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Front 1

During an outbreak of meningitis at a local
college, a 20-year-old young 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withdrawn from which of the following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?

Back 1

Subarachnoid space

Front 2

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

Back 2

Epidural space

Front 3

A 42-year-old woman with metastatic
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?

Back 3

Fifth cervical and fourth thoracic nerves

Front 4

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 the posterolateral
protrusion of the intervertebral disk between L4 and L5 vertebrae would most likely
affect nerve roots of which of the following
spinal nerves?

Back 4

Fifth lumbar nerve

Front 5

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 the following structures
would be responsible for these findings?

Back 5

Arachnoid villi

Front 6

After his car was broad-sided 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?

Back 6

Levator scapulae

Front 7

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

Back 7

Head of the fifth rib

Front 8

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 the meninges
and is diagnosed with which of the following
conditions?

Back 8

Meningomyelocele

Front 9

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?

Back 9

Iliocostalis

Front 10

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 injures both the dorsal scapular and
spinal accessory nerves. Such an injury could
result in paralysis or weakness of which of the
following muscles?

Back 10

Rhomboid major and trapezius

Front 11

An elderly man at a nursing home is
known to have 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?

Back 11

Ligamentum flavum

Front 12

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

Back 12

Lateral horn

Front 13

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

Back 13

Sacral hiatus

Front 14

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

Back 14

Splenius capitis

Front 15

A 26-year-old heavyweight boxer is 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 that joint. What movement
would be most affected?

Back 15

Rotation

Front 16

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?

Back 16

Ligamentum nuchae

Front 17

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 structures is most likely
ruptured?

Back 17

Internal vertebral venous plexus

Front 18

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?

Back 18

Kyphosis

Front 19

During a snowstorm, a 52-year-old man is
brought to the emergency department after a
multiple car pile-up. 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?

Back 19

Whiplash injury

Front 20

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

Back 20

Rectus capitis posterior minor

Front 21

A middle-aged coal miner injures 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?

Back 21

Denticulate ligament

Front 22

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

Back 22

Rhomboid major

Front 23

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?

Back 23

Rhomboid minor

Front 24

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?

Back 24

Trapezius

Front 25

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?

Back 25

Ventral roots of the sacral spinal nerves