Spine Disorders Practice Questions

Q: What is the most common site of a primary spinal tumor?

Intradural and Extramedullary. ### Explanation Spinal tumors are classified based on their anatomical relationship to the **dura mater** and the **spinal cord parenchyma**. **1. Why Intradural-Extramedullary is the Correct Answer:** Primary spinal tumors (originating from the spine rather than metastasizing to it) are most frequently found in the **intradural-extramedullary** compartment. This space lies inside the dura but outside the spinal cord itself. The two most common primary spinal tumors—**Schwannomas** (nerve sheath tumors) and **Meningiomas**—both occur in this location. Together, they account for approximately 55-60% of all primary spinal neoplasms. **2. Analysis of Incorrect Options:** * **Intramedullary (B & D):** These tumors arise within the substance of the spinal cord (e.g., Ependymomas, Gliomas). They are the least common type, accounting for only about 5-10% of spinal tumors. "Intra-axial" is a term more commonly used in brain imaging but refers to the same concept. * **Extradural (A):** This space lies outside the dura. While this is the most common site for **metastatic** spinal disease (secondary tumors), it is less common for **primary** tumors compared to the intradural-extramedullary space. **3. NEET-PG High-Yield Clinical Pearls:** * **Most common primary spinal tumor overall:** Schwannoma (Intradural-extramedullary). * **Most common intramedullary tumor in adults:** Ependymoma. * **Most common intramedullary tumor in children:** Astrocytoma. * **Metastatic disease:** Always the most common cause of **extradural** spinal masses (usually from lung, breast, or prostate). * **Radiological Sign:** Schwannomas often present with a "dumb-bell" shape as they exit the neural foramina.

Q: In actinomycosis of the spine, the abscess usually erodes:

Skin. **Explanation:** Actinomycosis is a chronic granulomatous infection caused by *Actinomyces israelii*, an anaerobic, Gram-positive commensal. Unlike Tuberculosis (Pott’s disease), which primarily targets the intervertebral disc and vertebral bodies, Actinomycosis is characterized by its **indolent nature and its tendency to disregard anatomical boundaries.** **Why Skin is Correct:** The hallmark of Actinomycosis is the formation of multiple **burrowing abscesses and chronic discharging sinuses** that track through tissues to reach the surface. In spinal involvement, the infection typically spreads from the cervicofacial or thoracic regions, eventually eroding through the soft tissues to the **Skin**, where it discharges characteristic "sulfur granules." **Why other options are incorrect:** * **Intervertebral Disc:** Actinomycosis is unique because it **spares the intervertebral disc**. This is a key radiological differentiator from Pyogenic or Tuberculous spondylitis, where disc destruction is early and prominent. * **Pleural Cavity & Retroperitoneal Space:** While the infection can involve these areas via direct extension (thoracic or abdominal actinomycosis), it does not typically "erode" into them as a terminal path; rather, it tends to penetrate through them to reach the cutaneous surface. **High-Yield Clinical Pearls for NEET-PG:** * **Sulfur Granules:** These are yellow-colored clumps of organisms found in the pus; they are diagnostic. * **Radiology:** Shows a "honeycomb" appearance of the vertebrae with dense sclerosis. * **Treatment:** High-dose **Penicillin G** for a prolonged period (6–12 months) is the treatment of choice. * **Key Differentiator:** If a question mentions spinal infection with **disc preservation and multiple discharging sinuses**, think Actinomycosis.

Q: Which of the following spine deformities is seen in the image?

Gibbus. ***Gibbus*** - A **gibbus deformity** is a sharply angular posterior projection of a vertebral segment, caused by the collapse of one or more vertebral bodies. - Most commonly due to **Pott's disease (spinal tuberculosis)**, where vertebral body destruction leads to a focal, acute-angle hump. - The image clearly shows a **localized, sharp posterior angulation** in the thoracic spine, which is characteristic of a gibbus. *Kyphosis* - **Kyphosis** refers to an exaggerated **posterior curvature** of the thoracic spine, producing a "rounded back." - While a gibbus is technically a severe form of kyphosis, kyphosis alone describes a more **generalized, smooth curve** — not the focal, angular hump seen in the image. *Lordosis* - **Lordosis** describes an **anterior (forward) curvature** of the lumbar spine, often called "swayback." - This is not seen in the image, which displays a prominent **posterior** projection, not an anterior one. *Scoliosis* - **Scoliosis** is a **lateral (side-to-side) curvature** of the spine, seen as a deviation when viewed from behind. - The image shows a deformity in the **sagittal plane** (anterior-posterior), not the coronal plane, ruling out scoliosis.

