Spinal Orthoses — MCQs
True regarding Hangman's fracture is:
When a lumbar puncture is performed to sample cerebrospinal fluid, which of the following external landmarks is the most reliable to determine the position of the L4 vertebral spine?
Which of the following is least useful for diagnosing spondylolisthesis?
Most common type of spinal injury is:
Patellar tendon-bearing P.O.P. cast is indicated in the following fracture:
A patient met with an accident and presents with paralysis of both upper and lower limbs. The patient has not passed urine and tenderness is elicited in the cervical region. What is the most appropriate immediate management?
In an accident involving potential cervical spine damage, the first line of management is:
Risser Localiser cast is used in the management of which condition?
Management of Smith's fracture is
The compression fracture is commonest in
Spinal Orthoses Indian Medical PG Practice Questions and MCQs
Question 1: True regarding Hangman's fracture is:
- A. Bilateral fractures of pars interarticularis of C2 (Correct Answer)
- B. Whiplash injury
- C. Odontoid process fracture of C2
- D. Fracture of hyoid bone
Explanation: ***Bilateral fractures of pars interarticularis of C2*** - A **Hangman's fracture** specifically refers to a **traumatic spondylolysis** of the C2 vertebral body, involving bilateral fractures through the **pars interarticularis** or pedicles of the axis. - This injury is typically caused by a forceful **hyperextension-distraction** mechanism, often associated with rapid deceleration trauma. *Whiplash injury* - A **whiplash injury** is a general term for a range of neck injuries caused by sudden, forceful back-and-forth movement of the head. - While it can result in various soft tissue damage and ligamentous injuries, it is not a specific fracture type like a Hangman's fracture. *Odontoid process fracture of C2* - An **odontoid fracture** involves the **dens**, a superior projection from the C2 vertebral body, and is distinct from a Hangman's fracture. - Odontoid fractures are classified into three types (I, II, III) based on the location of the fracture line and typically result from flexion or extension forces on the neck. *Fracture of hyoid bone* - The **hyoid bone** is located in the neck above the larynx and is typically fractured due to direct trauma to the neck, often associated with manual strangulation or hanging. - A hyoid fracture is entirely unrelated to injuries of the cervical spine or C2 vertebra.
Question 2: When a lumbar puncture is performed to sample cerebrospinal fluid, which of the following external landmarks is the most reliable to determine the position of the L4 vertebral spine?
- A. The iliac crests (Correct Answer)
- B. The lowest pair of ribs bilaterally
- C. The inferior angles of the scapulae
- D. The posterior superior iliac spines
Explanation: ***The iliac crests*** - A line drawn between the **highest points of the iliac crests** on both sides typically intersects the L4 vertebral body or the L4-L5 intervertebral space. - This anatomical landmark provides a **safe entry point** for lumbar puncture, avoiding the spinal cord which usually ends at L1-L2. *The lowest pair of ribs bilaterally* - The lowest pair of ribs (12th ribs) corresponds to the **twelfth thoracic vertebra (T12)**, which is much higher than the desired lumbar puncture site. - Using this landmark would place the needle at a level where the **spinal cord is still present**, posing a significant risk of injury. *The inferior angles of the scapulae* - The inferior angle of the scapula typically corresponds to the **seventh thoracic vertebra (T7)**. - This landmark is also too superior for a safe lumbar puncture and does not accurately localize the lumbar spine. *The posterior superior iliac spines* - The posterior superior iliac spines (PSIS) are located at the level of the **S2 vertebra**, which is too far inferior for a standard lumbar puncture at L4-L5. - While they are important pelvic landmarks, they are not used for determining the L4 vertebral spine in this context.
Question 3: Which of the following is least useful for diagnosing spondylolisthesis?
- A. X-ray spine lateral view
- B. MRI
- C. CT scan
- D. X-ray spine AP view (Correct Answer)
Explanation: ***X-ray spine AP view*** - An **AP (Anterior-Posterior) view** of the spine is least useful for diagnosing spondylolisthesis because it does not adequately demonstrate the **forward slippage** of one vertebra over another. - This view primarily visualizes the spine in the **coronal plane**, making it difficult to assess the **sagittal displacement** characteristic of spondylolisthesis. *X-ray spine lateral view* - A **lateral view** of the spine is highly useful as it directly shows the **sagittal alignment** and can clearly demonstrate the **anterior displacement** of a vertebral body. - It is often the **initial imaging modality** for suspecting and classifying spondylolisthesis severity. *MRI* - **MRI** is excellent for evaluating **soft tissue structures**, such as the spinal cord, nerve roots, and intervertebral discs, which can be compressed or damaged by spondylolisthesis. - While it can visualize the slippage, it is usually reserved for assessing **neurological compromise** or if surgical planning requires detailed soft tissue information. *CT scan* - **CT scans** provide detailed **bony anatomy** and are highly effective in visualizing the pars interarticularis defects (spondylolysis) often associated with spondylolisthesis. - It offers superior detail compared to plain X-rays for assessing the **extent of bone displacement** and associated degenerative changes.
