Spine Disorders Practice Questions

Q: Which of the following is NOT true about Jefferson's fracture?

It is a common type of fracture of the C1 vertebra.. **Explanation** **Jefferson’s fracture** is a specific type of burst fracture involving the **C1 vertebra (Atlas)**. 1. **Why Option C is the correct answer (The False Statement):** While Jefferson’s fracture is the most "famous" or classically described fracture of the atlas, it is **not the most common**. In clinical practice, isolated fractures of the posterior arch of C1 are more frequent than the classic four-part burst fracture (Jefferson’s) described by the mechanism of axial loading. 2. **Analysis of other options:** * **Option A (True):** It is specifically a fracture of the C1 vertebra, typically involving bilateral fractures of both the anterior and posterior arches. * **Option B (True):** The primary mechanism of injury is **axial loading** (vertical compression), such as a heavy object falling on the head or diving into a shallow pool. This force drives the occipital condyles into the lateral masses of C1, causing them to "burst" outward. * **Option D (True):** Approximately **50%** of patients with a Jefferson fracture have a concomitant cervical spine injury, most commonly a fracture of the C2 vertebra (Axis). **High-Yield Clinical Pearls for NEET-PG:** * **Stability:** It is often neurologically stable because the burst mechanism increases the diameter of the spinal canal (the fragments move outward). * **Radiology:** Diagnosis is made using the **Open-mouth (Odontoid) view** X-ray. A "lateral displacement of lateral masses" of >7mm (combined) indicates a rupture of the **Transverse Axial Ligament (TAL)**, signifying an unstable fracture. * **Treatment:** Stable fractures are treated with a hard cervical collar; unstable fractures require a Halo vest or surgical stabilization.

Q: Vertebral rotation in scoliosis is checked in which position?

Forward bending (Adam's forward bend test). **Explanation:** The correct answer is **A. Forward bending (Adam's forward bend test)**. **Why it is correct:** Scoliosis is a three-dimensional deformity involving lateral curvature and **axial rotation** of the vertebrae. Because the ribs are attached to the thoracic vertebrae, vertebral rotation causes the ribs on the convex side of the curve to project posteriorly. This creates a **"rib hump."** The Adam’s forward bend test is the standard clinical screening tool because bending forward accentuates this asymmetry, making the rotational component (the rib hump or lumbar prominence) visible to the examiner. **Why other options are incorrect:** * **B & C (Backward/Sideways bending):** These positions do not highlight the rotational deformity. In fact, lateral bending is used to assess the **flexibility** of the curve (distinguishing between structural and functional scoliosis) rather than checking for rotation. * **D (Without bending):** While a lateral shift or shoulder tilt may be visible while standing, the rotational component is often masked by overlying soft tissue and musculature. Forward flexion is required to bring the rib hump into clear view. **High-Yield Clinical Pearls for NEET-PG:** * **Scoliometer:** Used during the Adam’s test to measure the **Angle of Trunk Rotation (ATR)**. An ATR ≥ 7° usually warrants radiological evaluation. * **Cobb’s Angle:** The gold standard for measuring the severity of scoliosis on an X-ray. * **Nash-Moe Classification:** Used to grade vertebral rotation based on the position of the **pedicles** on an AP radiograph. * **Risser’s Sign:** Used to assess skeletal maturity via the ossification of the iliac apophysis, which helps predict the risk of curve progression.

Q: Which of the following is not recommended in the treatment of chronic low back pain?

Bed rest for 3 months. In the management of chronic low back pain (LBP), the primary goal is to maintain activity and prevent disability. **Why "Bed rest for 3 months" is the correct answer:** Prolonged bed rest is strictly contraindicated in both acute and chronic low back pain. Evidence shows that bed rest for more than 2–3 days leads to muscle atrophy (deconditioning), joint stiffness, bone mineral loss, and increased risk of thromboembolism. In chronic cases, it promotes "sick role" behavior and psychological distress. Current guidelines emphasize **early mobilization** and "staying active" to improve functional outcomes. **Analysis of other options:** * **NSAIDs:** These are the first-line pharmacological treatment for symptomatic relief of pain and inflammation in chronic LBP. * **Exercises:** Core strengthening, McKenzie exercises, and aerobic conditioning are the cornerstones of chronic LBP management. They improve spinal stability and reduce recurrence. * **Epidural steroid injections:** These are indicated for patients with radiculopathy (sciatica) or spinal stenosis who have failed conservative management, helping to reduce nerve root inflammation. **NEET-PG High-Yield Pearls:** * **Acute LBP:** Bed rest should not exceed **48 hours**. * **Red Flags for LBP:** Weight loss, night pain, saddle anesthesia, and bladder/bowel dysfunction (suggests malignancy or Cauda Equina Syndrome). * **Most common cause of LBP:** Lumbar spondylosis (degenerative changes). * **Gold Standard Imaging:** MRI is the investigation of choice for disc herniation and spinal canal stenosis.

