NMS Q&A Family Medicine

chapter 24Musculoskeletal Problemsof the Neck and BackExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 36-year-old male assembly line worker complainsthat 2 days ago, while hefting a bucket of metal partsthat slipped from his right hand while still grasping theother handle, experiences sudden pain in the left sideof his neck that radiates into the left lateral upper arminto the thumb, associated with paresthesias in thethumb. Strength testing shows that his left wrist extensionis 3/5. Which of the following is the nerve rootinvolved?(A) C5(B) C6(C) C7(D) C8(E) T12 Which of the following maneuvers or signs elicits orsignifies pain of cervical radiculopathy?(A) Hawkins maneuver(B) Yergason maneuver(C) Empty bucket test(D) Spurling maneuver(E) Babinski sign3 A 45-year-old man with back pain complains ofmedial forefoot numbness and weakness of extensionof the great toe. Knee jerk and ankle jerk deep tendonreflexes are normal and matching those of the otherextremity. Which of the following nerve roots isinvolved in this radiculopathy?(A) L3(B) L4(C) L5(D) S1(E) S24 A 25-year-old woman comes to you for neck painthat had its onset 6 hours after she was “rear-ended”in her automobile. In addition to her pain, she complainsthat her head feels “heavy” on her shoulders.She denies radiation of the pain into her arms. Shewas seen at an emergency room soon after the accidentbecause of the insistence of the emergency medicaltechnicians, and x-rays of the cervical spine werenegative for fracture and dislocation. Besides thefinding of normal strength and deep tendon reflexesof the upper extremities, you find you can elicit tactilecrepitus when you move the larynx against thecervical vertebral column. Which of the followingexpresses best the significance of the last finding inthis situation?(A) It rules out fracture of a vertebral body.(B) It assures you that there is no retrolaryngealneoplasm.(C) It assures you that there is no Ludwig angina.(D) This finding raises the likelihood of a laryngealfracture.(E) It rules against the presence of a hematomabetween the larynx and the cervical vertebrae.5 A 65-year-old man complains that he has deep hipand buttock pain on both sides, worse the longer hewalks and when dorsiflexing the spine. The pain isimmediately alleviated when he sits down. Deep tendonreflexes of the lower extremities and straight-legraising (SLR) tests are normal and symmetrical. Whichis the most likely diagnosis?(A) Herniated disc at L5, S1(B) Lumbosacral strain(C) Cauda equina syndrome(D) Lumbar spinal stenosis(E) Prostatitis151