Rheumatology: rheumatoid arthritis and the cervical spine: practice question

A General Medicine 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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General Medicine · Rheumatology: rheumatoid arthritis and the cervical spine

Sample item

A 58-year-old woman with 20 years of seropositive rheumatoid arthritis is scheduled for knee replacement under general anaesthesia. Which pre-operative step best reduces the risk of cord injury during intubation?

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

The answer and the reasoning

A. Lateral cervical spine radiograph in flexion and extension

Long-standing rheumatoid arthritis erodes the transverse ligament and odontoid process, leading to atlantoaxial subluxation. Neck movement during intubation may then compress the cord, so dynamic flexion and extension views (or MRI) are obtained and the anaesthetist is warned. Symptoms may be subtle, including neck pain and paraesthesia.

Option by option

  • A. Lateral cervical spine radiograph in flexion and extension (correct)

    Correct. Dynamic cervical films show atlantoaxial instability, which changes the airway technique.

  • B. Chest radiograph

    A chest radiograph screens for lung disease but does not assess the cervical spine.

  • C. Echocardiography

    Echocardiography evaluates cardiac function, not cervical instability.

  • D. Hand radiographs to assess erosions

    Hand radiographs show disease burden but give no information on cervical stability.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Lateral cervical spine radiograph in flexion and extension. Long-standing rheumatoid arthritis erodes the transverse ligament and odontoid process, leading to atlantoaxial subluxation.

Why is "Chest radiograph" not the answer?

A chest radiograph screens for lung disease but does not assess the cervical spine.

Why is "Echocardiography" not the answer?

Echocardiography evaluates cardiac function, not cervical instability.

Why is "Hand radiographs to assess erosions" not the answer?

Hand radiographs show disease burden but give no information on cervical stability.

What concept does this question test?

It tests Rheumatology: rheumatoid arthritis and the cervical spine in General Medicine. Neck movement during intubation may then compress the cord, so dynamic flexion and extension views (or MRI) are obtained and the anaesthetist is warned. Symptoms may be subtle, including neck pain and paraesthesia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Rheumatology: rheumatoid arthritis and the cervical spine?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.