Spine Disorders Practice Questions

Q: In which of the following conditions does pseudoclaudication occur?

Lumbar canal stenosis. **Explanation:** **Lumbar Canal Stenosis (LCS)** is the correct answer because it is the classic cause of **pseudoclaudication** (also known as neurogenic claudication). This condition occurs due to the narrowing of the spinal canal, which compresses the nerve roots of the cauda equina. During walking or standing, the lumbar spine undergoes extension, further narrowing the canal and increasing venous congestion around the nerve roots. This leads to ischemia of the nerves, manifesting as pain, heaviness, or paresthesia in the lower limbs. **Why the other options are incorrect:** * **Options A and B (Femoral and Popliteal artery stenosis):** These cause **true vascular claudication**. While the symptoms (leg pain on walking) are similar, the underlying mechanism is arterial insufficiency (decreased blood supply to muscles) rather than nerve compression. * **Option D (Radial artery stenosis):** This affects the upper limb and would not present with claudication symptoms in the legs. **Clinical Pearls for NEET-PG:** * **The "Shopping Cart Sign":** Patients with LCS feel relief when leaning forward (flexion), as this increases the functional diameter of the spinal canal. This distinguishes it from vascular claudication. * **Bicycle Test of van Gelderen:** Patients with neurogenic claudication can cycle longer than they can walk because the spine is in a flexed position while cycling. * **Pulses:** In pseudoclaudication, peripheral pulses (Dorsalis pedis/Posterior tibial) are **normal**, whereas they are absent or feeble in vascular claudication. * **Investigation of Choice:** MRI Spine is the gold standard for diagnosing Lumbar Canal Stenosis.

Q: What is the most common cause of acute sciatica?

Acute prolapsed intervertebral disc. **Explanation:** **Correct Answer: C. Acute prolapsed intervertebral disc (PIVD)** Sciatica refers to radiating pain along the distribution of the sciatic nerve (L4-S3), typically caused by compression or irritation of the nerve roots. The **most common cause** of acute sciatica is a **Prolapsed Intervertebral Disc (PIVD)**, specifically at the **L4-L5 or L5-S1** levels. In an acute setting, the nucleus pulposus herniates through the annulus fibrosus, leading to mechanical compression and chemical irritation (via inflammatory mediators like prostaglandin E2) of the adjacent nerve root. **Analysis of Incorrect Options:** * **A. Trauma:** While trauma can cause fractures or dislocations leading to nerve compression, it is a less frequent cause of isolated sciatica compared to degenerative disc disease. * **B. Spinal Metastases:** These typically present with "red flag" symptoms such as nocturnal pain, weight loss, and constitutional symptoms. While they can cause radiculopathy, they are statistically far less common than PIVD. * **C. Tuberculosis of the Spine (Pott’s Disease):** This is a common cause of chronic back pain and paraplegia in developing countries, but it usually presents with cold abscesses or kyphotic deformity (gibbus) rather than acute sciatica. **High-Yield Clinical Pearls for NEET-PG:** * **Most common levels for PIVD:** L4-L5 (most common) followed by L5-S1. * **Lasegue’s Sign (Straight Leg Raising Test):** The most sensitive physical exam finding for L4-S1 nerve root irritation. * **Gold Standard Investigation:** MRI of the Spine. * **Management:** 90% of cases resolve with conservative management (NSAIDs, activity modification). Surgery (Discectomy) is indicated for "Cauda Equina Syndrome" (Surgical Emergency) or progressive neurological deficits.

Q: Adam's test is performed for which of the following?