Question 4: Most common type of spinal injury is:
- A. Compression injury
- B. Rotation injury
- C. Extension injury
- D. Flexion injury (Correct Answer)
Explanation: **Flexion injury** - **Flexion injuries** are the most common type of spinal injury, particularly affecting the **cervical spine**. - These injuries often result from forceful forward bending of the spine, such as in **whiplash** or falls, leading to vertebral body compression or ligamentous tears. *Compression injury* - While **compression injuries** can occur, they are generally less common than flexion injuries across all spinal segments. - They primarily involve an axial load being applied to the spine, leading to **vertebral body fractures**. *Rotation injury* - **Rotation injuries** are relatively uncommon and often occur in combination with other forces, such as flexion or extension. - These injuries involve twisting of the spine, which can lead to **ligamentous damage** or **facet joint dislocation**. *Extension injury* - **Extension injuries** occur when the spine is forcefully bent backward, often seen in hyperextension trauma. - They are less common than flexion injuries and can result in **posterior element fractures** or **ligamentous avulsions**.
Question 5: Patellar tendon-bearing P.O.P. cast is indicated in the following fracture:
- A. Fracture of the tibia (Correct Answer)
- B. Fracture of the patella
- C. Fracture of the femur
- D. Fracture of the medial malleolus
Explanation: ***Fracture of the tibia*** - A **patellar tendon-bearing (PTB) cast** is specifically designed to bypass the knee joint and transfer weight from the patellar tendon to the cast, offloading the tibia. - This design is particularly useful for **stable, distal tibia fractures** where partial weight-bearing is desired to promote healing. *Fracture of the patella* - A PTB cast would place direct pressure on the **patella**, which is contraindicated in a patellar fracture. - Patellar fractures often require a **cylinder cast** or surgical fixation to immobilize the knee. *Fracture of the femur* - Femoral fractures are typically **more proximal** and require **traction**, **internal fixation**, or a **spica cast** for stabilization. - A PTB cast would not provide adequate immobilization or weight-bearing relief for a femoral fracture due to its design. *Fracture of the medial malleolus* - Medial malleolus fractures involve the **ankle joint**, which is distal to the area covered by a PTB cast. - These fractures typically require a **short leg cast** or surgical repair, focusing on ankle stabilization.
Question 6: A patient met with an accident and presents with paralysis of both upper and lower limbs. The patient has not passed urine and tenderness is elicited in the cervical region. What is the most appropriate immediate management?
- A. The doctor will instruct the radiographer to take cervical and chest x-ray
- B. The doctor should order a cervical x-ray and shift the patient from the trolley by himself
- C. The patient should not be shifted and portable x-ray machine should be used after neck stabilization (Correct Answer)
- D. The doctor will instruct the radiographer to take cervical x-ray AP and lateral view without any cervical support
Explanation: ***The patient should not be shifted and portable x-ray machine should be used after neck stabilization*** - This approach minimizes movement of a potentially unstable cervical spine fracture, preventing further neurological damage and optimizing patient safety. - **Spinal immobilization** (e.g., with a cervical collar and backboard) is the first priority before any diagnostic imaging to protect the spinal cord. - Using a **portable X-ray** avoids the need to transport the patient to radiology, adhering to trauma management principles. *The doctor will instruct the radiographer to take cervical and chest x-ray* - While cervical and chest X-rays are appropriate investigations, this option lacks the critical detail of **neck stabilization** and the need for a **portable X-ray** to avoid patient movement. - Moving the patient to a radiology suite for standard X-rays can exacerbate a spinal injury, especially without proper immobilization. *The doctor should order a cervical x-ray and shift the patient from the trolley by himself* - Shifting the patient from the trolley without adequate assistance and proper technique carries a high risk of causing further **spinal cord damage** due to uncontrolled movement. - This approach directly violates principles of **spinal precautions** in trauma management and requires at least 4-5 trained personnel for safe log-rolling. *The doctor will instruct the radiographer to take cervical x-ray AP and lateral view without any cervical support* - Taking X-rays without **cervical support** or immobilization is extremely dangerous in a patient with suspected cervical spine injury and paralysis. - Lack of support during imaging can lead to increased spinal instability and potentially irreversible **neurological deficits** or even death.
