During an outbreak of meningitis at a local college, a 20-year-old student presents to a hospital
emergency department 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(CSF) is normally withdrawn from which of the following spaces?
Subarachnoid space
Epidural space
Subdural space
Space between the spinal cord and the piamater
Space between the arachnoid and dura maters
A 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?
Epidural space
Space deep to the pia mater
Space between the arachnoid and duramaters
Subdural space
Subarachnoid space
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?
Fifth cervical and fourth thoracic nerves
Fourth cervical and fourth thoracic nerves
Fifth cervical and fifth thoracic nerves
Fourth cervical and fifth thoracic nerves
Third cervical and fourth thoracic nerves
A 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?
Fifth lumbar nerve
Third lumbar nerve
Fourth lumbar nerve
First sacral nerve
Second sacral nerve
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?
Arachnoid villi
Choroid plexus
Vertebral venous plexus
Internal jugular vein
Subarachnoid trabeculae
After a 26-year-old man’s car was broadsided by a large truck, he 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?
Levator scapulae
Trapezius
Rhomboid major
Serratus posterior superior
Rectus capitis posterior major
A 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?
Head of the fifth rib
Head of the third rib
Neck of the fourth rib
Tubercle of the fourth rib
Tubercle of the fifth rib
8. A 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 meninges and is diagnosed with which of the following conditions?
Meningomyelocele
Spina bifida occulta
Meningocele
Myeloschisis
Syringomyelocele
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?
Iliocostalis
Rhomboid major
Levator scapulae
Serratus posterior superior
Latissimus dorsi
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?
Rhomboid major and trapezius
Trapezius and serratus posterior superior
Rhomboid minor and latissimus dorsi
Splenius cervicis and sternocleidomastoid
Levator scapulae and erector spinae
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?
Ligamentum flavum
Pia mater
Filum terminale externum
Posterior longitudinal ligament
Annulus fibrosus
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?
Lateral horn
Dorsal horn
Ventral horn
Gray matter
Pia mater