Intervertebral Disc Disease Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Intervertebral Disc Disease. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Intervertebral Disc Disease Indian Medical PG Question 1: Which of the following is not a typical symptom of a lumbar disc herniation?
- A. Positive straight leg raise test
- B. Saddle anesthesia (Correct Answer)
- C. Radicular leg pain
- D. Weakness in foot dorsiflexion
Intervertebral Disc Disease Explanation: ***Saddle anesthesia***
- While a severe complication, **saddle anesthesia** is indicative of **cauda equina syndrome**, a medical emergency, and not a typical, isolated symptom of a simple lumbar disc herniation.
- It suggests **compression of multiple nerve roots** in the lumbosacral region, beyond what is usually seen with a single disc herniation.
*Positive straight leg raise test*
- This is a common and reliable physical exam finding in patients with **lumbar disc herniation**, indicating nerve root irritation.
- It elicits radiating pain down the leg when the affected leg is raised between 30 and 70 degrees.
*Radicular leg pain*
- **Radicular pain**, often described as sharp, shooting pain down the leg, is the hallmark symptom of a lumbar disc herniation as it signifies **nerve root compression**.
- The pain typically follows a **dermatomal pattern**, corresponding to the specific nerve root involved.
*Weakness in foot dorsiflexion*
- Weakness in **foot dorsiflexion** (commonly affecting the **L4 or L5 nerve roots**) is a frequently observed neurological deficit in lumber disc herniation.
- This can be assessed through manual muscle testing and is a sign of **motor nerve root compression**.
Intervertebral Disc Disease Indian Medical PG Question 2: Which of the following is the least common site for disc prolapse?
- A. C6 - C7
- B. T3 - T4 (Correct Answer)
- C. L5 - S1
- D. L4 - L5
Intervertebral Disc Disease Explanation: ***T3 - T4***
- **Thoracic disc prolapse** is significantly rarer than cervical or lumbar prolapse due to the **stability of the thoracic spine**, reinforced by the rib cage and smaller vertebral bodies.
- The narrow vertebral canal in the thoracic region also presents a diagnostic challenge, contributing to its low reported incidence compared to other spinal segments.
*L5 - S1*
- This is a **very common site** for disc prolapse due to the high biomechanical stress at the lumbosacral junction.
- It is often associated with symptoms such as **sciatica** affecting the S1 dermatome.
*C6 - C7*
- This is one of the **most common sites for cervical disc prolapse**, presenting with pain, numbness, or weakness in the arm, typically affecting the C7 dermatome.
- The mobility of the cervical spine contributes to its susceptibility to disc herniation compared to the thoracic spine.
*L4 - L5*
- This is another **extremely common site** for lumbar disc prolapse, second only to L5-S1.
- Prolapse at this level commonly causes **sciatica** symptoms affecting the L5 dermatome.
Intervertebral Disc Disease Indian Medical PG Question 3: All of the following contribute to the intervertebral disc EXCEPT:
- A. Fibrocartilage
- B. Elastic cartilage (Correct Answer)
- C. Annulus fibrosus
- D. Nucleus pulposus
Intervertebral Disc Disease Explanation: ***Elastic cartilage***
- **Elastic cartilage** is characterized by the presence of **elastic fibers**, providing flexibility to structures like the ear and epiglottis.
- It is **not found** within the intervertebral disc, which requires specific properties for weight-bearing and shock absorption.
*Fibrocartilage*
- **Fibrocartilage** is a primary component of the **annulus fibrosus** and plays a crucial role in providing tensile strength and resisting compressive forces [1].
- Its presence is essential for the structural integrity and function of the intervertebral disc.
*Annulus fibrosus*
- The **annulus fibrosus** is the **tough, outer fibrous ring** of the intervertebral disc, composed of concentric layers of fibrocartilage.
- It encircles the nucleus pulposus, containing it and providing stability to the disc.
*Nucleus pulposus*
- The **nucleus pulposus** is the **gel-like core** of the intervertebral disc, rich in proteoglycans and water.
- It acts as a shock absorber and allows for flexibility between vertebrae.
Intervertebral Disc Disease Indian Medical PG Question 4: A patient while lifting a heavy weight presents with sudden onset pain in the lower back radiating along the postero-lateral thigh and lateral leg to the big toe with numbness. The most likely diagnosis is:
- A. L4 - L5 Disc prolapsed (Correct Answer)
- B. L3 - IA Disc prolapsed
- C. L5 fracture
- D. L5 - SI Disc prolapse
Intervertebral Disc Disease Explanation: ***L4 - L5 Disc prolapsed***
- A disc prolapse at the **L4-L5 level** typically compresses the **L5 nerve root**.
- This compression leads to pain radiating along the **postero-lateral thigh** and **lateral leg**, reaching the **big toe**, often accompanied by numbness in the same distribution due to **L5 dermatome** involvement.
*L3 - IA Disc prolapsed*
- A prolapse at the **L3-L4 level** would compress the **L4 nerve root**, causing pain in the **anterior thigh** and medial leg, with potential numbness over the **medial calf** and ankle.
