{"id":4963,"date":"2025-01-08T00:09:00","date_gmt":"2025-01-08T00:09:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4963"},"modified":"2025-10-01T11:38:23","modified_gmt":"2025-10-01T19:38:23","slug":"usmle-step-2-question-of-the-day-neck-pain","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-neck-pain","title":{"rendered":"USMLE\u00ae Step 2 Question of the Day:\u00a0Neck pain"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-neck-pain\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 CK Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-neck-pain\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-neck-pain\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-neck-pain\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-question-of-the-day-neck-pain\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong>Today, let&#8217;s focus on the case of a 36-year-old woman who presents to the emergency department after a motor vehicle collision, exhibiting significant neck pain and symptoms suggestive of cervical spine injury. Can you identify the common mechanisms of injury associated with fractures of the axis (C2) and discuss the potential complications that may arise from such injuries? Let&#8217;s find out!<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 36-year-old woman who has no significant past medical history presents to the emergency department for evaluation following a motor vehicle collision. According to emergency medical services, the patient was the unrestrained driver of a vehicle traveling approximately 45 miles per hour that hit the back of a stationary truck. Upon arrival, the patient is boarded, collared, and states she has pain in the back of the neck. The patient states, \u201cMy neck is killing me. I slammed my chin on the steering wheel\u201d. Temperature is 37.0\u00b0C (98.6\u00b0F), pulse is 104\/min, respirations are 21\/min, blood pressure is 172\/94 mmHg, and oxygen saturation is 97% on room air. A cervical spine radiograph is shown below. <\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"599\" height=\"838\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2024\/12\/Hangmans_fracture.jpg\" alt=\"A cervical spine radiograph.\" class=\"wp-image-4965\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Hangmans_fracture.jpg 599w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Hangmans_fracture.jpg?resize=214,300 214w\" sizes=\"auto, (max-width: 599px) 100vw, 599px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the most likely diagnosis?\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Odontoid fracture<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Burst fracture of C1<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Spondylolisthesis of C2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Avulsion fracture of C3 spinous process<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Vertebral body compression fracture of C2<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 CK Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Spondylolisthesis of C2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the&nbsp;<strong>Main Explanation<\/strong>, let\u2019s see why the answer wasn\u2019t A, B, D, or E. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Today\u2019s incorrect answers are\u2026<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Odontoid fracture<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: The odontoid process, or dens, is a superior projecting bony element from the second cervical vertebrae that may become fractured during hyperextension or hyperflexion injuries. An associated fracture of the dens is not apparent on this radiograph. It is best identified on CT imaging of the head and neck.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Burst fracture of C1<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: A burst fracture of C1 is also known as a Jefferson fracture. It can be an unstable cervical spine injury, but typically is not and is treated with a collar. This injury more commonly occurs after a direct compression force is applied to the top of the head, and it may be difficult to identify on radiographs.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Avulsion fracture of C3 spinous process<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: An avulsion fracture of a spinous process, also referred to as a \u201cclay-shoveler fracture,\u201d is a rare fracture that is considered a stable cervical spine injury. There is no evidence of a C3 spinous process fracture in this patient\u2019s radiograph.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. Vertebral body compression fracture of C2<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Incorrect: Vertebral body compression fractures most commonly arise in patients with underlying osteoporosis. They appear as a wedge-shaped vertebral body on radiographic imaging.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents after a motor vehicle collision wherein she likely sustained a hyperextension injury to the neck. The radiograph demonstrates spondylolisthesis of the C2 vertebra, which can be an unstable cervical spine injury. However, this type of fracture typically does not cause spinal cord injury.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Traumatic spondylolisthesis and associated fractures of the C2 vertebra are also known as \u201changman\u2019s injuries\u201d or \u201changman\u2019s fracture\u201d&#8211;since this was a common finding in post-mortem autopsies of criminals executed by hanging. This injury pattern now most commonly occurs from car crashes and falls. It is caused by forcible hyperextension of the head, usually with the distraction of the neck or without distraction of the neck but with axial loading.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The fracture typically occurs in the axis&#8217;s superior and inferior articular processes, with an associated displacement of the C2 vertebra anteriorly on C3. Spinal cord or brainstem injury can occur if the fracture is unstable. Radiographically, it can be identified by anterior displacement of the C2 vertebra relative to C3. If the fracture is stable, then treatment is typically conservative with external fixation or bracing.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Traumatic spondylolisthesis and associated fractures of the C2 vertebra are known as \u201changman\u2019s injuries\u201d or \u201changman\u2019s fracture\u201d. This injury typically results from forcible hyperextension of the neck.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bransford, R.J., Alton, T.B., Patel, A.R., Bellabarba, C. (2014) Upper cervical spine trauma. The Journal of the American Academy of Orthopedic Surgeons. 22(11), 718-729. Doi: 10.5435\/JAAOS-22-11-718.<\/li>\n\n\n\n<li>Murphy, H., Schroeder, G.D., Shi, W.J., et al. (2017) Management of hangman&#8217;s fractures: A systematic review. Journal of Orthopedic Trauma. 31 Suppl 4, S90-S95. Doi: 10.1097\/BOT.0000000000000952.<\/li>\n\n\n\n<li>Walls, R., Hockberger, R., Gausche-Hill, M. (2017) Rosen&#8217;s emergency medicine: Concepts and clinical practice. Philadelphia, PA: Elsevier. ISBN: 978-0323354790.<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/osmosis.org\/create\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/hm-healthdigital-multisite.go-vip.net\/osmosisblog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_MD2_2023.png?w=700\" alt=\"\" class=\"wp-image-4966\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_MD2_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/12\/Blog_Display_Ads_MD2_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more &nbsp;USMLE\u00ae Step 2 CK practice questions?&nbsp;Try Osmosis by Elsevier today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Enhance your diagnostic skills and prepare effectively for the USMLE\u00ae Step 2 exam by exploring a case study involving a 36-year-old woman with acute neck pain following a motor vehicle collision.<\/p>\n","protected":false},"author":202,"featured_media":4964,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,43,1370,45],"tags":[482,218,440,448,84,483,245,279,484,185],"class_list":["post-4963","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-residency","category-step-2-questions","category-step-2","tag-cervical-spine","tag-clinical-skills","tag-emergency-medicine","tag-medical-diagnosis","tag-medical-education","tag-neck-pain","tag-nursing-education","tag-patient-assessment","tag-trauma-care","tag-usmle"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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