Question 7: In an accident involving potential cervical spine damage, the first line of management is:
- A. x-ray
- B. turn head to side
- C. maintain airway (Correct Answer)
- D. stabilize the cervical spine
Explanation: ***Correct: Maintain airway*** - In trauma management, the **ATLS protocol** follows the **A-B-C-D-E** approach where **Airway is the first priority** - In suspected cervical spine injury, airway management is performed **with concurrent cervical spine protection** (using jaw thrust maneuver instead of head tilt-chin lift) - A compromised airway leads to death within minutes, making it the **immediate first-line intervention** - **Cervical spine stabilization is performed simultaneously** during airway assessment and management, not as a separate preceding step - The correct approach: **"Airway with cervical spine protection"** - both are done together, but airway assessment/management takes priority *Incorrect: Stabilize the cervical spine* - While **cervical spine stabilization** is critical and must be maintained throughout trauma management, it is **not performed before airway assessment** - Manual inline stabilization and cervical collar application are done **during** airway management, not before it - ATLS teaches that C-spine protection is **integrated into** airway management, not a separate first step *Incorrect: X-ray* - **X-ray** is a diagnostic tool performed after initial stabilization and resuscitation - Imaging is part of the **secondary survey**, not primary trauma management - Never delay life-saving interventions for diagnostic studies *Incorrect: Turn head to side* - **Turning the head** is absolutely contraindicated in suspected cervical spine injury - Any movement can convert an unstable fracture into a **complete spinal cord injury** - If airway management is needed, use **jaw thrust** or **chin lift without head tilt**
Question 8: Risser Localiser cast is used in the management of which condition?
- A. Idiopathic scoliosis (Correct Answer)
- B. Lordosis
- C. Spondylolisthesis
- D. Kyphosis
Explanation: ***Idiopathic scoliosis*** - The **Risser Localiser cast** is specifically designed for the conservative management of **idiopathic scoliosis**, particularly in growing adolescents. - It works by applying localized pressure to correct the spinal curvature, often as a precursor to or instead of surgical intervention for moderate curves. *Kyphosis* - **Kyphosis** is an excessive curvature of the thoracic spine, distinct from the lateral curvature seen in scoliosis. - While bracing can be used for kyphosis (e.g., Milwaukee brace), the **Risser Localiser cast** is not the standard treatment for this condition. *Spondylolisthesis* - **Spondylolisthesis** involves the forward displacement of one vertebra over another, usually in the lumbar spine. - Management typically focuses on pain relief, exercise, and in some cases, surgical fusion; the Risser Localiser cast is not used. *Lordosis* - **Lordosis** refers to an excessive inward curve of the lumbar spine, which is a different type of spinal deformity than scoliosis. - Treatment for lordosis often involves physical therapy and exercises, and the Risser Localiser cast is not indicated.
Question 9: Management of Smith's fracture is
- A. Above-elbow cast with forearm in supination
- B. Above-elbow cast with forearm in pronation (Correct Answer)
- C. Open reduction and fixation
- D. Closed reduction with below-elbow cast
Explanation: ***Above-elbow cast with forearm in pronation*** - A Smith's fracture, also known as a **reverse Colles' fracture**, involves dorsal displacement of the distal radial fragment. - Applying an **above-elbow cast with the forearm in pronation** helps to stabilize the fracture by counteracting the deforming forces and maintaining reduction. *Above-elbow cast with forearm in supination* - **Supination** is typically used for a **Colles' fracture**, which involves volar (palmar) displacement. - In a Smith's fracture, supination would exacerbate the dorsal displacement and destabilize the reduction. *Open reduction and fixation* - This is considered for **unstable, highly comminuted, or irreducible fractures**, or when closed reduction fails. - For most Smith's fractures, especially if stable after reduction, conservative management with casting is the first line of treatment. *Closed reduction with below-elbow cast* - A **below-elbow cast** may not provide sufficient immobilization of the forearm, particularly in cases involving pronation/supination instability. - An **above-elbow cast** is generally preferred to control the rotation of the forearm and prevent redisplacement of the fracture fragments.
Question 10: The compression fracture is commonest in
- A. Upper thoracic spine
- B. Cervical spine
- C. Lumbosacral region
- D. Lower thoracic spine (Correct Answer)
Explanation: ***Lower thoracic spine*** - The **thoracolumbar junction (T11-L2)** is the most common site for compression fractures due to its high biomechanical stress, transitioning from stiff thoracic spine to more flexible lumbar spine. - This area is particularly vulnerable to axial loading and flexion injuries because it's a zone of increased mobility and stress concentration. *Upper thoracic spine* - The upper thoracic spine has **rib cage support** and less mobility, making fractures here less common without significant traumatic force. - Fractures in this region often indicate a **high-energy injury** due to its inherent stability. *Cervical spine* - While cervical fractures can be serious, they typically result from **high-energy trauma** and are less commonly simple compression fractures compared to the thoracolumbar region. - The **cervical spine** is more prone to **burst fractures** or **dislocations** from flexion-distraction or extension injuries. *Lumbosacral region* - The **sacrum and coccyx** are relatively stable bone structures and are less prone to common compression fractures unless there is severe trauma or significant bone weakening (e.g., severe osteoporosis). - While lumbar compression fractures do occur, the **junctional region** between the thoracic and lumbar spine (lower thoracic/upper lumbar) is statistically more frequent.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free