Spinal Deformities — MCQs
A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
What is the angle shown in the image known as?
Which imaging modality is least helpful for the diagnosis of spondylolisthesis?
Vertebra Plana is associated with all of the following conditions except -
Which of the following is least likely to be associated with progressive congenital scoliosis?
Anterolateral decompression is primarily indicated for
A 69-year-old man has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is the most likely diagnosis?
In which condition is the Milwaukee Brace primarily used?
How is the degree of deformity in scoliosis calculated?
Condition in which there is anterior or posterior displacement of a vertebra in relation to the vertebrae below:
Spinal Deformities Indian Medical PG Practice Questions and MCQs
Question 1: A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
- A. Bohler's Angle
- B. Ferguson's Angle
- C. Cobb's Angle (Correct Answer)
- D. Pauwels' Angle
Explanation: **Cobb's Angle** - **Cobb's angle** is the primary method for measuring the severity of **scoliosis** on radiographs. - It is measured by drawing lines parallel to the superior endplate of the most tilted superior vertebra and the inferior endplate of the most tilted inferior vertebra of the curve; the angle between these two lines (or their perpendiculars) is the Cobb angle. *Bohler's Angle* - **Bohler's angle** is used in the assessment of **calcaneus fractures** and is measured on a lateral foot radiograph. - A decrease in this angle is indicative of a calcaneal fracture. *Ferguson's Angle* - **Ferguson's angle**, also known as the lumbosacral angle, measures the inclination of the sacrum relative to the horizontal in the standing position. - It is primarily used in the assessment of **spondylolisthesis** and other lumbosacral conditions. *Pauwels' Angle* - **Pauwels' angle** is used to classify **femoral neck fractures** based on the angle of the fracture line relative to the horizontal. - It helps determine the severity and stability of femoral neck fractures, guiding treatment decisions.
Question 2: What is the angle shown in the image known as?
- A. Cobb angle (Correct Answer)
- B. Bohler angle
- C. Ferguson angle
- D. Baumann angle
Explanation: ***Correct Option: Cobb angle*** - The image displays a method for measuring the angle of a spinal curvature, which is known as the **Cobb angle** - This measurement is routinely used to assess the severity of **scoliosis** by drawing lines parallel to the vertebral endplates at the extreme ends of the curve and then determining the angle between these lines - The Cobb angle is the **gold standard** for quantifying scoliosis and monitoring curve progression *Incorrect Option: Bohler angle* - The **Bohler angle** is a measurement used in the assessment of **calcaneal fractures** - It is formed by two lines drawn on a lateral foot X-ray and is not relevant to spinal deformities *Incorrect Option: Ferguson angle* - The **Ferguson angle**, also known as the lumbosacral angle, measures the angle of the sacral base relative to the horizontal - It describes the degree of **lordosis** and is not used to quantify scoliosis as depicted in the image *Incorrect Option: Baumann angle* - The **Baumann angle** is an important measurement used in pediatric orthopedics to assess the alignment of the **distal humerus** after a supracondylar fracture - It is irrelevant to spinal imaging and curvature assessment
Question 3: Which imaging modality is least helpful for the diagnosis of spondylolisthesis?
- A. MRI
- B. CT
- C. Lateral x-ray of spine
- D. AP x-ray of spine (Correct Answer)
Explanation: ***AP x-ray of spine*** - An **AP (Anterior-Posterior) x-ray** projects the vertebral bodies directly on top of each other, making it very difficult to visualize the **anterior slippage** of one vertebra over another. - The primary diagnostic feature of spondylolisthesis, which is the **forward displacement** of a vertebral body, is best seen in a lateral view where the alignment can be assessed. *Lateral x-ray of spine* - A **lateral x-ray** is typically the **initial and most effective imaging study** for diagnosing spondylolisthesis. - It clearly shows the **forward displacement** of a vertebral body, allowing for grading of the slippage (e.g., Meyerding classification). *MRI* - **MRI (Magnetic Resonance Imaging)** is excellent for evaluating **soft tissue structures** like the spinal cord, nerve roots, and intervertebral discs. - While it can visualize the bony displacement, its primary role in spondylolisthesis is to assess for **nerve root compression** or **spinal canal stenosis**, not the initial diagnosis of the slip itself. *CT* - **CT (Computed Tomography)** provides **detailed bony anatomy** and is superior to plain x-rays for identifying bone defects like **pars interarticularis fractures (spondylolysis)**, which are a common cause of spondylolisthesis. - It can clearly show the **degree of slippage** and evaluate for associated **facet joint arthritis** or **spinal canal narrowing**, but it's not usually the primary screening tool.
