Back

During an outbreak of meningitis at a local college, a 20-year-old student presents to a hospital emergency room complaining of headache, fever, chills, and stiff neck. On examination, it appears that he may have meningitis and needs a lumbar puncture or a spinal tap. Cerebrospinal fluid (CSF) is normally withdrawn from which of the following spaces?

a) Epidural space
b) Subdural space
c) Space between the spinal cord and pia mater
d) Subarachnoid space
e) Space between the arachnoid and dura maters

A 23-year-old jockey falls from her horse and complians of headache, backache, and weakness. Radiologic examination woud reveal blood in which of the following spaces if the internal vertebral venous plexus was ruptured?

A) Space deep to the pia mater
B) Space between the arachnoid and dura maters
C) Subdural space
D) Epidural space
E) Subarachnoid space

A 42-year-old woman with matastatic breast cancer is known to have tumors in the intervertebral foramina between the fourth and fifth cervical vertebrae and between the fourth and fifth thoracic vertebrae. Which of the following spinal nerves may be damaged?

A) Fourth cervical and fourth thoracic nerves
B) Fifth cervical and fifth thoracic nerves
C) Fourth cervical and fifth thoracic nerves
D) Fifth cervical and fourth thoracic nerves
E) Third cervical and fourth thoracic nerves

A 39-year-old woman with headaches presents to her primary care physician with a possible herniated disk. Her magnetic resonance imaging (MRI) scan reveals that that posterolateral protrusion of the intercertebral disk between L4 and L5 vertebrae would most likely affect nerce roots of which of the following spinal nerves?

A) Third lumbar nerve
B) Fourth lumbar nerve
C) Fifth lumbar nerve
D) First sacral nerve
E) Second sacral nerve

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

A) Choroid plexus
B) Vertebral venous plexus
C) Arachnoid villi
D) Internal jugular vein
E) Subarachnoid trabeculae

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

A) Trapezius
B) Levator scapulae
C) Rhomboid major
D) Serratus posterior
E) Rectus capitis posterior major

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

A) Head of the third rib
B) Neck of the fourth rib
C) Tubercle of the fourth rib
D) Head of the fifth rib
E) Tubercle of the fifth rib

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

A) Spina bifida occulta
B) Meningocele
C) Meningomyelocele
D) Myeloschisis
E) Syringomyelocele

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

A) Rhomboid major
B) Levator scapulae
C) Serratus posterior superior
D) Iliocostalis
E) Latissimus dorsi

During a domestic dispute, a 16-year-old boy receives a deep stab wound around the superior angle of the scapula near the medial border, which injuries both the dorsal scapular and spinal accessory nerces. Such an injury could result in paralysis or weakness of which of the following muscles?

A) Trapezius and serratus posterior superior
B) Rhomboid major and trapezius
C) Rhomboid minor and latissimus dorsi
D) Splenius cervicis and sternocleidomastoid
E) Levator scapulae and erector spinae

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

A) Pia Mater
B) Filium terminale externum
C) Posterior longitudinal ligament
D) Ligamentum flavum
E) Annulus fibrosus

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

A) Dorsal horn
B) Ventral horn
C) Lateral horn
D) Gray matter
E) Pia mater

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

A) Intervetebral foramen
B) Sacral hiatus
C) Vertebral canal
D) Dorsal sacral foramen
E) Ventral sacral foramen

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

A) Rectus capitis posterior major
B) Semispinalis capitis
C) Splinius capitis
D) Obliquus capitis superior
E) Obliquus capitis inferior

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

A) Extension
B) Flexion
C) Abduction
D) Adduction
E) Rotation

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

A) Anterior longitudinal ligament
B) Alar Ligament
C) Posterior longitudinal ligament
D) Cruciform ligament
E) Ligamentum nuchae

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

A) Verterbral artery
B) Vertebral vein
C) External vertebral venous plexus
D) Internal vertebral venous plexus
E) Lumbar cistern

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

A) Lordosis
B) Spinal bifida occulta
C) Meningocele
D) Meningomyelocele
E) Kyphosis

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

A) Scoliosis
B) Hangman's fracture
C) Meningomyelocele
D) Whiplash injury
E) Herniated disk

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

A) Alar ligament
B) Apical ligament
C) Semispinalis cervicis muscle
D) Rectus capitis posterior minor
E) Obliquus capitis inferior

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

A) Filum terminale internum
B) Coccygeal ligament
C) Denticulate ligament
D) Choroid plexus
E) Tectorial membrane

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

A) Semispinalis capitis
B) Rhomboid major
C) Multifidus
D) Rotator longus
E) Iliocostalis

After an automobile accident, a back muscle that forms the boundaries of the triangle of auscultation and the lumbar triangle, receives no blood. Which of the following muscles might be ischemic?

A) Levator scapulae
B) Rhomboid minor
C) Latissimus dorsi
D) Trapezius
E) Splenius capitis

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

A) latissimus dorsi
B) Multifidus
C) Trapezius
D) Rhomboid major
E) Longissimus capitis

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

A) Dorsal primary rami
B) Ventral primary rami
C) Dorsal roots of the thoracic spinal nerves
D) Ventral roots of the sacral spinal nerves
E) Lumbar spinal nerves

Questions 26-30: Choose the appropriate lettered structure in this magnetic resonance imaging (MRI) scan of the back (see figure on page 316)