Joints: atlantoaxial subluxation in rheumatoid arthritis: 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 · Joints: atlantoaxial subluxation in rheumatoid arthritis

Sample item

In a patient with long-standing rheumatoid arthritis, a lateral flexion cervical radiograph shows an atlanto-dens interval above 3 mm. Which issue should be anticipated?

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

The answer and the reasoning

A. Atlantoaxial instability with risk of cord compression

Erosion of the transverse ligament and dens by synovitis allows anterior atlantoaxial subluxation, with an atlanto-dens interval above 3 mm in adults. Before general anaesthesia or neck manipulation, flexion-extension films are essential, and surgery is considered when there is cord compression.

Option by option

  • A. Atlantoaxial instability with risk of cord compression (correct)

    Correct. An increased interval signals instability and a risk to the cord.

  • B. Isolated muscle strain

    Muscle strain does not alter the interval.

  • C. Discitis

    Discitis is an infection and not part of this problem.

  • D. Odontoid fracture

    There is no fracture in this setting.

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, Atlantoaxial instability with risk of cord compression. Erosion of the transverse ligament and dens by synovitis allows anterior atlantoaxial subluxation, with an atlanto-dens interval above 3 mm in adults.

Why is "Isolated muscle strain" not the answer?

Muscle strain does not alter the interval.

Why is "Discitis" not the answer?

Discitis is an infection and not part of this problem.

Why is "Odontoid fracture" not the answer?

There is no fracture in this setting.

What concept does this question test?

It tests Joints: atlantoaxial subluxation in rheumatoid arthritis in Orthopaedics. Before general anaesthesia or neck manipulation, flexion-extension films are essential, and surgery is considered when there is cord compression.

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 Joints: atlantoaxial subluxation in rheumatoid arthritis?

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.