cervical radiculopathy should not avoid:
A) Cervical flexion
Cervical flexion increases the diameter of the intervertebral foramina.
Upon inspection of the lumbar spine from the side, which of the following observations is not true?
D) Pelvic obliquity is evident when the two dimples overlying the posterior iliac spines directly above the buttocks does not lie along the same horizontal plane.
Pelvic obliquity can be observed in posterior view.
A patient has been admitted to your hospital with severe low back pain. The patient will be placed in a pelvic belt for intermittent traction. The following applies to proper pelvic belt application, except:
A) The straps must be placed perpendicular to each other and to the patient's thighs when attached to the traction cords.
The straps must be placed parallel to each other and to the patient's thighs when attached to the traction cords.
Signs of meningeal irritation include the following, except:
B) In severe meningitis, there may even be rigid flexion of the neck and back, but generally, does not limit lateral rotation.
In severe meningitis, there may even be rigid hyperextension of the neck and back, but generally, does not limit lateral rotation.
The following statements apply to lower lumbar root compression, except:
C) Ankle jerk reflex is commonly diminished or absent in L5 root impingement, but may be normal in S1 root syndrome.
Ankle jerk reflex is commonly diminished or absent in S1 root impingement, but may be normal in L5 root syndromes.
What will you do to reverse postural kyphosis?
A) None of these
To reverse postural kyphosis, you must stretch the pectoralis major and minor and strengthen the rhomboids major and minor.
An example of a synovial pivot joint is:
A) None of these
Radioulnar and atlantoaxial joints are examples of synovial pivot joints.
The following statements are true of herniated disc, except:
B) Only about 50% of the disc herniations occur in the cervical area.
Only about 5% of the disc herniations occur in the cervical area.
The most superficial muscle in the posterior trunk is:
C) Longissimus
In getting a laminectomy patient out of bed, the following procedures are observed, except:
A) The incision site should be splinted.
The incision site neednot besplinted.
Injury to this/these ligament/s will limit the rotation of skull and atlas on axis.
B) Alar ligament
Injury to the alar ligament and accessory atlanto-axial ligament will limit the rotation of skull and atlas on axis.
Which of the following is true about atlanto-occipital joints, except:
A) The anterior and posterior margins of the occiput are united to the margins of the foramen magnum.
The anterior and posterior margins of the atlas are united to the margins of the foramen magnum.
In root compression syndrome, the following statements are true, except:
A) Paresthesias are common and are usually experienced on the proximal segment of the body.
Paresthesias are common and are usually experienced on the distal segment of the body.
What are the conditions that are indicated for spinal fusion?
D) All of these
Spinal fusion can help correct spinal deformities, such as scoliosis. Abnormal or excessive motion between vertebrae is common in spondylosis, and spinal fusion can help restore spinal stability in such cases. Likewise, spinal fusion may be used to stabilize the spine after the removal of a herniated disc.
Signs of meningeal irritation include the following, except:
A) Brudzinski sign is absent when flexion of the knees follows attempt to flex the neck.
Brudzinski sign is present when flexion of the knees follows attempt to flex the neck.
The act of inspiration increases the capacity of the thoracic cage in which principal direction?
C) All of these
The following statements characterize the atlanto-axial joint, except:
D) The gliding movement occurs on the atlas.
The gliding movement occurs on the axis.
The line of fusion between the external obliques is the:
A) Linea alba
The following statements are true about thoracolumbar fascia, except:
C) It is composed of three layers: anterior, posterior, and lateral.
It is composed of three layers: anterior, posterior, and middle. The middle layer attaches to the lumbar transverse processes, 12th rib, and transversus abdominis, whereas the posterior layer attaches to the spinous processes and supraspinous ligament.
The following should be observed following laminectomy, except:
A) Limit sitting to more than 30 minutes.
Limit sitting to less than 30 minutes.
Action/s of the external abdominal oblique:
A) Bilateral contraction causes compression of the abdominal viscera.
The bilateral contraction of external abdominal oblique causes compression of the abdominal viscera, expiration, and trunk flexion. Meanwhile, its unilateral contraction causes trunk lateral flexion towards the same side and trunk rotation towards the opposite side.