Q: Which of the following is NOT an X-ray finding of Rheumatoid Arthritis?

Periarticular new bone formation. **Explanation:** Rheumatoid Arthritis (RA) is primarily an **inflammatory, erosive** polyarthritis. The hallmark of the disease is synovial hypertrophy (pannus formation) which leads to the destruction of articular cartilage and bone. **Why "Periarticular new bone formation" is the correct answer:** In RA, the inflammatory process is destructive rather than osteoblastic. **Periarticular osteopenia** (decreased bone density) is a classic finding due to increased local blood flow and cytokine activity. In contrast, **new bone formation** (such as osteophytes, subchondral sclerosis, or involucrum) is characteristic of degenerative conditions like Osteoarthritis or infective conditions like Osteomyelitis, but is notably absent in RA. **Analysis of Incorrect Options:** * **Soft tissue swelling:** This is the earliest radiographic sign of RA, representing active synovitis and effusion. * **Reduced joint space:** As the pannus destroys the articular cartilage, the space between the bone ends narrows symmetrically. * **Subchondral cysts (Geodes):** These occur when synovial fluid is forced into the bone through surface erosions, creating radiolucent pockets. **NEET-PG High-Yield Pearls:** 1. **Earliest Sign:** Soft tissue swelling. 2. **Earliest Bone Sign:** Periarticular osteopenia (juxta-articular rarefaction). 3. **Pathognomonic Finding:** Marginal erosions (Rat-bite erosions) at the "bare areas" of the bone. 4. **Spine Involvement:** RA characteristically involves the **Cervical Spine** (specifically Atlanto-axial subluxation); it notably spares the Thoracic and Lumbar spine. 5. **Key Distinction:** Osteoarthritis shows subchondral sclerosis and osteophytes; RA shows osteopenia and no new bone formation.

Q: Which of the following is a poor prognostic indicator of Pott's paraplegia?

Healed disease. **Explanation:** Pott’s paraplegia (spinal tuberculosis with neurological deficit) is classified into two types based on the timing of onset relative to disease activity. The prognosis depends significantly on the underlying pathology causing cord compression. **Why "Healed Disease" is the correct answer:** Late-onset paraplegia occurring in **healed disease** carries a poor prognosis. In these cases, the compression is usually caused by **permanent structural changes** such as a sharp "internal kyphosis" (bony ridge), spinal stenosis, or dense pachymeningitis (fibrosis of the dura). Since the compression is mechanical and chronic rather than inflammatory, it does not respond to Anti-Tubercular Therapy (ATT) and often requires complex surgical decompression with limited neurological recovery. **Analysis of Incorrect Options:** * **Early onset & Active disease:** These occur during the peak of the infection. The compression is typically due to "soft" factors like inflammatory edema, abscess (cold abscess), or granulation tissue. These respond excellently to ATT and rest, leading to a **good prognosis**. * **Wet lesion:** This refers to an active lesion with significant pus/abscess formation. While it sounds severe, "wet" lesions are easier to evacuate surgically or treat with medication compared to "dry" (fibrous/bony) lesions, thus carrying a **better prognosis** than healed disease. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Thoracic spine (narrowest canal, highest risk of paraplegia). * **First clinical sign:** Spasticity and increased deep tendon reflexes (UMN lesion). * **Girdlestone’s Classification:** Differentiates early-onset (active) from late-onset (healed) paraplegia. * **Surgery Indication:** If there is no neurological improvement after 3–4 weeks of conservative treatment (ATT), surgery (Anterolateral decompression) is indicated.

Q: Which of the following is NOT true about spinal tuberculosis?

Exaggerated lumbar lordosis is a characteristic feature.. **Explanation:** Spinal tuberculosis (Pott’s disease) typically involves the destruction of the anterior portion of the vertebral bodies and the intervening disc space. **1. Why Option C is the correct answer (False statement):** In spinal TB, the destruction and collapse of the anterior vertebral bodies lead to a **Kyphotic deformity** (Gibbus or hunchback), not an exaggerated lumbar lordosis. As the anterior column collapses, the spine bends forward. Lumbar lordosis is actually **lost or flattened** as a compensatory mechanism or due to muscle spasms in the early stages. **2. Analysis of Incorrect Options (True statements):** * **Option A:** **Back pain** is indeed the earliest and most common presenting symptom, often accompanied by localized tenderness and stiffness (night cries in children). * **Option B:** The **dorsolumbar (thoracolumbar) junction** (T12-L1) is the most common site of involvement, followed by the lumbar spine. * **Option C:** Spinal TB is almost always **secondary** to a primary focus elsewhere in the body, most commonly the **lungs** (via hematogenous spread through Batson’s venous plexus) or lymph nodes. **Clinical Pearls for NEET-PG:** * **Paradiscal type:** The most common pattern where the infection starts in the subchondral bone and crosses the disc space. * **Cold Abscess:** A hallmark of Pott's disease; it lacks the traditional signs of inflammation (heat, redness). In the lumbar region, it may track down the psoas muscle sheath (**Psoas abscess**). * **Neurological Deficit:** Pott’s paraplegia is the most serious complication, often caused by pressure from an abscess, granulation tissue, or bony sequestra. * **Radiology:** The earliest sign is narrowing of the disc space and blurring of the vertebral endplates.

