Head and neck: atlas fracture: practice question

A Anatomy 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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Anatomy · Head and neck: atlas fracture

Sample item

A diver strikes the pool floor head first. A lateral cervical film shows a ring fracture with the lateral masses displaced outward. Which vertebra is fractured and which ligament decides stability?

AAxis, anterior longitudinal ligamentBAtlas, transverse ligamentCAxis, alar ligamentDSeventh cervical vertebra, ligamentum nuchae

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

The answer and the reasoning

B. Atlas, transverse ligament

A Jefferson fracture is a burst fracture of the atlas ring from axial loading. If the lateral masses are spread widely (Rule of Spence), the transverse ligament is torn and the injury is unstable. The atlas has no body or spinous process and the dens of the axis is held against its anterior arch.

Option by option

A. Axis, anterior longitudinal ligament
The anterior longitudinal ligament links the vertebral bodies and does not hold the dens.
B. Atlas, transverse ligament (correct)
Correct. The ring fracture is of the atlas and stability depends on the transverse ligament.
C. Axis, alar ligament
The axis fracture of the pars is the hangman's fracture and is not a ring burst of C1.
D. Seventh cervical vertebra, ligamentum nuchae
The seventh vertebra lacks the ring shape of the atlas and the nuchal ligament does not stabilise the atlas.

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 Anatomy question

What is the answer to this Anatomy question?

The best answer is B, Atlas, transverse ligament. A Jefferson fracture is a burst fracture of the atlas ring from axial loading.

Why is "Axis, anterior longitudinal ligament" not the answer?

The anterior longitudinal ligament links the vertebral bodies and does not hold the dens.

Why is "Axis, alar ligament" not the answer?

The axis fracture of the pars is the hangman's fracture and is not a ring burst of C1.

Why is "Seventh cervical vertebra, ligamentum nuchae" not the answer?

The seventh vertebra lacks the ring shape of the atlas and the nuchal ligament does not stabilise the atlas.

What concept does this question test?

It tests Head and neck: atlas fracture in Anatomy. If the lateral masses are spread widely (Rule of Spence), the transverse ligament is torn and the injury is unstable. The atlas has no body or spinous process and the dens of the axis is held against its anterior arch.

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 Head and neck: atlas fracture?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy 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.