Q: Identify the instrument:

Crutchfield tongs. ***Crutchfield tongs*** - These tongs are used for **skeletal traction** in cases of **cervical spine injuries**, particularly cervical dislocations. - They are specifically designed for insertion into the temporal bones of the skull to apply continuous traction, as seen with the pointed ends and adjustable bar. *Boyle-Davis gag* - A Boyle-Davis gag is a type of **mouth gag** used to hold the mouth open during oral and pharyngeal surgeries, and it does not resemble the instrument shown. - It usually features a tongue depressor and often a method for suction, which are absent here. *Decapitator* - A decapitator is a historical surgical instrument used for **fetal decapitation** during difficult childbirth, and it has a very different morphology, usually involving a sharp cutting or crushing mechanism. - Its design is entirely distinct from the traction device pictured. *Jewett nail* - A Jewett nail is an **intramedullary nail** used in orthopedic surgery to fix **intertrochanteric hip fractures**. - It is an internal fixation device, not an external traction tong, and bears no resemblance to the instrument shown.

Q: What is the likely diagnosis?

Spondylolisthesis. ***Spondylolisthesis*** - The image shows a **forward slip** of one vertebral body over another, specifically at the L5-S1 level, which is the hallmark of spondylolisthesis. - The white arrow points to the area where the superior vertebra has translated anteriorly on the inferior one, indicative of this condition. *Spondylosis* - Spondylosis refers to **degenerative changes** in the spinal column, such as **osteophytes** (bone spurs) and **disc space narrowing**. - While some degenerative changes might be present, the primary and most striking finding visible is the displacement of the vertebral body, not just degenerative changes. *Compression fracture* - A compression fracture would typically present as a **wedging deformity** or a significant **reduction in the height** of the vertebral body. - The image does not show a loss of vertebral height or a clear fracture line within the vertebral body itself, but rather a displacement. *Osteoporosis* - Osteoporosis is a systemic condition characterized by **reduced bone density**, making bones fragile and prone to fractures. - While it can predispose to compression fractures, the radiographic finding in the image is not primarily about bone density or a typical osteoporotic fracture, but rather a **vertebral slip**.

Q: The following test is used to evaluate lumbar disc herniation at which level?

L4-L5. ***L4-L5*** - The image shows the **straight leg raise test**, a common maneuver to evaluate **lumbosacral nerve root compression**, especially due to disc herniation. - A positive straight leg raise test (pain radiating down the leg when raised between 30 and 70 degrees) is most commonly associated with herniation at the **L4-L5 or L5-S1 levels**, affecting the L5 or S1 nerve roots respectively. Given common prevalence, L4-L5 is a very frequent site. *L2-L3* - Herniation at the L2-L3 level typically compresses the **L3 nerve root**, which is primarily associated with the **femoral stretch test**, not the straight leg raise test. - Symptoms would usually include pain in the anterior thigh and weakness in quadriceps, rather than radiating down the back of the leg. *L3-L4* - This level corresponds to compression of the **L4 nerve root**, which is also better evaluated with the **femoral stretch test** in conjunction with quadriceps weakness and loss of patellar reflex. - While it can cause anterior thigh pain, a positive straight leg raise is less specific for this level. *L5-S1* - Herniation at the L5-S1 level affects the **S1 nerve root**, and a positive straight leg raise test is indeed indicative of this. - However, L4-L5 is also a very common site, and without additional clinical details (e.g., specific dermatome/myotome deficits like foot drop for L5 or Achilles reflex loss for S1), it's difficult to exclusively pinpoint S1. In many contexts, L4-L5 is presented as a primary target.

Q: A 10-year-old girl presents with severe back pain for last 4 weeks and deformity of spine. MRI spine was performed and is shown below. All are true about the condition image shown except:

Block vertebra. ***Block vertebra*** - The image shows **Pott's disease** (tuberculous spondylitis), characterized by destruction of vertebral bodies and intervertebral discs. **Block vertebrae** are congenital fusions of two or more vertebral bodies and are not typically seen in active Pott's disease. - While Pott's disease can lead to vertebral collapse and eventual fusion if untreated, this is a secondary process of healing, not the primary presentation shown here or a congenital block vertebra. *Gibbus* - **Gibbus deformity** is a sharply angulated kyphosis, commonly seen in Pott's disease due to the collapse of anterior vertebral bodies. The clinical image shows spinal curvature consistent with such a deformity. - This is a characteristic clinical manifestation of advanced tuberculous spondylitis. *Paravertebral abscess formation* - **Paravertebral abscesses** are a common complication of Pott's disease, resulting from the spread of infection from the vertebrae into surrounding soft tissues. The MRI clearly shows evidence of fluid collections and signal changes around the spine, highly suggestive of abscesses. - These abscesses can cause compressive symptoms and contribute to back pain. *Paraplegia can present during healing* - Paraplegia in Pott's disease (known as **Pott's paraplegia**) can occur during the active phase due to compression from abscesses, granuloma, or bony fragments. - However, it can also paradoxically worsen or appear during the **healing phase** due to fibrosis, calcification, or spinal deformity progression, making this a true statement about the condition.

Q: What is the test being performed in the patient?

