Vertebral Column — MCQs

10 questions

Spine MRI shows 'pencil-sharpened' vertebral bodies and 'H-shaped' vertebrae on T1-weighted images. Most likely diagnosis?

A resident at the emergency department is preparing for a lumbar puncture in a 26 years old female with suspected subarachnoid bleeding. Although she presented with altered sensorium, CT brain was found to be normal. During LP, which structure is pierced after the spinal needle crosses interspinous ligament?

Third part of vertebral artery is related to which of the following ?

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:

All of the following are true regarding ankylosing spondylitis except:

A 69-year-old man has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is the most likely diagnosis?

All are pierced in Lumbar Puncture except:

What constitutes a spinal motion segment?

In a diving accident that severed the spinal cord below the sixth cervical vertebra, which of the following muscles would be affected?

Q10

The lower two thirds of the following hematoxylin and eosin stained specimen is similar in appearance to which of the following structures?

Vertebral Column Indian Medical PG Practice Questions and MCQs

Question 1: Spine MRI shows 'pencil-sharpened' vertebral bodies and 'H-shaped' vertebrae on T1-weighted images. Most likely diagnosis?

A. Sickle cell disease (Correct Answer)
B. Paget's disease
C. Thalassemia
D. Osteopetrosis

Explanation: ***Sickle cell disease*** - **'Pencil-sharpened' vertebral bodies** and **'H-shaped' vertebrae** are characteristic findings in sickle cell disease due to chronic **ischemic necrosis** of the vertebral endplates. - This vertebral deformity arises from the collapse of the central portion of the vertebral body, often associated with episodes of **vaso-occlusion**. *Paget's disease* - Characterized by abnormal bone remodeling, leading to **bone enlargement** and thickening, not vertebral notching or collapse. - Common radiological findings include **cotton wool appearance** of the skull and **sclerosis** of the vertebrae, distinct from the described MRI findings. *Thalassemia* - Causes significant **bone marrow expansion** due to ineffective erythropoiesis, leading to cortical thinning and widened medullary spaces. - While it can affect bone morphology, it typically does not produce the specific 'H-shaped' or 'pencil-sharpened' vertebral body deformities. *Osteopetrosis* - Known as **'marble bone disease'**, characterized by abnormally dense bones due to defective osteoclast function. - Radiologically, it presents with **generalized increased bone density** and obliterated marrow spaces, which is opposite to the changes seen in sickle cell disease.

Question 2: A resident at the emergency department is preparing for a lumbar puncture in a 26 years old female with suspected subarachnoid bleeding. Although she presented with altered sensorium, CT brain was found to be normal. During LP, which structure is pierced after the spinal needle crosses interspinous ligament?

A. Supra/inter spinous ligament
B. Skin
C. Sub cutaneous fascia
D. Dura mater
E. Arachnoid mater
F. Ligamentum flava (Correct Answer)

Explanation: The enriched explanation is the original text provided because none of the references were sufficiently relevant to the anatomy of a lumbar puncture. Ligamentum flava - After passing the interspinous ligament, the next significant structure pierced by the spinal needle during a lumbar puncture is the ligamentum flava. - This ligament is crucial for stabilizing the vertebral column and is located anterior to the interspinous ligament, connecting the laminae of adjacent vertebrae. *Supra/inter spinous ligament* - The question explicitly states that the needle has already crossed the interspinous ligament, making this an incorrect choice for the next structure. - The supraspinous ligament lies superficial to the interspinous ligament, both of which are encountered before the ligamentum flava. *Skin* - The skin is the very first layer pierced when performing a lumbar puncture. - The question is asking what is pierced after the interspinous ligament, not what is pierced first. *Sub cutaneous fascia* - The subcutaneous fascia is located directly beneath the skin and is encountered very early in the lumbar puncture procedure. - It lies superficial to all ligaments of the vertebral column, including the interspinous ligament. *Dura mater* - The dura mater is pierced after the ligamentum flava. - It is the outermost meningeal layer, which, once penetrated, indicates entry into the epidural space, followed by the subarachnoid space. *Arachnoid mater* - The arachnoid mater is a thin, delicate membrane that lies immediately deep to the dura mater. - It is pierced almost simultaneously with the dura mater, and its penetration allows entry into the subarachnoid space where CSF is collected. *Return of CSF* - The return of CSF is the result of successfully traversing all necessary layers and entering the subarachnoid space. - It is not an anatomical structure that is pierced itself, but rather the clinical endpoint of the procedure.

Question 3: Third part of vertebral artery is related to which of the following ?