Question 4: Vertebra Plana is associated with all of the following conditions except -
- A. Leukemia
- B. Excessive use of systemic steroids
- C. Scheurmanns Disease (Correct Answer)
- D. Histiocytosis X
Explanation: ***Scheurmanns Disease*** - **Scheuermann's disease** is characterized by **vertebral wedging** and **kyphosis**, not a complete flattening of the vertebral body (vertebra plana). - It involves irregularities of the vertebral endplates and Schmorl's nodes, differing from the destructive process seen in vertebra plana. *Histiocytosis X* - **Histiocytosis X** (Langerhans cell histiocytosis) can cause destructive lesions in the vertebral body, leading to its collapse and the appearance of **vertebra plana**. - This condition is common among young children and is associated with eosinophilic granuloma. *Leukemia* - **Leukemic infiltration** of bone marrow can weaken vertebral bodies, causing **osteopenia** and eventual collapse, which may present as vertebra plana. - This is often seen in pediatric patients with acute lymphoblastic leukemia. *Excessive use of systemic steroids* - Long-term or excessive use of **systemic corticosteroids** can lead to **osteoporosis**, which weakens bones and makes vertebral bodies prone to compression fractures and collapse into vertebra plana. - This iatrogenic cause results from the negative impact of steroids on bone formation and increased bone resorption.
Question 5: Which of the following is least likely to be associated with progressive congenital scoliosis?
- A. Hemivertebra
- B. Unilateral unsegmented vertebra with bar
- C. Wedge vertebra (Correct Answer)
- D. Block vertebra
Explanation: ***Wedge vertebra*** - A **wedge vertebra** is a less severe form of vertebral anomaly compared to a hemivertebra, characterized by incomplete formation of the vertebral body on one side. - While it can cause scoliosis, it is significantly **less likely to progress** rapidly or severely compared to anomalies that involve complete lack of formation or fusion. *Hemivertebra* - A **hemivertebra** is a fully unsegmented vertebral body fused to one side of the adjacent segments, leading to a profound congenital deformity and a powerful growth plate on the opposite side. - This imbalance causes a **high likelihood of progression** in congenital scoliosis due to differential growth. *Unilateral unsegmented vertebra with bar* - This anomaly involves a **failure of segmentation** on one side of a vertebral body, creating a "bar" that inhibits growth on that side, while the other side grows normally. - The unrestricted growth on one side coupled with restricted growth on the other creates a significant imbalance, leading to a **high potential for progressive scoliosis**. *Block vertebra* - A **block vertebra** results from a complete failure of segmentation between two or more vertebral bodies along both sides. - While it causes a reduction in vertebral height and potentially some stiffness, it generally leads to **little or no progressive scoliosis** because the growth inhibition is symmetric and balanced on both sides of the spine.
Question 6: Anterolateral decompression is primarily indicated for
- A. Spinal tuberculosis (Pott's disease) (Correct Answer)
- B. Lumbar disc herniation
- C. Ankylosing spondylitis
- D. Spinal metastasis
Explanation: ***Spinal tuberculosis (Pott's disease)*** - **Anterolateral decompression** is crucial for **Pott's disease** to remove infected bone and pus, relieve pressure on the spinal cord, and facilitate fusion. - This approach allows direct access to the anterior spinal column, which is commonly affected by the destructive process of **tuberculosis**. *Spinal metastasis* - While spinal metastasis can cause compression, **anterolateral decompression** is less common as a primary approach; often, surgical treatment involves posterior decompression, stabilization, and adjuvant therapies like radiation. - The goal is often **pain management** and neurological preservation in the context of advanced disease. *Lumbar disc herniation* - **Lumbar disc herniation** is typically addressed by posterior approaches like **microdiscectomy** or laminectomy, which directly access the posterior aspect of the disc. - **Anterolateral decompression** is generally not indicated as the primary treatment for standard disc herniations. *Ankylosing spondylitis* - Surgical intervention in **ankylosing spondylitis** is usually reserved for severe kyphosis or spinal fractures, employing osteotomies and stabilization techniques, often through posterior approaches. - **Anterolateral decompression** is not a standard procedure for the typical manifestations or complications of **ankylosing spondylitis**.
Question 7: A 69-year-old man has an abnormally increased curvature of the thoracic vertebral column. Which of the following conditions is the most likely diagnosis?
