Spine: cervical spondylotic myelopathy: practice question

A Orthopaedics 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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Orthopaedics · Spine: cervical spondylotic myelopathy

Sample item

A 62-year-old has clumsy hands, difficulty with buttons, a broad-based gait and brisk reflexes with positive Hoffmann sign. What is the diagnosis?

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

The answer and the reasoning

A. Cervical spondylotic myelopathy

Cervical spondylotic myelopathy is cord compression by degenerative disc osteophytes, ligamentum flavum hypertrophy and canal narrowing, producing upper motor neuron signs such as hyperreflexia, Hoffmann sign and spasticity, with hand clumsiness. MRI shows the compression and decompression is advised for progressive deficits.

Option by option

  • A. Cervical spondylotic myelopathy (correct)

    Correct. Upper motor neuron signs with hand clumsiness suggest myelopathy.

  • B. Peripheral neuropathy

    Peripheral neuropathy would show reduced reflexes.

  • C. Lumbar radiculopathy

    Lumbar radiculopathy does not affect the hands.

  • D. Carpal tunnel syndrome

    Carpal tunnel syndrome causes median nerve sensory symptoms with no hyperreflexia.

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 Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is A, Cervical spondylotic myelopathy. Cervical spondylotic myelopathy is cord compression by degenerative disc osteophytes, ligamentum flavum hypertrophy and canal narrowing, producing upper motor neuron signs such as hyperreflexia, Hoffmann sign and spasticity, with hand clumsiness.

Why is "Peripheral neuropathy" not the answer?

Peripheral neuropathy would show reduced reflexes.

Why is "Lumbar radiculopathy" not the answer?

Lumbar radiculopathy does not affect the hands.

Why is "Carpal tunnel syndrome" not the answer?

Carpal tunnel syndrome causes median nerve sensory symptoms with no hyperreflexia.

What concept does this question test?

It tests Spine: cervical spondylotic myelopathy in Orthopaedics. MRI shows the compression and decompression is advised for progressive deficits.

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 Spine: cervical spondylotic myelopathy?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics 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.