Spine Disorders Practice Questions

Q: A 60-year-old man with treated TB 1 year ago presents with low back pain. MRI spine shows a lesion. What is the most appropriate next investigation?

Mantoux test. ***Mantoux test*** - In a patient with a history of treated tuberculosis presenting with a new spinal lesion, reactivation or reinfection must be considered, and the **Mantoux test** (or Tuberculin Skin Test) helps assess the patient's immune response to Mycobacterium tuberculosis. - While the Mantoux test helps guide the clinical suspicion, a **positive test** in a previously treated patient requires careful clinical correlation to distinguish between old immunity and active disease. *CECT spine* - A **CECT spine** generally provides less soft-tissue resolution compared to an MRI, which has already been performed in this case. - Further imaging with contrast is usually focused on the extent of the disease or planning for intervention rather than the primary next diagnostic step in this context. *CT chest* - While **CT chest** may show old healed TB foci or reactivation, it is not the next most appropriate step to characterize the specific spinal lesion presenting as back pain. - It is a secondary investigation to rule out pulmonary involvement but does not directly diagnose the spinal pathology. *Biopsy* - Although **histopathology** via biopsy is the gold standard for a definitive diagnosis of Pott's spine or suspected malignancy, it is an invasive procedure generally reserved for cases where prior non-invasive testing or clinical suspicion remains unresolved. - In the initial diagnostic workup for a suspected tuberculous spinal lesion, less invasive investigations are prioritized before proceeding to surgical intervention.

Q: Which of the following is NOT a clinical feature of Tuberculosis of the Spine?

Weight gain. **Explanation:** Tuberculosis (TB) of the spine, also known as **Pott’s Disease**, is a chronic granulomatous infection caused by *Mycobacterium tuberculosis*. Understanding its systemic and local manifestations is crucial for NEET-PG. **Why "Weight Gain" is the correct answer:** Tuberculosis is a **chronic catabolic state**. The body’s immune response to the infection increases the basal metabolic rate, leading to significant **weight loss** and anorexia (loss of appetite). Therefore, weight gain is clinically inconsistent with a diagnosis of active spinal TB. **Analysis of other options:** * **Loss of lordosis (Option A):** This is a classic early sign. The infection typically affects the anterior part of the vertebral body, leading to bone destruction and collapse. This causes the normal inward curve (lordosis) of the cervical or lumbar spine to straighten or reverse, eventually leading to a **kyphotic deformity (Gibbus)**. * **Night sweats (Option B) & Evening rise of temperature (Option D):** These are hallmark **constitutional symptoms** of TB. They are mediated by cytokines like TNF-alpha and Interleukins released during the chronic inflammatory process. **High-Yield Clinical Pearls for NEET-PG:** 1. **Most common site:** Lower thoracic and upper lumbar vertebrae (Thoracolumbar junction). 2. **Earliest sign:** Loss of joint space (disc space narrowing) on X-ray, though the disc is initially spared as it is avascular. 3. **Paradiscal type:** The most common pattern of involvement where the infection starts in the metaphysis and spreads under the anterior longitudinal ligament. 4. **Cold Abscess:** A collection of pus without the typical signs of inflammation (heat/redness), often presenting as a psoas abscess in lumbar TB.

Q: Flowing wax appearance on anterior and posterior borders of vertebrae with normal intervertebral disc space, occurring due to ligament calcification, is seen in which condition?

Diffuse idiopathic skeletal hypertrophy. **Explanation:** The correct answer is **Diffuse Idiopathic Skeletal Hypertrophy (DISH)**, also known as Forestier’s disease. **1. Why DISH is correct:** DISH is a non-inflammatory systemic condition characterized by the ossification of ligaments and entheses. The hallmark radiological feature is the **"flowing wax"** or **"melted candle wax"** appearance, caused by the ossification of the **Anterior Longitudinal Ligament (ALL)**. * **Key Diagnostic Criteria:** * Involvement of at least four contiguous vertebral bodies. * **Preservation of intervertebral disc height** (unlike degenerative disc disease). * **Absence of sacroiliac (SI) joint involvement** (distinguishes it from Ankylosing Spondylitis). **2. Why other options are incorrect:** * **Ankylosing Spondylitis (AS):** Characterized by thin, vertical **syndesmophytes** (Bamboo spine) and mandatory **SI joint involvement** (sacroiliitis). It involves the destruction of disc spaces and is an inflammatory condition (HLA-B27 positive). * **Psoriatic Spondyloarthropathy:** Features asymmetric, coarse, and bulky non-marginal syndesmophytes. It usually presents with skin lesions and "pencil-in-cup" deformities in peripheral joints. * **Rheumatoid Arthritis:** Primarily affects the cervical spine (atlantoaxial subluxation). It does not cause flowing calcification of the thoracolumbar ligaments and typically spares the rest of the spine. **3. High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in elderly males (>50 years). * **Metabolic Association:** Strongly associated with **Diabetes Mellitus** and obesity. * **Clinical Presentation:** Often asymptomatic or presents with stiffness; large cervical osteophytes may rarely cause **dysphagia**. * **Radiology Tip:** If you see "Bamboo spine," think AS; if you see "Flowing wax" with normal discs and normal SI joints, think DISH.