- This presentation does not match the described symptoms of pain radiating to the big toe and lateral leg.
*L5 fracture*
- An **L5 fracture** would primarily manifest as localized lower back pain, often exacerbated by movement, and might not necessarily cause radiating pain or numbness in a dermatomal pattern to the big toe unless there's associated nerve root compression.
- The sudden onset with radiating pain in a specific distribution points more towards nerve impingement from a disc prolapse rather than a fracture.
*L5 - SI Disc prolapse*
- A disc prolapse at the **L5-S1 level** compresses the **S1 nerve root**.
- This typically results in pain radiating down the **posterior thigh**, **calf**, and to the **little toe** and lateral foot, along with numbness in the **S1 dermatome**, which is different from the big toe and lateral leg involvement described.
Intervertebral Disc Disease Indian Medical PG Question 5: A patient presented with Saddle anaesthesia with bladder and bowel involvement and muscle power is normal. The diagnosis is:
- A. L4-L5 disc prolapsed
- B. L3-L4 root involvement
- C. Conus medullaris lesion (Correct Answer)
- D. Cauda equina syndrome
Intervertebral Disc Disease Explanation: ***Conus medullaris lesion***
- A **conus medullaris lesion** typically presents with **saddle anesthesia**, early and severe **bladder and bowel dysfunction**, and often **symmetrical neurological deficits** [1], [3].
- **Motor weakness in the legs** is usually minimal or absent, which aligns with the patient's normal muscle power in this case.
*L4-L5 disc prolapsed*
- A **L4-L5 disc prolapse** primarily causes **radicular pain** and weakness in the distribution of the L5 nerve root (e.g., foot drop, weakness of ankle dorsiflexion) [2].
- While it can cause some sensory changes, **saddle anesthesia** and severe bladder/bowel dysfunction are not typical features.
*L3-L4 root involvement*
- **L3-L4 root involvement**, often from a disc herniation, would typically present with **quadriceps weakness**, absent patellar reflex, and sensory loss over the medial thigh [2].
- It would not cause **saddle anesthesia** or significant bladder/bowel dysfunction as a primary symptom.
*Cauda equina syndrome*
- **Cauda equina syndrome** presents with **saddle anesthesia** and **bladder/bowel dysfunction**, but it is generally characterized by **significant motor weakness** in the lower extremities (e.g., severe leg weakness, foot drop), which is absent here.
- The onset of bladder and bowel symptoms in cauda equina syndrome is often more gradual and less severe initially compared to conus medullaris lesions.
Intervertebral Disc Disease Indian Medical PG Question 6: A 60-year-old woman with a history of chronic back pain presents with acute-onset sharp pain radiating down the right leg. She also reports numbness and tingling in the foot. What is the best next step in management?
- A. Bed rest
- B. MRI of the spine (Correct Answer)
- C. X-ray of the spine
- D. Physical therapy
Intervertebral Disc Disease Explanation: ### MRI of the spine
- The patient's symptoms of acute-onset sharp pain radiating down the right leg with numbness and tingling strongly suggest **radiculopathy**, likely due to **nerve root compression** from a herniated disc, stenosis, or other pathology [1].
- An **MRI of the spine** is the **most sensitive and specific imaging modality** to visualize soft tissue structures like intervertebral discs, nerve roots, and the spinal cord, allowing for accurate diagnosis and guiding further management.
*Bed rest*
- While historically recommended, **prolonged bed rest** is generally discouraged for acute low back pain and radiculopathy as it can lead to deconditioning and delayed recovery [2].
- **Modified activity** and early mobilization are often preferred over strict bed rest, even for severe pain [2].
*X-ray of the spine*
- An **X-ray of the spine** can identify bony abnormalities like fractures, severe degenerative changes, or spondylolisthesis, but it **cannot visualize soft tissue structures** that are typically responsible for radicular symptoms, such as herniated discs or nerve root compression.
- Therefore, it is not the best initial imaging choice for pinpointing the cause of the patient's neurological symptoms.
*Physical therapy*
- **Physical therapy** is an important component of long-term management for back pain and radiculopathy, focusing on exercises, stretching, and education to improve function and reduce pain.
- However, in the setting of **acute, severe radicular symptoms** with numbness and tingling, it is crucial to first establish a definitive diagnosis through imaging to rule out more serious compression and guide appropriate therapeutic interventions.
Intervertebral Disc Disease Indian Medical PG Question 7: A right-sided disc herniation at the L5-S1 level typically may cause:
- A. Low back pain and right-sided sciatica (Correct Answer)
- B. Normal ankle jerk reflex.
- C. Weakness of dorsiflexion of the right foot.
- D. Diminished sensation over the medial aspect of the foot.
Intervertebral Disc Disease Explanation: ***Low back pain and right-sided sciatica***
- A right-sided disc herniation at the L5-S1 level typically compresses the **S1 nerve root** on the right side.