Differentiating between structural and postural scoliosis. **Explanation:** **Adam’s Forward Bend Test** is the standard clinical screening tool used to differentiate between **structural scoliosis** and **non-structural (postural/functional) scoliosis**. * **The Mechanism:** The patient is asked to bend forward at the waist with feet together and arms hanging down. * In **structural scoliosis**, the vertebral bodies are rotated. This rotation causes the ribs to push posteriorly on the convex side, creating a visible **rib hump**. This deformity persists or becomes more prominent during the forward bend. * In **postural scoliosis**, the curvature is flexible and lacks vertebral rotation; therefore, the spine straightens out and the rib hump disappears upon bending. **Analysis of Incorrect Options:** * **Option A (Thoracic Outlet Syndrome):** This is evaluated using tests like **Adson’s test**, Roo’s test, or Wright’s test, which assess neurovascular compression at the superior thoracic aperture. * **Option C (Perfusion of the hand):** This is assessed using the **Allen’s test**, which checks the patency of the radial and ulnar arteries. * **Option D (Nerve regeneration):** This is monitored using the **Tinel’s sign**, where distal tingling is elicited by percussing over a regenerating nerve trunk (Hoffmann-Tinel sign). **NEET-PG High-Yield Pearls:** * **Scoliometer:** Used during Adam’s test to measure the Angle of Trunk Rotation (ATR). An ATR **>7°** usually warrants radiological evaluation. * **Cobb’s Angle:** The gold standard for quantifying scoliosis on an X-ray. * **Risser’s Sign:** Used to grade skeletal maturity on a pelvic X-ray to predict the risk of scoliosis progression. * **Most common type:** Adolescent Idiopathic Scoliosis (AIS) is the most frequent form, typically presenting with a right-sided thoracic curve.

Q: The following X-ray was taken of a 50-year-old female with chronic backache. What is the most likely diagnosis?

Spondylolisthesis. ***Spondylolisthesis*** - **Anterior vertebral slippage** creating a **step-ladder deformity** on lateral lumbar spine X-ray is pathognomonic for spondylolisthesis. - The **Meyerding grading system** can classify the degree of slippage based on the percentage of vertebral body displacement forward. *Spondylolysis* - Refers to a **pars interarticularis defect** (stress fracture) without vertebral slippage, appearing as a **"collar on Scotty dog"** on oblique views. - Would not show the characteristic **anterior displacement** of one vertebra over another seen in this case. *Spondylosis* - Represents **degenerative changes** including **osteophyte formation** and **disc space narrowing** without vertebral slippage. - X-ray would show **joint space narrowing** and **bone spurs** rather than the step-ladder deformity of vertebral displacement. *Prolapsed inter-vertebral disc* - A **soft tissue abnormality** that is **not directly visible** on plain X-rays and requires MRI for visualization. - May show secondary signs like **reduced disc height** but would not demonstrate the clear **vertebral slippage** pattern seen here.

Q: What condition is characterized by a "wind-swept deformity"?

Rickets. **Explanation:** **Rickets** is the correct answer because it is a metabolic bone disease characterized by deficient mineralization of the osteoid matrix, typically due to Vitamin D deficiency. In a growing child, the softened bones are unable to withstand the mechanical stress of weight-bearing. The **"wind-swept deformity"** occurs when there is a combination of **genu valgum** (knock-knee) in one leg and **genu varum** (bow-leg) in the other, making it appear as if the knees have been blown to one side by the wind. **Analysis of Incorrect Options:** * **Ankylosing Spondylitis:** Characterized by "Bamboo spine" and "Question mark posture" due to progressive spinal fusion and kyphosis, not limb angulation. * **Scurvy:** Presents with subperiosteal hemorrhages and specific radiological signs like the "Wimberger ring" and "Pelkan spur," but does not cause wind-swept limbs. * **Rheumatoid Arthritis:** Typically leads to joint erosions and deformities like "Swan neck" or "Boutonniere" in the hands, rather than the classic wind-swept appearance of the lower limbs seen in metabolic bone disease. **Clinical Pearls for NEET-PG:** * **Radiological signs of Rickets:** Cupping, fraying, and splaying of the metaphysis (most prominent at the distal radius and ulna). * **Harrison’s Sulcus:** A horizontal groove along the lower border of the thorax corresponding to the diaphragmatic attachment, seen in Rickets. * **Rachitic Rosary:** Palpable enlargement of the costochondral junctions. * **Craniotabes:** Softening of the skull bones (earliest sign of Rickets).

