Cervical Spine Disorders — MCQs

10 questions

A patient has a herniated intervertebral disc impinging on the right C5 nerve roots. Which of the following movements would most likely be affected?

A 45-year-old patient presents with chronic lower back pain. X-ray shows anterior displacement of a vertebral body. What is the likely diagnosis?

What type of neurological signs would you expect from a lesion in the cauda equina?

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:

All of the following are seen in cervical syringomyelia except:

What is a Hangman's fracture?

All of the following are true about fracture of the atlas vertebra, except -

Undertaker's fracture is seen at the level of cervical vertebra:

Q10

Which of the following joints are commonly affected in osteoarthritis? I. First metatarsophalangeal joint II. Proximal interphalangeal joint III. Ankle joint IV. 5th and 6th cervical vertebrae joint Select the correct answer using the code given below :

Cervical Spine Disorders Indian Medical PG Practice Questions and MCQs

Question 1: A patient has a herniated intervertebral disc impinging on the right C5 nerve roots. Which of the following movements would most likely be affected?

A. Extension of the fingers
B. Extension of the shoulder
C. Flexion of the elbow (Correct Answer)
D. Flexion of the wrist

Explanation: ***Flexion of the elbow*** - The **C5 nerve root** is a primary contributor to the innervation of the **biceps brachii** and **brachialis** muscles, which are the prime movers for elbow flexion. - The C5 myotome specifically includes elbow flexion as one of its key motor functions. - Impingement of the C5 nerve root would therefore most directly impact the strength and function of **elbow flexion**, leading to weakness in this movement. *Extension of the fingers* - Finger extension is primarily mediated by the **C7 and C8 nerve roots** via the posterior interosseous nerve (branch of the radial nerve). - C5 does not significantly contribute to finger extension. *Extension of the shoulder* - Shoulder extension involves muscles primarily innervated by the **C6, C7, and C8 nerve roots** (e.g., latissimus dorsi via thoracodorsal nerve, teres major). - While C5 contributes to some shoulder movements (particularly **shoulder abduction** via the deltoid), it is not primarily responsible for shoulder extension. *Flexion of the wrist* - Wrist flexion is primarily served by muscles innervated by the **C6, C7, and C8 nerve roots** (e.g., flexor carpi radialis - C6/C7, flexor carpi ulnaris - C7/C8). - The C5 nerve root has minimal to no role in wrist flexion.

Question 2: A 45-year-old patient presents with chronic lower back pain. X-ray shows anterior displacement of a vertebral body. What is the likely diagnosis?

A. Spondylosis
B. Compression fracture
C. Osteoporosis
D. Spondylolisthesis (Correct Answer)

Explanation: ***Spondylolisthesis*** - This condition involves the **anterior displacement** (slipping forward) of one vertebral body over the one below it, which perfectly matches the X-ray finding. - It often causes **chronic lower back pain**, especially in active individuals or those with degenerative changes. *Spondylosis* - Refers to **degenerative changes** in the spine, including **osteophytes** and **disc space narrowing**, but typically does not involve anterior vertebral displacement. - While it can cause chronic back pain, the specific X-ray finding points away from isolated spondylosis. *Compression fracture* - Involves a **collapse of the vertebral body**, usually due to trauma or osteoporosis, leading to a **decreased vertebral height**. - It does not present as an anterior displacement of an entire vertebral body. *Osteoporosis* - This is a condition of **decreased bone density**, making bones fragile and prone to fractures (e.g., compression fractures), but it does not directly cause anterior vertebral displacement. - While osteoporosis can be an underlying factor for some spinal conditions, it is not the direct diagnosis for the described X-ray finding.

Question 3: What type of neurological signs would you expect from a lesion in the cauda equina?

