Spine Disorders Practice Questions

Q: Which of the following is NOT an X-ray finding of Rheumatoid Arthritis?

Periarticular new bone formation. **Explanation:** Rheumatoid Arthritis (RA) is primarily an **inflammatory, erosive** polyarthritis. The hallmark of the disease is synovial hypertrophy (pannus formation) which leads to the destruction of articular cartilage and bone. **Why "Periarticular new bone formation" is the correct answer:** In RA, the inflammatory process is destructive rather than osteoblastic. **Periarticular osteopenia** (decreased bone density) is a classic finding due to increased local blood flow and cytokine activity. In contrast, **new bone formation** (such as osteophytes, subchondral sclerosis, or involucrum) is characteristic of degenerative conditions like Osteoarthritis or infective conditions like Osteomyelitis, but is notably absent in RA. **Analysis of Incorrect Options:** * **Soft tissue swelling:** This is the earliest radiographic sign of RA, representing active synovitis and effusion. * **Reduced joint space:** As the pannus destroys the articular cartilage, the space between the bone ends narrows symmetrically. * **Subchondral cysts (Geodes):** These occur when synovial fluid is forced into the bone through surface erosions, creating radiolucent pockets. **NEET-PG High-Yield Pearls:** 1. **Earliest Sign:** Soft tissue swelling. 2. **Earliest Bone Sign:** Periarticular osteopenia (juxta-articular rarefaction). 3. **Pathognomonic Finding:** Marginal erosions (Rat-bite erosions) at the "bare areas" of the bone. 4. **Spine Involvement:** RA characteristically involves the **Cervical Spine** (specifically Atlanto-axial subluxation); it notably spares the Thoracic and Lumbar spine. 5. **Key Distinction:** Osteoarthritis shows subchondral sclerosis and osteophytes; RA shows osteopenia and no new bone formation.

Q: Which of the following is a poor prognostic indicator of Pott's paraplegia?

Healed disease. **Explanation:** Pott’s paraplegia (spinal tuberculosis with neurological deficit) is classified into two types based on the timing of onset relative to disease activity. The prognosis depends significantly on the underlying pathology causing cord compression. **Why "Healed Disease" is the correct answer:** Late-onset paraplegia occurring in **healed disease** carries a poor prognosis. In these cases, the compression is usually caused by **permanent structural changes** such as a sharp "internal kyphosis" (bony ridge), spinal stenosis, or dense pachymeningitis (fibrosis of the dura). Since the compression is mechanical and chronic rather than inflammatory, it does not respond to Anti-Tubercular Therapy (ATT) and often requires complex surgical decompression with limited neurological recovery. **Analysis of Incorrect Options:** * **Early onset & Active disease:** These occur during the peak of the infection. The compression is typically due to "soft" factors like inflammatory edema, abscess (cold abscess), or granulation tissue. These respond excellently to ATT and rest, leading to a **good prognosis**. * **Wet lesion:** This refers to an active lesion with significant pus/abscess formation. While it sounds severe, "wet" lesions are easier to evacuate surgically or treat with medication compared to "dry" (fibrous/bony) lesions, thus carrying a **better prognosis** than healed disease. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Thoracic spine (narrowest canal, highest risk of paraplegia). * **First clinical sign:** Spasticity and increased deep tendon reflexes (UMN lesion). * **Girdlestone’s Classification:** Differentiates early-onset (active) from late-onset (healed) paraplegia. * **Surgery Indication:** If there is no neurological improvement after 3–4 weeks of conservative treatment (ATT), surgery (Anterolateral decompression) is indicated.

Q: Which of the following is NOT true about spinal tuberculosis?

Exaggerated lumbar lordosis is a characteristic feature.. **Explanation:** Spinal tuberculosis (Pott’s disease) typically involves the destruction of the anterior portion of the vertebral bodies and the intervening disc space. **1. Why Option C is the correct answer (False statement):** In spinal TB, the destruction and collapse of the anterior vertebral bodies lead to a **Kyphotic deformity** (Gibbus or hunchback), not an exaggerated lumbar lordosis. As the anterior column collapses, the spine bends forward. Lumbar lordosis is actually **lost or flattened** as a compensatory mechanism or due to muscle spasms in the early stages. **2. Analysis of Incorrect Options (True statements):** * **Option A:** **Back pain** is indeed the earliest and most common presenting symptom, often accompanied by localized tenderness and stiffness (night cries in children). * **Option B:** The **dorsolumbar (thoracolumbar) junction** (T12-L1) is the most common site of involvement, followed by the lumbar spine. * **Option C:** Spinal TB is almost always **secondary** to a primary focus elsewhere in the body, most commonly the **lungs** (via hematogenous spread through Batson’s venous plexus) or lymph nodes. **Clinical Pearls for NEET-PG:** * **Paradiscal type:** The most common pattern where the infection starts in the subchondral bone and crosses the disc space. * **Cold Abscess:** A hallmark of Pott's disease; it lacks the traditional signs of inflammation (heat, redness). In the lumbar region, it may track down the psoas muscle sheath (**Psoas abscess**). * **Neurological Deficit:** Pott’s paraplegia is the most serious complication, often caused by pressure from an abscess, granulation tissue, or bony sequestra. * **Radiology:** The earliest sign is narrowing of the disc space and blurring of the vertebral endplates.

