Paediatric emergencies: paediatric cervical spine injury: practice question

A Pediatrics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pediatrics · Paediatric emergencies: paediatric cervical spine injury

Sample item

A 3-year-old is brought after a fall from a height. Why are cervical spine injuries at this age more often at upper levels than in adults?

AThick paraspinal muscles that fix the lower cervical spineBA fully ossified odontoid that fractures at its tipCRelatively large head, lax ligaments and a high fulcrum of movementDRigid facet joints that transmit force to the thoracic spine

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Relatively large head, lax ligaments and a high fulcrum of movement

In young children the head is large relative to the body, ligaments are lax and the fulcrum of cervical movement is at C2-C3, so injuries are mostly upper cervical and ligamentous. Spinal cord injury without radiographic abnormality is also more common.

Option by option

A. Thick paraspinal muscles that fix the lower cervical spine
Paraspinal muscles are relatively weak in young children, so they provide little protection.
B. A fully ossified odontoid that fractures at its tip
The odontoid is not fully ossified at this age, and its synchondrosis is a typical site of injury.
C. Relatively large head, lax ligaments and a high fulcrum of movement (correct)
Correct. The large head, ligamentous laxity and high fulcrum concentrate injury at the upper cervical spine.
D. Rigid facet joints that transmit force to the thoracic spine
Facet joints in young children are shallow and flexible, not rigid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pediatrics question

What is the answer to this Pediatrics question?

The best answer is C, Relatively large head, lax ligaments and a high fulcrum of movement. In young children the head is large relative to the body, ligaments are lax and the fulcrum of cervical movement is at C2-C3, so injuries are mostly upper cervical and ligamentous.

Why is "Thick paraspinal muscles that fix the lower cervical spine" not the answer?

Paraspinal muscles are relatively weak in young children, so they provide little protection.

Why is "A fully ossified odontoid that fractures at its tip" not the answer?

The odontoid is not fully ossified at this age, and its synchondrosis is a typical site of injury.

Why is "Rigid facet joints that transmit force to the thoracic spine" not the answer?

Facet joints in young children are shallow and flexible, not rigid.

What concept does this question test?

It tests Paediatric emergencies: paediatric cervical spine injury in Pediatrics. Spinal cord injury without radiographic abnormality is also more common.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric emergencies: paediatric cervical spine injury?

Memorise milestones and the vaccine schedule as tables and revise them often. Then use the flashcards and the other Pediatrics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.