A. Normal reflexes
B. Flaccid paralysis
C. Muscle atrophy
D. Lower motor neuron signs (Correct Answer)

Explanation: ***Lower motor neuron signs*** - A lesion in the **cauda equina** affects the spinal nerve roots after they've left the spinal cord, which are part of the **peripheral nervous system**. [2] - Therefore, it presents with classic features of **lower motor neuron (LMN) damage**, including muscle weakness, absent or reduced reflexes, and flaccid paralysis. [1] *Normal reflexes* - This would be an unexpected finding; **hyporeflexia or areflexia** are typical due to damage to the reflex arc within the LMN fibers. [1] - **Normal reflexes** often suggest an intact LMN pathway, which is not the case with cauda equina compression. *Flaccid paralysis* - While **flaccid paralysis** is indeed a sign of lower motor neuron damage and occurs with cauda equina lesions, it is a specific symptom rather than the encompassing neurological category. [1] - **Lower motor neuron signs** is a broader and more accurate description of the overall clinical picture. *Muscle atrophy* - **Muscle atrophy** is a chronic sign of lower motor neuron damage due to denervation, and while it will develop over time with a cauda equina lesion, it is usually not an initial acute finding. [1] - The question asks for expected neurological signs, and a more immediate and overarching description is **Lower motor neuron signs**.

Question 4: 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 5: 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 6: All of the following are seen in cervical syringomyelia except:

A. Absent biceps reflex
B. Burning sensation in hands
C. Plantar extensor
D. Hypertrophy of abductor pollicis brevis (Correct Answer)

Explanation: ***Hypertrophy of abductor pollicis brevis*** - Syringomyelia typically causes **muscle atrophy** and weakness due to damage to anterior horn cells, not hypertrophy or increased muscle bulk. - The cystic cavity (syrinx) in the spinal cord expands and compresses nerve fibers, leading to **motor neuron dysfunction** and **muscle wasting**. *Absent biceps reflex* - This is a common finding in cervical syringomyelia due to damage to the **anterior horn cells** in the cervical spinal cord (C5-C6 segments) responsible for the biceps reflex arc. - Impairment of these motor neurons leads to a **lower motor neuron lesion**, resulting in diminished or absent reflexes. *Burning sensation in hands* - The syrinx often expands to compress the **spinothalamic tracts**, which carry pain and temperature sensations. - This can lead to **dissociated sensory loss** (loss of pain and temperature but preserved touch, vibration, and proprioception) and neuropathic symptoms like a burning sensation. *Plantar extensor* - This refers to an **extensor plantar response** (Babinski sign), which indicates an **upper motor neuron lesion** in the corticospinal tract. - As the syrinx expands, it can compress the descending corticospinal tracts, leading to hyperreflexia and extensor plantar responses in the lower extremities.

Question 7: What is a Hangman's fracture?

A. Fracture dislocation of C2 (Correct Answer)
B. Fracture dislocation of ankle joint
C. Fracture of odontoid
D. Subluxation of C5 over C6

Explanation: ***Fracture dislocation of C2*** - A Hangman's fracture classically refers to a **bilateral fracture of the pars interarticularis of the axis (C2)**, often with an associated anterior subluxation of C2 on C3. - This injury is typically caused by **hyperextension-distraction forces**, such as those experienced in judicial hangings or motor vehicle accidents. *Subluxation of C5 over C6* - While cervical subluxations are serious, a **C5-C6 subluxation** does not specifically describe a Hangman's fracture. - This type of injury involves different vertebral levels and typically results from different mechanisms. *Fracture dislocation of ankle joint* - This option refers to an injury in the **lower limb**, completely unrelated to the cervical spine. - A Hangman's fracture is a specific type of **cervical vertebral fracture**. *Fracture of odontoid* - A fracture of the odontoid process involves the **dens (odontoid process)** of C2. - This is a distinct type of C2 fracture from a Hangman's fracture, which involves the **pars interarticularis**.

