Unit review
Bring the unit together
Start with the case synthesis, answered in 4 separate parts, then work through mixed case-based questions. Every answer explains the clue that matters and why the closest alternative fails.
Case synthesis
Bringing it together: a lift, a pop and a pain down the leg
A 38-year-old removal worker bends forward at the waist, lifts a heavy crate and feels a sudden pain in his lower back. By evening the pain runs down the back of his right thigh and calf to the outer border of the foot. MRI shows that the lowest disc of the column has bulged backward and to the right.
1. The level
Which disc is the lowest disc of the column?
2. The tissue
What has happened inside the disc?
3. The nerve
Which nerve root is most likely compressed, and beside which opening?
4. The reason
Why are the lowest lumbar discs the ones that fail most often?
Mixed case review
Morphology, mechanism and application. Some items need two sections at once.
- Q1Regional features and curvesConnects 1 + 2OpenStax 7.3
A dry vertebra is handed to you. It has a large body, a short blunt spinous process, no opening in its transverse processes and no facet for a rib.
Where in the column did it come from, and what kind of curve does that region have?
- Q2Axis and the first discConnects 2 + 3Netter p.31–32, 187–188
On a lateral radiograph of the neck you count the vertebral bodies downward from the dens.
The dens belongs to which vertebra, and which disc is the first you meet below it?
- Q3Sternal angleConnects 4OpenStax 7.4
A clinician runs a finger down the front of a patient's chest from the notch at the top of the sternum and feels a horizontal ridge a few centimetres lower.
What is the ridge, and which rib lies level with it?
- Q4Rib parts, joints and classesConnects 2 + 4Netter p.225–226OpenStax 7.4
A radiology report describes a fracture of “the posterior part of the left eighth rib, close to its joint with the transverse process”.
Which part of the rib is that, which vertebra is involved, and what class of rib is it?
- Q5Floating ribs and sidesConnects 1 + 4OpenStax 7.4BodyParts3D
A specimen is photographed from directly in front. The lowest rib that reaches the photograph's right-hand edge has a free front end.
Which rib could it be?
- Q6Cervical disc herniationConnects 1 + 2 + 3Netter p.181–182OpenStax 7.3
A 52-year-old office worker has pain running from the neck into the shoulder and arm. MRI shows a disc pressing on a nerve root.
Which levels are the usual sites in this region, and through which opening does the affected root leave?
- Q7Ligaments and movementConnects 3Netter p.189–190
A motorcyclist is thrown and his neck is forced violently backward into extension.
Which ligament of the column is stretched most directly by this movement?
- Q8Why the thoracic region is stiffConnects 1 + 2 + 3OpenStax 7.3Netter p.183–184
A student says: “The thoracic spine is the stiffest region because thoracic discs are the thickest.”
What is wrong with this statement?
- Q9Atlas and Jefferson fractureConnects 2Netter p.31–32
After a fall from a ladder onto the top of the head, CT shows breaks in both the anterior and the posterior arch of the first cervical vertebra.
Which statement about this vertebra is correct?
- Q10Superior thoracic aperture and orientationConnects 1 + 4Netter p.223–224BodyParts3D
In the Superior view of the specimen you look down into the top of the cage.
Which three pieces form the ring you are looking through, and where is the patient's left?
Want exam conditions? Take the single-answer review items as a timed quiz in the standard AL-MED quiz player.
Timed practice