- A. Meningocele
- B. Kyphosis (Correct Answer)
- C. Meningomyelocele
- D. Lordosis
Explanation: ***Kyphosis*** - **Kyphosis** is defined as an exaggerated posterior curvature of the **thoracic spine**, often seen in older adults due to **osteoporosis** or degenerative disc disease. - The patient's age and description of an "abnormally increased curvature of the thoracic vertebral column" directly correspond to the definition of **kyphosis**. *Meningocele* - A **meningocele** is a type of **spina bifida** where the meninges protrude through an opening in the spine, forming a sac. - This condition involves a **neural tube defect** and typically presents at birth, not as an acquired condition in a 69-year-old. *Meningomyelocele* - A **meningomyelocele** is a more severe form of **spina bifida** where the spinal cord and meninges protrude through an opening in the spine. - Like meningocele, it is a congenital birth defect and does not present as an abnormally increased spinal curvature in an elderly individual. *Lordosis* - **Lordosis** is an exaggerated anterior curvature, most commonly affecting the **lumbar spine**. - It results in an inward swayback appearance, which is the opposite of an increased posterior curvature of the thoracic spine.
Question 8: In which condition is the Milwaukee Brace primarily used?
- A. Spondylolisthesis
- B. Scheuermann's Disease
- C. Congenital Kyphosis
- D. Adolescent Idiopathic Scoliosis (Correct Answer)
Explanation: ***Adolescent Idiopathic Scoliosis*** - The **Milwaukee Brace** is a widely recognized and historically significant orthotic device used primarily for the non-surgical management of **scoliosis**, particularly **adolescent idiopathic scoliosis**. - It works by applying corrective forces to the spine to prevent further curvature progression and often allows for some correction during growth. *Congenital Kyphosis* - **Congenital kyphosis** is a spinal deformity present at birth, often caused by vertebral malformations, which is typically managed surgically, especially if progressive. - While bracing can be attempted for mild, flexible curves, the Milwaukee Brace is not the primary or most effective treatment for its structural nature. *Scheuermann's Disease* - **Scheuermann's disease** is a form of kyphosis where wedging of the vertebrae causes a rigid, exaggerated forward curvature of the thoracic spine. - While bracing can be used to treat Scheuermann's disease, the **Milwaukee brace** is not the brace of choice. A **kyphosis-specific brace** such as a kyphosis-bifocal brace or a molded thoracolumbar sacral orthosis (TLSO) is typically preferred. *Spondylolisthesis* - **Spondylolisthesis** involves the forward slippage of one vertebra over another, often in the lumbar spine. - Management typically involves activity restriction, physical therapy, and sometimes surgical fusion, with bracing aimed at stabilizing the spine rather than correcting a lateral curve, making the Milwaukee Brace unsuitable.
Question 9: How is the degree of deformity in scoliosis calculated?
- A. Hamburger method
- B. Haldane method
- C. Milwaukee method
- D. Cobb's method (Correct Answer)
Explanation: ***Cobb's method*** - This is the **standard radiographic measurement** used to assess the severity of spinal curvature in scoliosis. - It involves drawing lines along the **most tilted vertebrae** at the ends of the curve and measuring the angle formed by their intersection. *Hamburger method* - This is not a recognized method for calculating the degree of deformity in scoliosis. - There is **no established medical or orthopedic technique** bearing this name for scoliosis assessment. *Haldane method* - This method is primarily used in **biochemistry** to describe **enzyme kinetics** and is unrelated to scoliosis measurement. - It describes the relationship between reaction rates and reactant concentrations in biological systems. *Milwaukee method* - The **Milwaukee brace** is a historical type of orthotic device used to treat scoliosis, but it is not a method for calculating the degree of deformity. - While it is associated with scoliosis treatment, it does not involve the measurement of the curve itself.
Question 10: Condition in which there is anterior or posterior displacement of a vertebra in relation to the vertebrae below:
- A. Spondylitis
- B. Spondylolisthesis (Correct Answer)
- C. Spondylolysis
- D. Spondylosis
Explanation: ***Spondylolisthesis*** - This term specifically refers to the **slippage** (anterior or posterior displacement) of one vertebra relative to an adjacent one. - It often results from conditions like **spondylolysis** (a defect in the pars interarticularis) or degenerative changes. *Spondylitis* - This condition involves **inflammation of the vertebrae**, often seen in diseases like ankylosing spondylitis. - While it can cause pain and stiffness, it does not primarily describe the displacement of one vertebra over another. *Spondylolysis* - This refers to a **defect or stress fracture in the pars interarticularis** of a vertebra. - It is a common *cause* of spondylolisthesis, but not the slippage itself. *Spondylosis* - This is a general term for **degenerative changes** in the spine, including osteoarthritis of the spinal joints and disc degeneration. - It describes age-related wear and tear, not the direct displacement of a vertebra.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free