Spine Disorders Practice Questions

Q: Jefferson fracture is:

C1 fracture. ***C1 fracture*** - A **Jefferson fracture** specifically refers to a **burst fracture** of the first cervical vertebra (C1), also known as the **atlas**. - This type of fracture typically results from an **axial loading injury**, such as diving headfirst into shallow water, causing forces to be transmitted through the occipital condyles to the lateral masses of C1. *Atlanto- axial dislocation* - This involves the **dislocation** of the joint between the atlas (C1) and the axis (C2), which is distinct from a C1 fracture. - While a Jefferson fracture can sometimes be associated with instability at the atlanto-axial joint, it is not the primary definition of the fracture itself. *Fracture of talus* - The **talus** is a bone in the **foot**, and its fracture is completely unrelated to the cervical spine or a Jefferson fracture. - Fractures of the talus typically result from high-impact injuries and affect ankle and foot function. *C2 fracture* - A **C2 fracture** or **axis fracture** can take various forms, such as a **Hangman's fracture** (bilateral pedicle fractures). - While it's an injury to a cervical vertebra, it is distinct from a C1 fracture and has different mechanisms and implications.

Q: A patient presents with a burning sensation in the middle finger and weak triceps reflex. Which cervical disc level is most likely involved?

C6-C7. ***C6-C7*** - Compression at the **C7 nerve root** (typically C6-C7 disc level) causes a burning sensation and paresthesia in the **middle finger**. - A **weak triceps reflex** (C7-C8 reflex) is a key indicator of C7 nerve root involvement. *C3-C4* - Compression at the C4 nerve root typically presents with neck pain radiating to the **posterior neck** and **shoulder blade**, without significant finger paresthesia or triceps reflex changes. - While it can cause sensory disturbances, these are usually referred to the shoulder and upper arm, not specifically the middle finger. *C2-C3* - Compression at the C3 nerve root primarily causes signs and symptoms in the **neck** and **occipital region**, possibly with some **headache**. - It does not typically involve motor or sensory deficits in the upper extremity, especially the triceps reflex or middle finger. *C5-C6* - Compression at the C6 nerve root (typically C5-C6 disc level) would primarily affect the **biceps reflex** and cause sensory symptoms in the **thumb** and **index finger**. - It would not typically cause a weak triceps reflex or paresthesia in the middle finger.

Q: Prolapsed intervertebral Disc (PID) is most common at -

L5-S1. ***L5-S1*** - The **L5-S1** disc is most frequently affected due to its location at the junction of the **lumbar spine** and the relatively immobile **sacrum**, leading to high biomechanical stress. - This level experiences significant forces during bending and lifting, making it vulnerable to **disc herniation**. *L2-L4* - While disc prolapse can occur at these levels, it is **less common** than at the lower lumbar segments like L5-S1. - The L2-L4 discs are under less mechanical stress compared to the lower lumbar and lumbosacral junctions. *C5-C6* - This level is a common site for cervical disc prolapse, but the question generally refers to the **overall most common site** for PID, which is in the lumbar region. - Cervical disc prolapse at C5-C6 typically presents with **neck pain** and **radiculopathy** affecting the upper extremities. *C2-C3* - Disc prolapse at this level is **rare** due to the relatively small range of motion and protective musculature in the upper cervical spine. - When it does occur, it can cause severe symptoms including **myelopathy** due to spinal cord compression.

Q: 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:

L4 - L5 Disc prolapsed. ***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.

Q: The given test is used for-

Prolapsed intervertebral disc. ***Prolapsed intervertebral disc*** - This test, likely referring to the **straight leg raise test** (Lasègue's sign), is a classic maneuver used to assess for **nerve root irritation** due to a prolapsed intervertebral disc. - A positive test reproduces radicular pain (sciatica) when the hip is flexed with the knee extended, stretching the **sciatic nerve**. *Hip injury* - While some hip conditions might cause pain during movement, the straight leg raise test is not a primary diagnostic for **structural hip injuries** like fractures or labral tears. - Specific orthopedic tests such as the **Faber test** (Flexion, ABduction, External Rotation) are more indicative of hip joint pathology. *Ankle injury* - Ankle injuries primarily involve the joint itself, tendons, and ligaments around the ankle. - Diagnostic tests for ankle injuries typically focus on palpation, range of motion, and **ligamentous stress tests** (e.g., anterior drawer test for the anterior talofibular ligament). *None of the options* - This option is incorrect because the straight leg raise test is a well-established and important clinical test for diagnosing **lumbar radiculopathy** caused by a prolapsed intervertebral disc.

Q: What is the most common cause of a single vertebral collapse?

