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Orthopedic Prometric MCQs - Chapter 3 Part 1

Orthopedic Prometric MCQs - Chapter 3 Part 28

25 Apr 2026 25 min read 2 Views
Orthopedic Prometric MCQs - Chapter 3 Part 28

Welcome to Chapter 3 Part 28 of our comprehensive Orthopedic Prometric Exam Simulator. This interactive test features 20 high-yield multiple-choice questions designed to help you prepare for the Saudi Prometric (SCFHS), DHA, HAAD, SLE, and OMSB orthopedic surgery exams.

Use the Study Mode to view detailed explanations instantly, or switch to Exam Mode to test your speed and accuracy under simulated testing conditions.

Prometric Exam Simulator


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Question 1

A patient with a fracture dislocation of the spine has a sensory level at the xiphoid process. Which of the following nerve root levels indicates this finding:





Explanation

The skin over the xiphoid process area is innervated by the T7 nerve root. In addition to knowing the innervation of selected muscles and the deep tendon reflexes, the clinician should also know the sensory levels to localize pathologic processes. T4 Nipple line T7 Xiphoid process T10 Umbilicus T12 Groin

Question 2

A patient with a fracture dislocation of the spine has a sensory level at the umbilicus. Which of the following nerve root levels indicates this finding:





Explanation

The skin of the umbilicus is innervated by the T10 nerve root.br> In addition to knowing the innervation of selected muscles and the deep tendon reflexes, the clinician should also know the sensory levels to localize pathologic processes. T4 Nipple line T7 Xiphoid process T10 Umbilicus T12 Groin

Question 3

Which of the following statements regarding the presentation of thoracic disk herniations is false:





Explanation

Patients with thoracic disk herniations may present with mechanical axial back pain, radicular pain, or myelopathy, but pain is the principal symptom. Bowel and bladder symptoms occur in 10% to 20% of affected patients.

Question 4

Which of the following statements regarding the treatment of thoracic disk herniations is true:





Explanation

The majority (75%) of patients with thoracic disk herniations may be managed nonoperatively. Surgical procedures must adequately decompress the involved nerve root. Posterior approach by laminectomy is usually not adequate, and costotransversectomy is not effective for large central calcified herniations (an anterior approach is preferred). The anterior transthoracic approach is effective for T5-T12 lateral and anterior disk herniations.

Question 5

Which of the following is the only accepted pharmacological agent for the acute treatment of a spinal cord injury:





Explanation

Methylprednisolone is currently the only accepted pharmacologic agent for the treatment of spinal cord injury. The North American Spinal C ord Injury Studies (NASC IS) found significant motor and sensory improvement in patients who were treated within 8 hours of injury with a methylprednisolone bolus of 30 mg/kg, followed by an infusion of 5.4 mg per hour for 24 hours. Other agents have been studied in animal experiments but have not been promising in clinical trials.

Question 6

A 45-year-old man has neck pain following a motor vehicle accident. His neurologic examination is normal. His plain radiographs are shown (Slide). The most likely diagnosis is:





Explanation

The lateral radiograph shows translation and kyphosis at the level of injury. The facets of C4 do not superimpose on each to create a "double sail" sign. This patient has a unilateral facet dislocation. With unilateral facet dislocations, there is usually 3 mm to 4 mm of forward translation and 5° to 7° of angulation.

Question 7

A 35-year-old man has neck pain following a motor vehicle accident. His axial computed tomography scan is shown (Slide). The most likely diagnosis is:





Explanation

The axial computed tomography scan of C 4-C 5 shows a unilateral facet dislocation. Notice that the superior facet of C 5 lies posterior to the inferior facet of C 4. This relationship should be the exact opposite. Also, notice that C 4 is rotated on the body of C 5 and translated forward.

Question 8

A 40-year-old woman has severe neck pain following a motor vehicle accident. Her plain lateral radiograph of the spine is shown (Slide). A sagittal magnetic resonance scan is shown (Slide). The most likely diagnosis is:





Explanation

There is significant subluxation of C 5 on C 6 on the plain radiograph. The facets of C 5 and C 6 have lost their normal relationship. This patient has a bilateral facet dislocation. There is compression and significant changes within the spinal cord. This patient should be treated with reduction and fusion.

Question 9

A 40-year-old woman has severe neck pain following a motor vehicle accident. Her plain lateral radiograph of the spine is shown (Slide). A sagittal magnetic resonance is shown (Slide). The most appropriate treatment would be:





Explanation

There is significant subluxation of C 5 on C 6 on the plain radiograph. The facets of C 5 and C 6 have lost their normal relationship. This patient has a bilateral facet dislocation. There is compression and significant changes within the spinal cord. This patient should be treated with reduction and fusion. This is a ligamentous injury so reduction and immobilization will not result in satisfactory healing. Orthopedic Prometric Exam Chapter 3 Image

Question 10

In which of the following nerve roots is compression neuropathy common in cervical spondylosis:





Explanation

The nerve roots that are most commonly affected in cervical spondylosis are C6 and C7, secondary to degenerative changes in the C 5-C 6 and C 6-C 7 nerve roots. Patients may have specific dermatomal pain or pain that is diffuse and poorly localized.