Q: Jefferson's fracture involves which cervical vertebra(e)?

C1. **Explanation:** **Jefferson’s fracture** is a classic burst fracture of the **C1 vertebra (Atlas)**. It typically occurs due to a severe axial loading force applied to the top of the head (e.g., diving into a shallow pool or falling from a height onto the head) [1]. Because the Atlas is a ring-shaped bone with thin anterior and posterior arches, the vertical force drives the lateral masses of C1 outward, causing multiple fractures (usually four) through the arches [1]. **Analysis of Options:** * **Option A (C1): Correct.** By definition, a Jefferson fracture specifically involves the ring of the Atlas. * **Option B (C2): Incorrect.** Fractures of the C2 (Axis) are distinct. A fracture of the pars interarticularis of C2 is known as a **Hangman’s fracture**, while fractures of the dens are simply called **Odontoid fractures**. * **Option C & D: Incorrect.** While multiple cervical vertebrae can be injured in high-trauma accidents, the specific eponym "Jefferson’s fracture" refers exclusively to the C1 burst fracture. **Clinical Pearls for NEET-PG:** 1. **Mechanism:** Axial loading (compression) [1]. 2. **Radiology:** On an **Open-mouth (Odontoid) X-ray view**, a Jefferson fracture is identified by the lateral displacement (overhang) of the C1 lateral masses relative to the C2 articular facets. 3. **Stability:** The stability of this fracture depends on the integrity of the **Transverse ligament of the Atlas**. If this ligament is ruptured, the fracture is considered unstable. 4. **Neurology:** Interestingly, patients often remain neurologically intact because the "burst" mechanism actually increases the diameter of the spinal canal, reducing the risk of immediate cord compression.

Q: All of the following are included as yellow flag signs of low back pain, except?

History of systemic steroid use. In the clinical evaluation of low back pain, "Flags" are used to categorize risk factors. The distinction between **Red Flags** and **Yellow Flags** is a high-yield topic for NEET-PG. ### 1. Why "History of systemic steroid use" is the correct answer: **History of systemic steroid use** is a **Red Flag**, not a yellow flag. Red flags indicate serious underlying structural or systemic pathology that requires urgent investigation. Chronic steroid use is a major risk factor for **osteoporotic vertebral compression fractures** and increased susceptibility to spinal infections (e.g., Pott’s disease). ### 2. Analysis of Incorrect Options (Yellow Flags): Yellow flags are **psychosocial factors** that increase the risk of developing chronic pain and long-term disability. * **Reliance on passive treatment (Option B):** Patients who prefer passive modalities (massage, bed rest) over active rehabilitation (exercise) have a poorer prognosis. * **Social isolation (Option C):** Withdrawal from social activities and lack of support systems are strong predictors of chronicity. * **Belief that back pain is severely disabling (Option D):** This is known as **Catastrophizing**. Patients who believe pain is harmful or permanently disabling are less likely to return to work. ### 3. Clinical Pearls for NEET-PG: * **Red Flags (Physical/Structural):** Age >50 or <20, history of malignancy, unexplained weight loss, night pain, saddle anesthesia, bowel/bladder dysfunction (Cauda Equina Syndrome), and fever. * **Yellow Flags (Psychosocial):** Depression, anxiety, fear-avoidance behavior, and job dissatisfaction. * **Blue Flags:** Perceptions about the relationship between work and health (e.g., belief that the job is too demanding). * **Black Flags:** Systemic/Contextual factors (e.g., insurance claims, litigation, or restrictive sick-pay policies).

Q: Injury to which region may result in paraplegia?