Question 8: All of the following are true about fracture of the atlas vertebra, except -

A. Quadriplegia is seen in 80% cases (Correct Answer)
B. Atlantooccipital fusion may sometimes be needed
C. Jefferson fracture is the most common type
D. CT scans should be done for diagnosis

Explanation: ***Quadriplegia is seen in 80% cases*** - This statement is incorrect; **neurological deficits** such as quadriplegia are **uncommon** in atlas fractures (Jefferson fractures) because the fracture fragments tend to spread outwards, decompressing the spinal cord. - While significant trauma can lead to neurological injury, the classic Jefferson fracture mechanism often spares the spinal cord from direct compression. *Atlantooccipital fusion may sometimes be needed* - **Atlanto-occipital fusion** (craniovertebral fusion) is a surgical option reserved for **unstable atlas fractures** or those associated with significant ligamentous injury. - It aims to provide **stability** to the craniocervical junction, preventing further neurological damage, especially if non-operative measures fail. *Jefferson fracture is the most common type* - The **Jefferson fracture** is indeed the **most common type of atlas fracture**, characterized by a burst fracture of the C1 ring. - It typically results from an **axial load** to the head, such as a diving accident, leading to fractures of both anterior and posterior arches. *CT scans should be done for diagnosis* - **CT scans** are the **gold standard** for diagnosing atlas fractures due to their superior ability to visualize bone and detect subtle fractures of the C1 ring. - They provide detailed three-dimensional images that are crucial for assessing the **fracture pattern**, displacement, and involvement of adjacent structures.

Question 9: Undertaker's fracture is seen at the level of cervical vertebra:

A. C5-C6
B. C6-C7 (Correct Answer)
C. C3-C4
D. C1-C2

Explanation: **C6-C7** - An **undertaker's fracture** is a post-mortem injury typically seen in cases of hanging, resulting from the neck's hyperextension. - It commonly affects the lower cervical spine, most frequently at the **C6-C7 level**, due to the biomechanics of the forces involved. *C5-C6* - While cervical fractures can occur at various levels, **C5-C6** is less common for an undertaker's fracture specifically. - This level is more frequently associated with **cervical spondylosis** or traumatic injuries from falls. *C3-C4* - Fractures at the **C3-C4 level** can be life-threatening as they are close to the phrenic nerve origin, but they are not characteristic of "undertaker's fracture." - Injuries at this level are less common in the specific context of post-mortem hyperextension. *C1-C2* - Fractures of **C1 (atlas) and C2 (axis)**, such as a Jefferson fracture or hangman's fracture, are distinct and result from different mechanisms. - They are not typically referred to as "undertaker's fracture," which implies a specific post-mortem injury pattern.

Question 10: Which of the following joints are commonly affected in osteoarthritis? I. First metatarsophalangeal joint II. Proximal interphalangeal joint III. Ankle joint IV. 5th and 6th cervical vertebrae joint Select the correct answer using the code given below :

A. I, II, III and IV
B. I and II only
C. III and IV only
D. I, II and IV only (Correct Answer)

Explanation: ***I, II and IV only*** - **Osteoarthritis** commonly affects joints that bear significant weight or are subject to repetitive stress, such as the **first metatarsophalangeal joint**, **proximal interphalangeal joints**, and the **cervical spine**. - Degenerative changes in these joints, including cartilage loss and **osteophyte formation**, are characteristic findings in osteoarthritis. *I, II, III and IV* - While the first metatarsophalangeal joint, proximal interphalangeal joints, and cervical vertebrae are commonly affected, the **ankle joint** is typically spared in primary osteoarthritis. - Ankle involvement in osteoarthritis is usually secondary to **trauma** or inflammatory arthritis rather than primary degenerative change. *III and IV only* - This option misses the common involvement of the **first metatarsophalangeal joint** and **proximal interphalangeal joints**, which are frequently affected in osteoarthritis. - The ankle joint is less commonly involved in primary osteoarthritis compared to other load-bearing joints like the **knee** and **hip**. *I and II only* - This option incorrectly omits the **cervical vertebrae**, which are a very common site for osteoarthritis, often leading to neck pain and **radiculopathy**. - While the metatarsophalangeal and proximal interphalangeal joints are correct, the exclusion of the cervical spine makes this option incomplete.

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