Q: A 42-year-old male presents with frequent attacks of joint pain. An X-ray reveals soft tissue swelling. What is the most likely diagnosis?

Gout. ### Explanation **Correct Answer: A. Gout** **Why it is correct:** Gout is a crystal-induced arthropathy characterized by recurrent, episodic attacks of acute joint pain (typically the first metatarsophalangeal joint). In the early stages of gout, X-rays are often normal or show only **nonspecific soft tissue swelling** around the affected joint due to acute inflammation. As the disease progresses to chronic tophaceous gout, characteristic "punched-out" erosions with overhanging edges (Martel’s sign) appear, but soft tissue swelling remains the earliest radiographic hallmark. **Why the other options are incorrect:** * **B. Parathyroid Adenoma:** This leads to hyperparathyroidism. Radiographic features typically include subperiosteal bone resorption (especially in phalanges), "salt and pepper" skull, and Brown tumors, rather than simple episodic joint pain with soft tissue swelling. * **C. Psoriasis:** Psoriatic arthritis typically presents with "pencil-in-cup" deformities, joint space narrowing, and dactylitis ("sausage digit"). While it causes swelling, the clinical history of "frequent attacks" and the classic radiographic presentation differ from gout. * **D. Rheumatoid Arthritis:** This is characterized by symmetrical small joint involvement, periarticular osteopenia, and marginal erosions. While soft tissue swelling occurs, the chronicity and symmetry distinguish it from the episodic nature of gout. **High-Yield NEET-PG Pearls:** * **Earliest X-ray sign of Gout:** Soft tissue swelling. * **Pathognomonic X-ray sign:** Punched-out erosions with overhanging margins (**Martel’s sign** or Gouty hooks). * **Gold Standard Diagnosis:** Demonstration of **negatively birefringent, needle-shaped** monosodium urate crystals under polarized microscopy. * **Joint of choice:** The first MTP joint is the most common site (**Podagra**).

Q: A 22-year-old man presents with low back pain and stiffness, which have progressively worsened over several months. He also reports nocturnal stiffness and hip pain. Physical examination reveals paravertebral muscle tenderness and limited lumbar spine flexion. Radiographic findings of the lumbar spine are shown. What is the most likely diagnosis?

Ankylosing spondylitis. ***Ankylosing spondylitis*** - Progressive **low back pain** and **stiffness** with **nocturnal symptoms** in a young male, along with **limited lumbar spine flexion**, are classic features of ankylosing spondylitis. - Radiographic findings typically show **sacroiliac joint involvement** and may progress to the characteristic **"bamboo spine"** appearance due to syndesmophyte formation. *Reiter syndrome* - Also known as **reactive arthritis**, typically follows **genitourinary** or **gastrointestinal infections** and presents with the classic triad of **arthritis**, **conjunctivitis**, and **urethritis**. - Usually affects **peripheral joints** asymmetrically rather than causing progressive spinal involvement with characteristic radiographic changes. *Marfan syndrome* - A **connective tissue disorder** characterized by **tall stature**, **arachnodactyly**, **lens dislocation**, and **cardiovascular abnormalities** like aortic root dilatation. - Does not typically cause **inflammatory back pain** or the specific radiographic spinal changes seen in spondyloarthropathies. *Rheumatoid arthritis* - Primarily affects **small joints** of the hands and feet in a **symmetric pattern**, with morning stiffness that improves throughout the day. - Associated with **positive rheumatoid factor** and **anti-CCP antibodies**, and does not typically cause the characteristic spinal fusion seen in ankylosing spondylitis.

Q: Which of the following is not a feature of Tuberculosis of the spine?

Exaggerated lumbar lordosis. **Explanation:** Spinal Tuberculosis (Pott’s Disease) typically involves the destruction of the anterior portion of the vertebral bodies. This leads to a **loss of lumbar lordosis** rather than an exaggeration of it. **Why "Exaggerated lumbar lordosis" is the correct answer (The False Statement):** In TB spine, the destruction and collapse of the anterior vertebral body cause the spine to bend forward, leading to **Kyphosis** (Gibbus deformity). In the lumbar region, the normal inward curve (lordosis) is first flattened and then reversed. Exaggerated lordosis is typically seen in conditions like spondylolisthesis or pregnancy, not in spinal infections. **Analysis of Incorrect Options (True Features of TB Spine):** * **Back pain:** This is the **earliest and most common** presenting symptom. It is usually dull, aching, and localized to the site of involvement. * **Stiffness of the back:** This occurs due to protective paravertebral muscle spasms. Patients often exhibit the "Coin Test" positive (bending at the knees instead of the waist to pick up an object). * **Cold abscess:** A hallmark of TB, these are collections of liquefactive necrosis and debris that lack the typical signs of acute inflammation (heat, redness). They can track along tissue planes (e.g., Psoas abscess). **NEET-PG High-Yield Pearls:** * **Most common site:** Lower Thoracic and Upper Lumbar vertebrae. * **First radiological sign:** Paradoxical expansion of the disc space (rare) followed by **narrowing of the disc space** and erosion of the subchondral bone. * **Paradiscal type:** The most common pattern of involvement (affects adjacent vertebrae and the intervening disc). * **Gold Standard Investigation:** MRI is the investigation of choice for early diagnosis and assessing neurological involvement.