Q: Which of the following is not a feature of Tuberculosis of the spine?

Exaggerated lumbar lordosis. **Explanation:** Spinal Tuberculosis (Pott’s Disease) typically involves the destruction of the anterior portion of the vertebral bodies. This leads to a **loss of lumbar lordosis** rather than an exaggeration of it. **Why "Exaggerated lumbar lordosis" is the correct answer (The False Statement):** In TB spine, the destruction and collapse of the anterior vertebral body cause the spine to bend forward, leading to **Kyphosis** (Gibbus deformity). In the lumbar region, the normal inward curve (lordosis) is first flattened and then reversed. Exaggerated lordosis is typically seen in conditions like spondylolisthesis or pregnancy, not in spinal infections. **Analysis of Incorrect Options (True Features of TB Spine):** * **Back pain:** This is the **earliest and most common** presenting symptom. It is usually dull, aching, and localized to the site of involvement. * **Stiffness of the back:** This occurs due to protective paravertebral muscle spasms. Patients often exhibit the "Coin Test" positive (bending at the knees instead of the waist to pick up an object). * **Cold abscess:** A hallmark of TB, these are collections of liquefactive necrosis and debris that lack the typical signs of acute inflammation (heat, redness). They can track along tissue planes (e.g., Psoas abscess). **NEET-PG High-Yield Pearls:** * **Most common site:** Lower Thoracic and Upper Lumbar vertebrae. * **First radiological sign:** Paradoxical expansion of the disc space (rare) followed by **narrowing of the disc space** and erosion of the subchondral bone. * **Paradiscal type:** The most common pattern of involvement (affects adjacent vertebrae and the intervening disc). * **Gold Standard Investigation:** MRI is the investigation of choice for early diagnosis and assessing neurological involvement.

Question 1

Which of the following is NOT true about Jefferson's fracture?

Accepted Answer

It is a common type of fracture of the C1 vertebra.

Answer

It is a fracture of the C1 vertebra.

Answer

It is a vertical compression fracture.

Answer

It has a 50% association with concomitant injury in the cervical spine elsewhere.

Question 2

A middle-aged female with rheumatoid arthritis on treatment develops upper motor neuron signs in her limbs. What is the investigation required to evaluate her further?

Accepted Answer

Spine lateral view flexion and extension views

Answer

Open mouth view

Answer

Swimmer's view

Answer

Broden's view

Question 3

Vertebral rotation in scoliosis is checked in which position?

Accepted Answer

Forward bending (Adam's forward bend test)

Answer

Backward bending

Answer

Sideways bending

Answer

Without bending

Question 4

Which of the following is not recommended in the treatment of chronic low back pain?

Accepted Answer

Bed rest for 3 months

Answer

NSAIDs

Answer

Exercises

Answer

Epidural steroid injection

Question 5

Which of the following is NOT an X-ray finding of Rheumatoid Arthritis?

Accepted Answer

Periarticular new bone formation

Answer

Reduced joint space

Answer

Soft tissue swelling

Answer

Subchondral cyst

Question 6

Which of the following is a poor prognostic indicator of Pott's paraplegia?

Accepted Answer

Healed disease

Answer

Early onset

Answer

Active disease

Answer

Wet lesion

Question 7

Which of the following is NOT true about spinal tuberculosis?

Accepted Answer

Exaggerated lumbar lordosis is a characteristic feature.

Answer

Back pain is the earliest symptom.

Answer

The dorsolumbar spine is the commonest site.

Answer

It is usually secondary to lung infection.

Question 8

When do you operate for a prolapsed disc?

Accepted Answer

When there is severe pain interfering with activity and not relieved by rest and treatment for 8 weeks.

Answer

When a busy executive requires quick surgery.

Answer

Only when there is weakness but no pain.

Answer

In a patient with cauda equina syndrome and difficulty in ambulation.

Question 9

Which of the following is not a feature of Tuberculosis of the spine?

Accepted Answer

Exaggerated lumbar lordosis

Answer

Back pain as the earliest symptom

Answer

Stiffness of the back

Answer

Cold abscess

Question 10

Careless handling of a suspected case of cervical spine injury may result in what complication?

Accepted Answer

Injury to the spinal cord leading to quadriparesis or quadriplegia

Answer

Intracranial haemorrhage with cerebral irritation or unconsciousness

Answer

Cervical haematoma with compression of brachial vessels

Answer

Complete paralysis of the affected upper extremity

Spine Disorders — MCQs

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