A. Foramen magnum and intracranial course
B. Transverse foramen of C6 vertebra
C. Posterior arch of atlas (C1) (Correct Answer)
D. Transverse foramina of C2-C6 vertebrae

Explanation: ***Posterior arch of atlas (C1)*** - The **third part** of the vertebral artery emerges from the **transverse foramen of C1** and courses laterally and posteriorly around the **posterior arch of the atlas**. - This segment then pierces the **posterior atlanto-occipital membrane** and dura to enter the skull. *Transverse foramina of C2-C6 vertebrae* - This describes the typical course of the **second part** of the vertebral artery, which ascends through the transverse foramina of the cervical vertebrae from **C6 to C2**. - The third part's specific relation is to C1, not the lower cervical vertebrae. *Foramen magnum and intracranial course* - This refers to the **fourth part** of the vertebral artery, which enters the skull through the **foramen magnum** and then runs superiorly to join the other vertebral artery to form the basilar artery. - The third part is extra-cranial, occurring before entry into the skull. *Transverse foramen of C6 vertebra* - The **first part** of the vertebral artery courses superiorly from its origin, typically entering the transverse foramen of the **C6 vertebra**. - The third part is located much higher, at the level of the C1 vertebra.

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

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.

Question 5: All of the following are true regarding ankylosing spondylitis except:

A. 50% of patients may have urinary infection (Correct Answer)
B. Involvement of sacroiliac joint
C. Bamboo spine may be a radiological feature
D. Most of people are HLAB27 positive

Explanation: ***50% of patients may have urinary infection*** - Urinary tract infections are **not a characteristic feature** or a common complication of **ankylosing spondylitis**. - This statement is incorrect as there is no significant epidemiological or pathophysiological link between AS and a high incidence of UTIs. *Involvement of sacroiliac joint* - **Sacroiliitis**, inflammation of the sacroiliac joints, is one of the **hallmark features** and often the earliest sign of ankylosing spondylitis [1]. - It is typically **bilateral and symmetrical**, and its presence is crucial for diagnosis [1]. *Bamboo spine may be a radiological feature* - **Bamboo spine** is a characteristic late radiological finding in ankylosing spondylitis, resulting from **syndesmophyte formation** (ossification of spinal ligaments) and fusion of vertebral bodies [1]. - This appearance signifies severe spinal rigidity and advanced disease. *Most of people are HLAB27 positive* - The **HLA-B27 allele** is strongly associated with ankylosing spondylitis, being present in around **90% of Caucasian patients** [1]. - While not diagnostic on its own, its presence significantly increases susceptibility and supports the diagnosis in the right clinical context.

Question 6: A 69-year-old man has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is the most likely diagnosis?

A. Meningocele
B. Kyphosis (Correct Answer)
C. Meningomyelocele
D. Lordosis

Explanation: ***Kyphosis*** - **Kyphosis** is defined as an exaggerated posterior curvature of the **thoracic spine**, often seen in older adults due to **osteoporosis** or degenerative disc disease. - The patient's age and description of an "abnormally increased curvature of the thoracic vertebral column" directly correspond to the definition of **kyphosis**. *Meningocele* - A **meningocele** is a type of **spina bifida** where the meninges protrude through an opening in the spine, forming a sac. - This condition involves a **neural tube defect** and typically presents at birth, not as an acquired condition in a 69-year-old. *Meningomyelocele* - A **meningomyelocele** is a more severe form of **spina bifida** where the spinal cord and meninges protrude through an opening in the spine. - Like meningocele, it is a congenital birth defect and does not present as an abnormally increased spinal curvature in an elderly individual. *Lordosis* - **Lordosis** is an exaggerated anterior curvature, most commonly affecting the **lumbar spine**. - It results in an inward swayback appearance, which is the opposite of an increased posterior curvature of the thoracic spine.

Question 7: All are pierced in Lumbar Puncture except:

A. Interspinous Ligament
B. Ligamentum Flavum
C. Supraspinous ligament
D. Posterior longitudinal ligament (Correct Answer)

Explanation: ***Posterior longitudinal ligament*** - The **posterior longitudinal ligament** runs along the **posterior surface of the vertebral bodies**, forming the **anterior wall of the spinal canal**. - A lumbar puncture needle **does not reach this ligament** as it enters from the **posterior aspect** of the spinal canal. *Interspinous Ligament* - The **interspinous ligament** is located between the **spinous processes of adjacent vertebrae**. - It is **pierced** during a lumbar puncture as the needle advances through the posterior elements to reach the spinal canal. *Ligamentum Flavum* - The **ligamentum flavum** connects the **laminae of adjacent vertebrae**. - This ligament is **pierced** by the needle just before it enters the epidural space and then the subarachnoid space during a lumbar puncture. *Supraspinous ligament* - The **supraspinous ligament** runs along the tips of the **spinous processes**. - It is the **first ligament pierced** by the needle as it enters the skin and subcutaneous tissue during a lumbar puncture.