Hoover test. ***Hoover test*** - The image depicts the **Hoover test**, where the examiner places one hand under the asymptomatic heel while the patient attempts to lift the symptomatic leg. The hand under the asymptomatic heel should feel downward pressure if the patient is genuinely trying to lift the affected leg. - This test is used to detect **malingering** or non-organic weakness in the lower limbs, often in cases of suspected sciatica or lumbar radiculopathy. *Patrick test* - The **Patrick test**, also known as the **FABER test** (Flexion, Abduction, External Rotation), assesses the hip joint and sacroiliac joint. - It involves placing the foot of the symptomatic leg on the opposite knee and allowing the knee to fall towards the examination table, which is not what is shown in the image. *Waddell test* - The **Waddell signs** are a group of physical signs used to identify non-organic (psychological) components in low back pain. - These signs include superficial tenderness, non-anatomic tenderness, simulation tests, distraction tests, and regional disturbances, none of which are individually represented by the specific maneuver in the image. *McMurray test* - The **McMurray test** is used to assess for **meniscal tears** in the knee. - It involves flexing and extending the knee while applying varus or valgus stress and internal or external rotation to elicit a click or pain, which is markedly different from the maneuver shown.

Q: A 40-year-old construction worker presents with pain in the arm on lifting weights. The following test and X-ray of neck was performed. Which is correct about this patient?

Elevated arm stress test: Cervical rib. ***Elevated arm stress test: Cervical rib*** - The image shows a patient performing the **Elevated Arm Stress Test (EAST)**, or Roos Test, which places tension on the neurovascular structures in the thoracic outlet. The X-ray image reveals the presence of a **cervical rib** (indicated by the arrow), a common cause of **thoracic outlet syndrome (TOS)**. - The patient's symptom of **pain in the arm on lifting weights** is consistent with **neurovascular compression** due to a cervical rib, which is often exacerbated by arm elevation. *Adson test: Cervical rib* - The **Adson test** involves palpating the radial pulse while the patient extends, externally rotates the arm, and turns their head toward the ipsilateral arm and inhales. This maneuver compresses the **subclavian artery** by the anterior and middle scalene muscles, not the position shown. - While a cervical rib can cause a positive Adson test, the maneuver depicted in the image is not the Adson test. *Falconer test: Spinal canal stenosis* - The **Falconer test** is not a standard or widely recognized orthopedic special test. - **Spinal canal stenosis** typically presents with different symptoms, such as **neurogenic claudication** or myelopathy, and is assessed with specific neurological examination techniques and imaging (MRI), not the maneuver shown. *Allen test: Fracture of first rib* - The **Allen test** is used to assess **patency of the radial and ulnar arteries** in the hand, and involves compressing both arteries and observing capillary refill. It is not performed as shown in the picture. - A **fracture of the first rib** might cause pain, but the Allen test is not used to diagnose a rib fracture.

Question 1

A scooter rider is hit from behind and thrown off, landing with their head hitting the kerb. The rider is unresponsive, complains of severe neck pain, and is unable to turn their head. Well-meaning onlookers attempt to sit them up. What is the best course of action in this situation?

Accepted Answer

The patient should be turned onto their back with a support placed behind their neck and transported to the nearest hospital.

Answer

The patient should be propped up and given water to drink.

Answer

The patient should not be propped up but turned onto their face and rushed to the hospital.

Answer

The patient should not be moved at all but carried to the nearest hospital in the same position as they fell.

Question 2

What is the most common site of a primary spinal tumor?

Accepted Answer

Intradural and Extramedullary

Answer

Intramedullary and Extradural

Answer

Intramedullary only

Answer

Intra-axial only

Question 3

In actinomycosis of the spine, the abscess usually erodes:

Accepted Answer

Skin

Answer

Intervertebral disc

Answer

Pleural cavity

Answer

Retroperitoneal space

Question 4

Which of the following spine deformities is seen in the image?

Accepted Answer

Gibbus

Answer

Kyphosis

Answer

Lordosis

Answer

Scoliosis

Question 5

Identify the instrument:

Accepted Answer

Crutchfield tongs

Answer

Boyle-Davis gag

Answer

Decapitator

Answer

Jewett nail

Question 6

What is the likely diagnosis?

Accepted Answer

Spondylolisthesis

Answer

Spondylosis

Answer

Compression fracture

Answer

Osteoporosis

Question 7

The following test is used to evaluate lumbar disc herniation at which level?

Accepted Answer

L4-L5

Answer

L2-L3

Answer

L3-L4

Answer

L5-S1

Question 8

A 10-year-old girl presents with severe back pain for last 4 weeks and deformity of spine. MRI spine was performed and is shown below. All are true about the condition image shown except:

Accepted Answer

Block vertebra

Answer

Gibbus

Answer

Paravertebral abscess formation

Answer

Paraplegia can present during healing

Question 9

What is the test being performed in the patient?

Accepted Answer

Hoover test

Answer

Patrick test

Answer

Waddell test

Answer

McMurray test

Question 10

A 40-year-old construction worker presents with pain in the arm on lifting weights. The following test and X-ray of neck was performed. Which is correct about this patient?

Accepted Answer

Elevated arm stress test: Cervical rib

Answer

Adson test: Cervical rib

Answer

Falconer test: Spinal canal stenosis

Answer

Allen test: Fracture of first rib

Spine Disorders — MCQs

Spine Disorders — MCQs

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