Question 11

Which of the following sensory areas is affected by compression of the C 6 nerve root:





Explanation

It is important to remember the sensory dermatome when examining patients who have neck and upper extremity pain: C3 Posterior neck, occiput C4 Base of neck, medial shoulder C5 Base of neck to shoulder and upper arm C6 Lateral forearm into the radial side of the hand C7 Posterolateral forearm into the middle finger of the hand C8 Ulnar side of the forearm and hand

Question 12

Which of the following sensory areas is affected by compression of the C 7 nerve root:





Explanation

It is important to remember the sensory dermatome when examining patients who have neck and upper extremity pain: C3 Posterior neck, occiput C4 Base of neck, medial shoulder C5 Base of neck to shoulder and upper arm C6 Lateral forearm into the radial side of the hand C7 Posterolateral forearm into the middle finger of the hand C8 Ulnar side of the forearm and hand

Question 13

A patient comes into your office with neck and arm pain. The patientâ s plain radiograph is shown (Slide). Which of the following signs is most likely to be found on physical examination:





Explanation

The lateral radiograph shows narrowing of the C 5-C 6 intervertebral disk space with osteophytes arising anteriorly and posteriorly. This degenerative process results in facet joint hypertrophy, osteophytes in the uncovertebral joints, and hypertrophy of the ligamentum flavum. The C 6 nerve root is compressed resulting in numbness on the lateral forearm into the radial side of the hand. Elbow and wrist extension may be affected, and the biceps tendon reflex may be diminished or absent. It is important to remember the sensory dermatome when examining patients who have neck and upper extremity pain: C3 Posterior neck, occiput C4 Base of neck, medial shoulder Orthopedic Prometric Exam Chapter 3 Image C5 Base of neck to shoulder and upper arm C6 Lateral forearm into the radial side of the hand C7 Posterolateral forearm into the middle finger of the hand C8 Ulnar side of the forearm and hand

Question 14

A 45-year-old woman has pain in her right upper extremity and neck. The plain film is is presented (Slide 1) as well as an axial post myelogram CT images (Slide 2, A & B). Her pain has not responded to nonsteroidal anti- inflammatory drugs or physical therapy. Which of the following is the most appropriate treatment:





Explanation

The axial post myelogram CT image shows a disk herniation, and the sagittal view shows prominent osteophytes. There is no evidence of an infection or a neoplasm. This patient is a candidate for anterior disckectomy and fusion.

Question 15

Plain radiographs of the lumbosacral spine are useful for:





Explanation

Plain radiographs are useful for assessing the alignment of the spine, bone destruction by tumors and infections, and instability patterns. The radiographs also will show degenerative intervertebral disks. Plain radiographs are not sensitive for detecting marrow changes, herniated disks, and neural compression secondary to degenerative changes.

Question 16

Computerized tomography scans are efficacious for detecting which of the following conditions:





Explanation

Computerized tomography scans are excellent for assessing bone structure, especially in patients with metastatic bone disease and primary bone tumors of the spine. C omputerized tomography is useful for distinguishing between bone and soft tissue compression in neural compressive disorders.

Question 17

A 35-year-old construction worker has left leg pain and difficulty walking. His examination is normal except for decreased sensation to the lateral border of the left foot, the inability to walk on the toes of the left foot, and a positive stretch test producing left heel and lateral foot pain. A magnetic resonance image shows a large posterolateral herniated nucleus pulposus on the left side at L5-S1. The gait abnormality is most likely due to:





Explanation

In the lumbar spine, direct posterior and posterolateral disk herniations typically compress the traversing nerve root. In this patient, the herniated disk at the L5-S1 level compresses the shoulder of the S1 nerve root as it comes off the dural sac. The S1 nerve root supplies sensation to the posterior calf and lateral border of the foot, and motor chiefly to the gastrocsoleus muscle complex.

Question 18

Which of the following types of neural dysfunction is present with a cervical fracture-dislocation, resulting in a Brown-Sequard neurological injury:





Explanation

A Brown-Sequard injury causes damage to half of the spinal cord. Brown- Sequard injuries produce ipsilateral proprioceptive and motor loss and contralateral loss of sensitivity to pain and temperature. Proprioceptive sensory fibers enter the spinal cord, travel in the dorsal columns and lateral and ventral spinothalmic tracts, and decussate high in the thalamus. Motor efferent nerves cross in the medulla and travel down in the lateral corticospinal tracts.Spinthalamic fibers enter and decussate in the spinal cord. Hence, cord hemi-section produces contralateral pain and temperature (spinothalamic) loss, and ipsilateral motor (corticospinal) and, proprioceptive (dorsal columns) deficit. Often due to penetrating injuries, Brown-Sequard injuries have the best prognosis of the cord injury complexes.

Question 19

The axial computed tomography scan depicts a patient with spinal stenosis (Slide). The primary source of neural compression is impingement on the traversing nerve root by the:





Explanation

Spinal stenosis involves narrowing of the spinal canal by a combination of factors. Degeneration of the disk with dehydration allows loss of disk height and bulging posteriorly into the canal. The ligamentum flavum becomes redundant at the segment due to loss of the disk height and buckling of the ligament. C hief among the sources of compression, however, is the overgrowth of the facet joint, which acts to autostabilize the motion segment. The facets are oriented in an oblique plane, depending on the level involved. The superior facet of the subjacent vertebral body lies anterior and lateral to its counterpart from the level above, forming a shingle configuration. The superior articular process, therefore, lies adjacent to the shoulder of the traversing nerve root and is a significant source of lateral recess stenosis. Orthopedic Prometric Exam Chapter 3 Image

Question 20

The type of disk herniation shown (Slide) at the L5-S1 level is most likely to cause:





Explanation

This slide shows a posterolateral disk herniation on the right. Posterolateral disk herniations cause compression of the traversing S1 nerve root at this level. Sensation affected is the posterior calf and lateral border of the foot, while motor innervation is to the gastroc soleus complex. With far lateral disk herniations, the exiting nerve root is compressed and symptoms may be seen referred to the level above. Orthopedic Prometric Exam Chapter 3 Image

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Dr. Mohammed Hutaif
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