Q: What is the investigation of choice for a lumbar prolapsed disc?

MRI. **Explanation:** **MRI (Magnetic Resonance Imaging)** is the investigation of choice (Gold Standard) for a lumbar prolapsed intervertebral disc (PIVD). The primary reason is its superior **soft-tissue contrast resolution**, which allows for clear visualization of the nucleus pulposus, the annulus fibrosus, and the relationship between the herniated disc material and neural structures (thecal sac and nerve roots). It is non-invasive and does not involve ionizing radiation. **Analysis of Incorrect Options:** * **X-ray:** This is the initial screening tool. While it can show indirect signs like disc space narrowing or rule out bony pathologies (fractures, tumors), it cannot visualize the disc itself or neural compression. * **CT Scan:** Excellent for assessing bony anatomy and lateral recess stenosis. However, it has poor soft-tissue resolution compared to MRI and involves significant radiation. It is usually reserved for patients with contraindications to MRI (e.g., pacemakers). * **Myelogram:** An invasive procedure involving the injection of contrast into the subarachnoid space. It was the gold standard in the pre-MRI era but is now rarely used except in specific cases of "CT Myelography" when MRI is unavailable or inconclusive. **Clinical Pearls for NEET-PG:** * **Most common level of Lumbar PIVD:** L4-L5, followed by L5-S1. * **Most common direction of protrusion:** Posterolateral (due to the thinning of the Posterior Longitudinal Ligament). * **Rule of Nerve Root Involvement:** In a posterolateral protrusion, the **traversing (lower) nerve root** is typically compressed (e.g., L4-L5 disc affects the L5 root). * **Emergency Indication:** Immediate MRI and surgery are required if **Cauda Equina Syndrome** (saddle anesthesia, bladder/bowel dysfunction) is suspected.

Question 1

Which of the following is NOT an X-ray finding of Rheumatoid Arthritis?

Accepted Answer

Periarticular new bone formation

Answer

Reduced joint space

Answer

Soft tissue swelling

Answer

Subchondral cyst

Question 2

Which of the following is a poor prognostic indicator of Pott's paraplegia?

Accepted Answer

Healed disease

Answer

Early onset

Answer

Active disease

Answer

Wet lesion

Question 3

Which of the following is NOT true about spinal tuberculosis?

Accepted Answer

Exaggerated lumbar lordosis is a characteristic feature.

Answer

Back pain is the earliest symptom.

Answer

The dorsolumbar spine is the commonest site.

Answer

It is usually secondary to lung infection.

Question 4

When do you operate for a prolapsed disc?

Accepted Answer

When there is severe pain interfering with activity and not relieved by rest and treatment for 8 weeks.

Answer

When a busy executive requires quick surgery.

Answer

Only when there is weakness but no pain.

Answer

In a patient with cauda equina syndrome and difficulty in ambulation.

Question 5

A 42-year-old male presents with frequent attacks of joint pain. An X-ray reveals soft tissue swelling. What is the most likely diagnosis?

Accepted Answer

Gout

Answer

Parathyroid adenoma

Answer

Psoriasis

Answer

Rheumatoid arthritis

Question 6

A 22-year-old man presents with low back pain and stiffness, which have progressively worsened over several months. He also reports nocturnal stiffness and hip pain. Physical examination reveals paravertebral muscle tenderness and limited lumbar spine flexion. Radiographic findings of the lumbar spine are shown. What is the most likely diagnosis?

Accepted Answer

Ankylosing spondylitis

Answer

Reiter syndrome

Answer

Marfan syndrome

Answer

Rheumatoid arthritis

Question 7

In a patient with cervical disc prolapse, what is the recommended management?

Accepted Answer

Immediate surgery to prevent neurological complications

Answer

Immediate restrictive exercises

Answer

Skeletal traction and manipulation

Answer

Medical management only

Question 8

Which of the following is not a feature of Tuberculosis of the spine?

Accepted Answer

Exaggerated lumbar lordosis

Answer

Back pain as the earliest symptom

Answer

Stiffness of the back

Answer

Cold abscess

Question 9

Which of the following is FALSE regarding Charcot's joint in diabetes mellitus?

Accepted Answer

Total ankle replacement

Answer

Limitation of movements with bracing

Answer

Arthrodesis

Answer

Arthrocentesis

Question 10

What is the investigation of choice for a lumbar prolapsed disc?

Accepted Answer

MRI

Answer

X-ray

Answer

CT Scan

Answer

Myelogram

Spine Disorders — MCQs

Spine Disorders — MCQs

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