Metastasis. Metastasis - Metastatic disease is the leading cause of a single vertebral collapse, especially in older adults, due to the preferential vascularity of the spine [1]. - The vertebral body is a common site for secondary spread of cancers, such as those originating from the breast, prostate, lung, and kidney [3]. Trauma - While trauma can cause vertebral collapse, it typically results from significant force and may involve multiple contiguous vertebrae or present with other signs of injury [1]. - Traumatic vertebral fractures are more common in younger individuals or in severe accidents, whereas metastasis is more prevalent in a single vertebral collapse in the absence of significant trauma. Tuberculosis - Pott's disease (tuberculous spondylitis) can cause vertebral collapse, but it often involves multiple adjacent vertebrae and disc spaces [2]. - It usually presents with constitutional symptoms like fever, night sweats, and weight loss, which are not implied by "single vertebral collapse" alone. All of the options - While all listed conditions can cause vertebral collapse, metastasis is statistically the most frequent cause for a single vertebral collapse, making this option incorrect. - This choice fails to identify the most common primary etiology and is thus not the best answer.

Q: Tuberculosis of the spine commonly affects all of the following parts of the vertebra except:

Spinous process. ***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.

Q: Block vertebrae are seen in

Klippel-Feil syndrome. ***Klippel-Feil syndrome*** - **Block vertebrae** are a hallmark feature of **Klippel-Feil syndrome**, characterized by the **congenital fusion of two or more cervical vertebrae**. - This fusion results from a failure of normal segmentation of the cervical somites during early embryonic development. *Paget's disease* - Characterized by **disorganized bone remodeling**, leading to thickened, enlarged, and often deformed bones. - While it can affect the spine, it causes **osteosclerosis** and **vertebral expansion**, not congenital fusion or block vertebrae. *Leukemia* - A malignancy of white blood cells that can infiltrate bone marrow, leading to **osteopenia**, **lytic lesions**, or **osteosclerosis**. - It does not directly cause the congenital fusion of vertebrae or formation of block vertebrae. *TB* - **Tuberculosis (TB) of the spine**, also known as **Pott's disease**, causes **vertebral destruction**, **collapse**, and **kyphosis**. - Although it can lead to reactive bone formation, it is an infectious process that destroys and sometimes fuses vertebrae secondarily due to healing, not congenital block formation.

Q: All of the following are the classical presentation of Craniovertrebral junction anomalies except

Pupillary asymmetry. ***Pupillary asymmetry*** - While some neurological findings can be associated with craniovertebral junction anomalies, **pupillary asymmetry** is not considered a classical presentation. - It usually suggests pathology affecting the **oculomotor nerve** or **sympathetic/parasympathetic pathways** to the eye, which is less directly linked to the structural abnormalities at the craniovertebral junction itself. *Short neck* - A **short neck** is a common external dysmorphic feature associated with various craniovertebral junction anomalies, such as **Klippel-Feil syndrome**, due to vertebral fusion. - This anatomical alteration can limit neck mobility and is often an early indicator of underlying structural issues. *Low hairline* - A **low posterior hairline** is another frequent physical finding in patients with craniovertebral junction abnormalities, particularly in conditions involving cervical vertebral fusions or abnormalities. - It is a visible sign reflecting the altered anatomy and development of the neck and skull base. *Pyramidal signs* - **Pyramidal signs** (e.g., hyperreflexia, spasticity, positive Babinski sign) are crucial neurological indicators of **spinal cord compression** or dysfunction at the craniovertebral junction. - These signs result from compromise of the **corticospinal tracts** due to impingement, commonly seen in conditions like **Chiari malformations** or basilar invagination.

Question 1

Jefferson fracture is:

Accepted Answer

C1 fracture

Answer

Atlanto- axial dislocation

Answer

Fracture of talus

Answer

C2 fracture

Question 2

A patient presents with a burning sensation in the middle finger and weak triceps reflex. Which cervical disc level is most likely involved?

Accepted Answer

C6-C7

Answer

C3-C4

Answer

C2-C3

Answer

C5-C6

Question 3

Prolapsed intervertebral Disc (PID) is most common at -

Accepted Answer

L5-S1

Answer

L2-L4

Answer

C5-C6

Answer

C2-C3

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:

Accepted Answer

L4 - L5 Disc prolapsed

Answer

L3 - IA Disc prolapsed

Answer

L5 fracture

Answer

L5 - SI Disc prolapse

Question 5

The given test is used for-

Accepted Answer

Prolapsed intervertebral disc

Answer

Hip injury

Answer

Ankle injury

Answer

None of the options

Question 6

What is the most common cause of a single vertebral collapse?

Accepted Answer

Metastasis

Answer

Trauma

Answer

Tuberculosis

Answer

All of the options

Question 7

Tuberculosis of the spine commonly affects all of the following parts of the vertebra except:

Accepted Answer

Spinous process

Answer

Lamina

Answer

Body

Answer

Pedicle

Question 8

False about fracture of vertebrae

Accepted Answer

Anterior longitudinal ligament runs along the posterior surface of vertebral bodies

Answer

Fracture dislocation is common in flexion rotation injury

Answer

Chance fracture occurs due to flexion distraction injury

Answer

Wedge compression causes flexion injury

Question 9

Block vertebrae are seen in

Accepted Answer

Klippel-Feil syndrome

Answer

Pagets disease

Answer

Leukemia

Answer

TB

Question 10

All of the following are the classical presentation of Craniovertrebral junction anomalies except

Accepted Answer

Pupillary asymmetry

Answer

Short neck

Answer

Low hairline

Answer

Pyramidal signs

Spine Disorders — MCQs

Spine Disorders — MCQs

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