Question 8: What constitutes a spinal motion segment?

A. A disc and the vertebrae above and below, including their interlocking facet joints. (Correct Answer)
B. A disc and the facet joints at that level.
C. A vertebral body and the disc above.
D. A section of the spine involved in a physiological curve with the similar function (i.e. thoracic kyphosis).

Explanation: ***A disc and the vertebrae above and below, including their interlocking facet joints.*** - A **spinal motion segment** or **functional spinal unit** is defined as two adjacent vertebrae and the intervertebral disc between them. - This unit includes all the associated **ligaments**, **capsules**, and especially the **facet joints**, which together allow for complex movements. *A disc and the facet joints at that level.* - This definition is incomplete as it misses the crucial component of the **vertebral bodies** themselves. - The vertebral bodies provide the main structural support and articulation points for the disc and facet joints. *A vertebral body and the disc above.* - This partial definition describes only a fraction of the components required for a functional segment. - It omits the **inferior vertebral body** and the critical **facet joints** that enable motion. *A section of the spine involved in a physiological curve with the similar function (i.e. thoracic kyphosis).* - This option describes a broader **region** of the spine rather than a single, functional motion unit. - A physiological curve involves multiple motion segments working in concert, not a single segment.

Question 9: In a diving accident that severed the spinal cord below the sixth cervical vertebra, which of the following muscles would be affected?

A. Deltoid
B. Infraspinatus
C. Levator Scapulae
D. Latissimus Dorsi (Correct Answer)

Explanation: ***Latissimus Dorsi*** - The **latissimus dorsi muscle** is primarily innervated by the **thoracodorsal nerve**, which arises from the **C6, C7, and C8** nerve roots (with C7 and C8 being the predominant contributors) [1]. - A spinal cord injury below the sixth cervical vertebra would affect the C7 and C8 segments, thereby disrupting the nerve supply to the latissimus dorsi, leading to weakness or paralysis. - This muscle is responsible for adduction, extension, and internal rotation of the shoulder. *Deltoid* - The **deltoid muscle** is innervated by the **axillary nerve**, which arises predominantly from the **C5 and C6** nerve roots. - Since the injury is below the C6 vertebra, the upper cervical segments (C5 and C6) would remain intact above the level of injury. - Therefore, deltoid function would be preserved. *Infraspinatus* - The **infraspinatus muscle** is innervated by the **suprascapular nerve**, which arises from the **C5 and C6** nerve roots. - Similar to the deltoid, its innervation originates above the level of the spinal cord injury and would be spared. *Levator Scapulae* - The **levator scapulae muscle** receives innervation from the **C3, C4, and C5** spinal nerves, as well as contributions from the dorsal scapular nerve (predominantly C5). - All of these nerve roots originate well above the level of injury, so this muscle would not be affected.

Question 10: The lower two thirds of the following hematoxylin and eosin stained specimen is similar in appearance to which of the following structures?

A. Articular disk
B. Pinna
C. Epiphyseal growth plate
D. Intervertebral disk (Correct Answer)

Explanation: ***Intervertebral disk*** - The lower two-thirds of the specimen shows **hyaline-like cartilage** that histologically resembles the **transition zone** of the intervertebral disk, where the inner annulus fibrosus transitions from the nucleus pulposus. - While the nucleus pulposus itself is gelatinous and notochordal in origin, the **inner annulus fibrosus** contains fibrocartilage with regions that can appear similar to hyaline cartilage, particularly in the transitional zones. - The specimen's appearance, with **chondrocytes in lacunae** within a relatively homogeneous matrix, matches the cartilaginous components found in intervertebral disk structure. *Articular disk* - Articular disks are composed predominantly of **fibrocartilage**, characterized by **dense parallel collagen fiber bundles** clearly visible in the matrix and chondrocytes arranged in linear rows between collagen bundles. - The homogeneous matrix appearance in the specimen lacks the prominent fibrous architecture typical of articular disks. *Pinna* - The pinna (external ear) is supported by **elastic cartilage**, which contains abundant **elastic fibers** in its extracellular matrix providing flexibility and resilience. - With H&E staining, elastic cartilage would show a more textured matrix, and special stains would demonstrate extensive elastic fiber networks not present in this specimen. *Epiphyseal growth plate* - While the epiphyseal growth plate consists of **hyaline cartilage**, it exhibits highly characteristic **zonal organization**: resting zone, proliferative zone (with columnar arrangement), hypertrophic zone, and zone of calcification. - The specimen lacks the distinct columnar arrangement and zonal stratification that defines an active epiphyseal growth plate.

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