Thoracic spine. **Explanation:** The classification of spinal cord injury (SCI) depends on the level of the neurological deficit. **Paraplegia** refers to the impairment or loss of motor and/or sensory function in the thoracic, lumbar, or sacral segments of the spinal cord, resulting in the loss of function in the trunk and legs, but with **preserved function of the upper limbs.** 1. **Why Thoracic Spine is Correct:** The spinal cord ends at the lower border of the L1 vertebra (conus medullaris). An injury to the **Thoracic spine** (T1–T12) involves the spinal cord segments that supply the trunk and lower limbs. Since the brachial plexus (C5–T1) is largely spared, the arms function normally, but the legs are paralyzed, fitting the definition of paraplegia. 2. **Analysis of Incorrect Options:** * **Cervical Spine:** Injury here results in **Quadriplegia (Tetraplegia)** because it affects the nerve roots supplying both the upper and lower extremities. * **Lumbar/Sacral Spine:** Injuries below the L1 level typically involve the **Cauda Equina** (nerve roots) rather than the spinal cord itself. While this causes lower limb weakness, it is clinically distinct from "spinal cord" paraplegia and is often referred to as a Cauda Equina Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Level of Cord Termination:** In adults, the cord ends at **L1-L2**; in infants, it ends at **L3**. * **Most Common Site of Spinal Fracture:** The **Thoracolumbar junction (T12-L1)** is the most common site of injury due to the transition from a rigid thoracic spine to a mobile lumbar spine. * **Autonomic Dysreflexia:** Usually occurs in injuries at or above the **T6** level. * **Diaphragm Function:** Controlled by **C3, C4, C5** (Phrenic nerve); injuries above C3 are fatal without immediate ventilation.

Question 1

In which of the following conditions does pseudoclaudication occur?

Accepted Answer

Lumbar canal stenosis

Answer

Femoral artery stenosis

Answer

Popliteal artery stenosis

Answer

Radial artery stenosis

Question 2

What is the most common cause of acute sciatica?

Accepted Answer

Acute prolapsed intervertebral disc

Answer

Trauma

Answer

Spinal metastases

Answer

Tuberculosis of the spine

Question 3

Adam's test is performed for which of the following?

Accepted Answer

Differentiating between structural and postural scoliosis

Answer

Diagnosis of thoracic outlet syndrome

Answer

Checking the perfusion of the hand

Answer

Checking the progression of nerve regeneration

Question 4

The following X-ray was taken of a 50-year-old female with chronic backache. What is the most likely diagnosis?

Accepted Answer

Spondylolisthesis

Answer

Spondylolysis

Answer

Spondylosis

Answer

Prolapsed inter-vertebral disc

Question 5

What condition is characterized by a "wind-swept deformity"?

Accepted Answer

Rickets

Answer

Ankylosing spondylitis

Answer

Scurvy

Answer

Rheumatoid arthritis

Question 6

Jefferson's fracture involves which cervical vertebra(e)?

Accepted Answer

C1

Answer

C2

Answer

C2 and C1

Answer

C2 and C3

Question 7

All of the following are included as yellow flag signs of low back pain, except?

Accepted Answer

History of systemic steroid use

Answer

Reliance on passive treatment

Answer

Social isolation

Answer

Belief that back pain is severely disabling

Question 8

A person is hit from behind by a scooter. The rider is thrown off and lands with their head hitting the kerb. They do not move, complain of severe pain in the neck, and are unable to turn their head. Well-meaning bystanders attempt to make them sit up. What is the best course of action in this situation?

Accepted Answer

Turn the individual onto their back, place a support behind their neck, and transport them to the nearest hospital.

Answer

Prop the individual up and give them water to drink.

Answer

Do not prop the individual up; turn them onto their face and rush them to the hospital.

Answer

Do not move the individual at all; carry them to the nearest hospital in the same position they have been in since their fall.

Question 9

Trendelenburg test would be positive in which of the following conditions?

Accepted Answer

L4-L5 disc herniation

Answer

L5-S1 disc herniation

Answer

Synovitis of the hip

Answer

Femoroacetabular impingement syndrome

Question 10

Injury to which region may result in paraplegia?

Accepted Answer

Thoracic spine

Answer

Cervical spine

Answer

Lumbar spine

Answer

Sacral spine

Spine Disorders — MCQs

Spine Disorders — MCQs

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