Q: A 45-year-old male presents with bilateral hip pain and restricted range of motion for the past 8 months. He has a history of long-term corticosteroid use for rheumatoid arthritis. The X-ray is shown below. What is the most likely diagnosis?

Bilateral femoral-head osteonecrosis. The radiograph demonstrates bilateral femoral-head osteonecrosis with subchondral collapse, characterized by flattening and sclerosis of both femoral heads. In this clinical context — a middle-aged male on long-term corticosteroid therapy — corticosteroid-induced avascular necrosis (AVN) is the most likely etiology. Corticosteroids cause osteonecrosis through a multifactorial mechanism involving marrow fat-cell hypertrophy, increased intraosseous pressure, endothelial injury, and thrombosis, all of which impair femoral-head perfusion and lead to ischemia and subsequent bone death. Bilateral involvement is a hallmark feature of steroid-induced AVN. The radiographic findings of subchondral lucency (crescent sign), femoral head flattening, and increased sclerosis are consistent with advanced-stage osteonecrosis.

Q: Which of the following is NOT true regarding Scheuermann's osteochondritis?

Autosomal recessive inheritance. **Scheuermann’s Disease** (Juvenile Kyphosis) is a developmental disorder of the spine characterized by a structural increase in thoracic or thoracolumbar kyphosis. ### **Explanation of Options** * **Option B (Correct Answer):** The inheritance pattern of Scheuermann's disease is **Autosomal Dominant** with variable expressivity, not autosomal recessive. This makes Option B the false statement. * **Option A:** **Dorsal kyphosis** is the hallmark clinical feature. Unlike postural kyphosis, this is a "fixed" deformity (rigid) that becomes more apparent on the forward bending test (Adam’s test). * **Option C:** The condition typically presents in **adolescents** (13–16 years). While some studies suggest a near-equal gender distribution, classic teaching and many clinical series indicate a slight **predominance in boys**. * **Option D:** Pathologically, there is **irregular ossification of the vertebral endplates** and disc space narrowing. This leads to the classic radiographic finding of **Schmorl’s nodes** (herniation of the nucleus pulposus into the vertebral body). ### **NEET-PG High-Yield Pearls** * **Sorensen’s Radiographic Criteria:** Diagnosis requires at least **3 adjacent vertebrae** wedged by **5° or more** each. * **Clinical Sign:** Compensatory cervical and lumbar hyperlordosis is often present. * **Radiological Signs:** 1. **Schmorl’s nodes** (protrusion of disc into the vertebral body). 2. **Limbus vertebrae** (bone fragment at the anterior-superior edge of the vertebral body). 3. **Wedging** of vertebral bodies. * **Management:** Conservative (exercises/bracing) for curves 70–75° or progressive neurological deficits.

Question 1

A 60-year-old man with treated TB 1 year ago presents with low back
pain. MRI spine shows a lesion. What is the most appropriate next
investigation?

Accepted Answer

Mantoux test

Answer

CECT spine

Answer

CT chest

Answer

Biopsy

Question 2

Which of the following is NOT a clinical feature of Tuberculosis of the Spine?

Accepted Answer

Weight gain

Answer

Loss of lordosis

Answer

Night sweats

Answer

Evening rise of temperature

Question 3

Flowing wax appearance on anterior and posterior borders of vertebrae with normal intervertebral disc space, occurring due to ligament calcification, is seen in which condition?

Accepted Answer

Diffuse idiopathic skeletal hypertrophy

Answer

Ankylosing spondylitis

Answer

Psoriatic spondyloarthropathy

Answer

Rheumatoid arthritis

Question 4

A 45-year-old male presents with bilateral hip pain and restricted range of motion for the past 8 months. He has a history of long-term corticosteroid use for rheumatoid arthritis. The X-ray is shown below. What is the most likely diagnosis?

Accepted Answer

Bilateral femoral-head osteonecrosis

Answer

Idiopathic osteonecrosis

Answer

Bilateral degenerative osteoarthritis

Answer

Neurofibromatosis

Question 5

Which of the following is NOT true regarding Scheuermann's osteochondritis?

Accepted Answer

Autosomal recessive inheritance

Answer

Dorsal kyphosis

Answer

Predominantly affects adolescent boys

Answer

Irregular ossification of vertebral endplates

Spine Disorders — MCQs

Spine Disorders — MCQs

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