Spine Disorders Practice Questions

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: What is the commonest extradural spinal tumor?

Metastasis. **Explanation:** Spinal tumors are anatomically classified into three compartments based on their relationship to the dura mater and the spinal cord. **Metastasis** is the correct answer because it is the most common tumor involving the spinal column overall and specifically the **extradural** space. **1. Why Metastasis is Correct:** Extradural tumors (located outside the dura) account for approximately 80% of all spinal neoplasms. The vast majority of these are secondary deposits (metastases) from primary cancers, most commonly originating from the **lung, breast, prostate, and kidney**. These tumors typically reach the vertebral bodies via the Batson venous plexus. **2. Analysis of Incorrect Options:** * **Neurofibroma (Option A):** This is the most common **Intradural-Extramedullary** tumor. While it can occasionally have an extradural component (forming a "dumb-bell" shape), its primary classification is intradural. * **Glioma (Option B):** These (specifically Ependymomas and Astrocytomas) are **Intramedullary** tumors, meaning they arise within the substance of the spinal cord itself. Ependymomas are the most common intramedullary tumors in adults. * **Meningioma (Option C):** This is the second most common **Intradural-Extramedullary** tumor, frequently seen in middle-aged women in the thoracic spine. **Clinical Pearls for NEET-PG:** * **Most common spinal tumor overall:** Metastasis (Extradural). * **Most common primary Intradural-Extramedullary tumor:** Neurofibroma (followed by Meningioma). * **Most common Intramedullary tumor (Adults):** Ependymoma. * **Most common Intramedullary tumor (Children):** Astrocytoma. * **Red Flag:** New-onset back pain in an elderly patient with a history of weight loss should always be investigated for spinal metastasis.

Q: Boutonniere deformity involves:

Flexion at the PIP joint and extension at the DIP joint. **Explanation:** The **Boutonniere deformity** is a characteristic finger deformity most commonly seen in Rheumatoid Arthritis or following trauma. The primary pathology is the **rupture or attenuation of the central slip** of the extensor tendon at its insertion on the base of the middle phalanx. 1. **Why Option C is correct:** When the central slip is damaged, the lateral bands of the extensor mechanism slide volarly (towards the palm) past the axis of the PIP joint. These displaced lateral bands now act as flexors of the PIP joint. Simultaneously, the increased tension on these bands at their distal insertion causes **hyperextension of the DIP joint**. Thus, the classic presentation is **PIP flexion and DIP extension**. 2. **Why other options are incorrect:** * **Option A & B:** These describe uniform flexion or extension across both joints, which does not occur in isolated extensor mechanism injuries. * **Option D:** This describes **Swan-neck deformity** (PIP extension and DIP flexion), which is the functional opposite of Boutonniere deformity and is caused by volar plate laxity or terminal extensor tendon rupture (Mallet finger). **High-Yield Clinical Pearls for NEET-PG:** * **Elson’s Test:** The clinical test used to diagnose an acute central slip injury before the deformity becomes fixed. * **Etiology:** Often caused by a "jammed finger" (forced flexion of an actively extended PIP joint) or inflammatory erosion in Rheumatoid Arthritis. * **Management:** Initial treatment usually involves splinting the PIP joint in full extension for 6 weeks while allowing active DIP motion. * **Mnemonic:** **B**outonniere = **B**ent (Flexed) PIP.

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: What is the earliest radiological change in rheumatoid arthritis?

Periaicular osteopenia. **Explanation:** In Rheumatoid Arthritis (RA), the primary pathology is **synovitis**. The inflamed synovium (pannus) releases pro-inflammatory cytokines (like IL-1, IL-6, and TNF-α) and increases local blood flow (hyperemia). This process stimulates osteoclast activity and leads to the resorption of bone minerals in the immediate vicinity of the joint. Therefore, **periarticular osteopenia** (also known as juxta-articular osteoporosis) is the earliest radiological sign, appearing even before structural damage to the cartilage or bone occurs. **Analysis of Incorrect Options:** * **Decreased joint space:** This occurs later in the disease progression as the pannus destroys the articular cartilage. * **Articular erosion:** These are "marginal erosions" that occur at the "bare areas" (where the bone is not covered by cartilage). While characteristic of RA, they appear after the initial osteopenic phase. * **Subchondral cyst:** These are more characteristic of Osteoarthritis (Geodes) due to hydraulic pressure of synovial fluid through cracked cartilage; they are not a primary or early feature of RA. **NEET-PG High-Yield Pearls:** * **Earliest Sign overall:** Periarticular soft tissue swelling. * **Earliest Bone change:** Periarticular osteopenia. * **Most characteristic sign:** Marginal erosions. * **Spine involvement:** RA typically affects the **Cervical Spine** (atlanto-axial subluxation) but characteristically **spares** the Lumbar spine. * **Radiological hallmark:** Symmetrical joint involvement and absence of osteophytes (unlike Osteoarthritis).

Question 1

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 2

What is the commonest extradural spinal tumor?

Accepted Answer

Metastasis

Answer

Neurofibroma

Answer

Glioma

Answer

Meningioma

Question 3

Boutonniere deformity involves:

Accepted Answer

Flexion at the PIP joint and extension at the DIP joint

Answer

Flexion at the proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints

Answer

Extension at the PIP and DIP joints

Answer

Extension at the PIP joint and flexion at the DIP joint

Question 4

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 5

What is the earliest radiological change in rheumatoid arthritis?

Accepted Answer

Periaicular osteopenia

Answer

Decreased joint space

Answer

Articular erosion

Answer

Subchondral cyst

Spine Disorders — MCQs

Spine Disorders — MCQs

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