- This compression leads to **sciatica**, which presents as radiating pain along the S1 dermatome (back of the leg and sole of the foot), often accompanied by localized **low back pain**.
*Weakness of dorsiflexion of the right foot*
- **Dorsiflexion weakness** is primarily associated with compression of the **L4 or L5 nerve roots**, not S1.
- The muscles responsible for dorsiflexion (e.g., tibialis anterior) are predominantly innervated by L4 and L5.
*Normal ankle jerk reflex*
- The **ankle jerk reflex** is mediated by the **S1 nerve root**.
- Therefore, compression of the S1 nerve root would typically lead to a **diminished or absent ankle jerk reflex**, not a normal one.
*Diminished sensation over the medial aspect of the foot*
- **Diminished sensation** over the **medial aspect of the foot** corresponds to the **L4 dermatome**.
- A herniation at L5-S1 primarily affects the S1 dermatome, which involves the **lateral aspect of the foot** and sole.
Intervertebral Disc Disease Indian Medical PG Question 8: What type of neurological signs would you expect to see in a patient with a cauda equina lesion?
- A. Upper motor neuron signs
- B. Lower motor signs (Correct Answer)
- C. Flaccid paralysis
- D. Areflexia
Intervertebral Disc Disease Explanation: ***Lower motor signs***
- A **cauda equina lesion** affects the spinal nerves after they exit the conus medullaris, which are part of the **peripheral nervous system**. [1]
- As such, damage to these peripheral nerves results in **lower motor neuron (LMN) signs**, including weakness, hypotonia, and atrophy. [1]
*Upper motor neuron signs*
- **Upper motor neuron lesions** occur within the central nervous system (brain or spinal cord above the conus medullaris). [1]
- These lesions are characterized by spasticity, hyperreflexia, and a positive **Babinski sign**.
*Flaccid paralysis*
- While flaccid paralysis can be seen in cauda equina syndrome due to loss of muscle tone, it is a *symptom* that falls under the broader category of **lower motor neuron signs**.
- This option is too general and does not encompass all the neurological signs associated with LMN lesions.
*Areflexia*
- **Areflexia**, or the absence of reflexes, is another specific symptom commonly seen in cauda equina lesions because the reflex arc is interrupted at the peripheral nerve level.
- However, like flaccid paralysis, it is a *component* of lower motor neuron signs rather than the overarching type of neurological signs to expect.
Intervertebral Disc Disease Indian Medical PG Question 9: Investigation of choice for lumbar prolapsed disc -
- A. CT Scan
- B. Myelogram
- C. X-ray
- D. MRI (Correct Answer)
Intervertebral Disc Disease Explanation: ***MRI***
- An **MRI** provides the best visualization of **soft tissues**, including the intervertebral discs, spinal cord, and nerve roots, making it the **gold standard** for diagnosing lumbar prolapsed disc.
- It can accurately show the **degree of disc herniation**, its impact on neural structures, and associated edema, which are crucial for treatment planning.
*CT Scan*
- While a **CT scan** provides good bony detail and can show disc herniation, its ability to visualize soft tissues is inferior to MRI for this specific condition.
- It involves **ionizing radiation** and may miss subtle nerve root compression or spinal cord abnormalities apparent on MRI.
*Myelogram*
- A **myelogram** involves injecting contrast dye into the spinal canal and then performing X-rays or CT scans to outline the spinal cord and nerve roots.
- Though effective in showing **nerve compression**, it is an **invasive procedure** with potential complications and has largely been replaced by MRI as a first-line diagnostic investigation.
*X-ray*
- **X-rays** primarily visualize **bony structures** and are useful for detecting fractures, spinal alignment issues, or severe degenerative changes.
- They **cannot directly visualize intervertebral discs** or nerve compression, making them unsuitable for diagnosing a prolapsed disc.
Intervertebral Disc Disease Indian Medical PG Question 10: Tuberculosis of the spine commonly affects all of the following parts of the vertebra except:
- A. Lamina
- B. Body
- C. Spinous process (Correct Answer)
- D. Pedicle
Intervertebral Disc Disease Explanation: ***Spinous process***
- **Tuberculosis of the spine (Pott's disease)** typically affects the anterior columns of the vertebrae, primarily the vertebral bodies, due to their rich vascular supply.
- The **spinous process** (posterior element) is rarely involved in tuberculosis because it has a relatively poor blood supply compared to the vertebral body.
*Lamina*
- The **lamina**, part of the vertebral arch (posterior element), is also less commonly affected by tuberculous spondylitis compared to the vertebral body.
- While possible in advanced or disseminated disease, initial involvement is usually anterior.
*Body*
- The **vertebral body** is the most commonly affected part of the vertebra in tuberculosis of the spine.
- This is due to its abundant blood supply, allowing for easy hematogenous spread of the *Mycobacterium tuberculosis* bacteria.
*Pedicle*
- The **pedicle** connects the vertebral body to the lamina and is considered an anterior element, albeit less frequently involved than the vertebral body itself.
- Involvement of the pedicle tends to occur via direct extension from an affected vertebral body or disk space.
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