Cervical root compression syndromes are illustrated by the following, except:
D) Gentle manipulation of the neck produces pain felt above the elbow, and duplicates paresthesia in the hand.
Gentle manipulation of the neck produces pain felt below the elbow, and duplicates paresthesia in the hand.
The following are possible causes of spinal stenosis, except:
B) None of these
The patient suffered a head-on collision. The x-ray revealed ligamentous tear in the lateral view. What would be the most affected ligament in this type of injury?
A) All except intertransverse ligament
The spine of the scapula corresponds to what vertebral level?
D) T3-T4
A crush injury of the vertebral column can cause the spinal cord to swell. Which structure/s would be trapped between the dura and the vertebral body by the swelling of the spinal cord?
C) Both
The posterior longitudinal ligament and the ligamentum flavum are both situated within the vertebral canal.
The deepest layer is sometimes included as part of the deep muscles of the back. Which of the following muscles is included in this deepest layer?
E) Intertransversarii
The deepest layer includes the Intertransversarii, interspinales and levatores costarum muscles.
The deep layer includes the semispinalis, multifidus and rotatores.
The intermediate layer includes the iliocostalis, longissimus and spinals.
Which of the following is the insertion for the splenius cervicis?
D) Transverse processes of C1-C4
Splenius cervicis inserts on the transverse processes of C1-C4. It originates from the spinous process of T3-T6.
Splenius capitis inserts on the inferior nuchal line and mastoid process. It originates from the spinous processes of C7-T4 and nuchal ligament.
Which of the following is a site of origin for spinalis cervicis?
D) Spinous processes of C4-C7
Spinalis cervicis originates from the spinous processes of C4-C7. Spinalis cervicis inserts onto the spinous processes of C3-C5.
Spinalis capitis inserts onto the inferior nuchal line and nuchal ligament. Spinalis capitis originates from the spinous processes of C1, C3 and C4.
Spinalis thoracis originates from the spinous processes of T7-L1. Spinalis thoracis inserts onto the spinous processes of T1-T6.
Which of the following is the action of the spinalis muscle when contracted unilaterally?
D) Ipsilateral flexion of the spine
The erector spinae group of muscles include spinalis, longissimus and iliocostalis. Each of the muscles in the erector spinae group, when contracting unilaterally cause ipsilateral lateral flexion. If any of these muscles act bilaterally, they assist in extension of the spine.
Multifidus acts primarily to stabilize the spine.
When contracting unilaterally, semispinalis causes ipsilateral flexion and rotation. When contracting bilaterally, semispinalis causes extension of the spine.
Rotatores functions to rotate the spine, but also proprioceptive like multifidus.
Which of the following nerves innervates semispinalis cervicis?
E) Dorsal rami of all spinal nerves
Semispinalis cervicis and thoracis is innervated by the dorsal rami of all of the spinal nerves and is innervated segmentally (ie the superior parts are innervated by the superior dorsal rami).
Semispinalis capitis is supplied by the greater occipital nerve.
Splenius cervicis is innervated by the dorsal rami of C5-C8.
Splenius capitis is innervated by the dorsal rami of C3-C4.
Iliocostalis is innervated by the dorsal rami of C4-L5, but is innervated segmentally. For example, iliocostalis cervicis is innervated by the dorsal rami of C4-C6.
Which of the following is a point of origin of the multifidus?
D) Sacrum
The multifidus originates from the sacrum, iliac crest and erector spinae aponeurosis. It inserts into the spinous process of the vertebrae.
The rotatores originates from the transverse processes of all vertebrae. It inserts onto the spinous process of the superior vertebra.
The semispinalis capitis originates on the transverse processes of C7-T6.
Which of the following is a site of origin for iliocostalis cervicis?
E) Posterior aspect of rib 3-6
Iliocostalis cervicis originates from the posterior aspect of ribs 3-6. Iliocostalis cervicis inserts onto the transverse processes of C4-C6.
Iliocostalis thoracis originates from the superior border of ribs 1-6. Iliocostalis thoracis inserts into the superior border of ribs 6-12.
Iliocostalis lumborum originates from the deep thoracolumbar fascia, iliac crest and sacrum. Iliocostalis lumborum and inserts onto the inferior border of ribs 6-12.
