Radiographic Anatomy of Spine — MCQs
Bamboo spine with sacroilitis -
The spinal nerve pairs are :
False among the following
Which vertebra is known as vertebra prominens due to its long and prominent spinous process:
Which of the following is least useful for diagnosing spondylolisthesis?
Identify the condition shown in the image:
Vertebra Plana is associated with all of the following conditions except -
The best view to visualize zygomatic arches is
Earliest investigation for diagnosis of Ankylosing spondylitis:
A radiograph is obtained from a child with scoliosis. What is the name of the angle used to measure spinal curvature?
Radiographic Anatomy of Spine Indian Medical PG Practice Questions and MCQs
Question 1: Bamboo spine with sacroilitis -
- A. Psoriatic arthritis
- B. Ankylosing spondylitis (Correct Answer)
- C. OA
- D. RA
Explanation: ***Ankylosing spondylitis*** - **Bamboo spine** is a classic radiographic finding in advanced **ankylosing spondylitis**, resulting from ossification of the anulus fibrosus and spinal ligaments [1]. - **Sacroiliitis**, inflammation of the sacroiliac joints, is another hallmark feature and often the earliest radiographic sign of the disease [1], [3]. *Psoriatic arthritis* - While psoriatic arthritis can involve the spine and cause sacroiliitis, it typically presents with **asymmetric involvement** [2] and is less commonly associated with the widespread, progressive ossification characteristic of true "bamboo spine" [4]. - It often also involves **skin psoriasis** and **nail changes**, which are not indicated as the primary finding here [4]. *OA* - **Osteoarthritis (OA)** is a degenerative joint disease characterized by cartilage loss and osteophyte formation, often seen in weight-bearing joints and the spine [2]. - While OA can affect spinal joints and cause stiffness, it does **not cause inflammatory sacroiliitis** or the specific syndesmophyte formation that leads to "bamboo spine." *RA* - **Rheumatoid arthritis (RA)** primarily affects peripheral joints, particularly small joints of the hands and feet, and typically spares the sacroiliac joints and the thoracolumbar spine [2]. - Spinal involvement in RA is usually limited to the **cervical spine**, leading to atlantoaxial subluxation, and does not cause "bamboo spine" or widespread sacroiliitis.
Question 2: The spinal nerve pairs are :
- A. 30
- B. 33
- C. 28
- D. 31 (Correct Answer)
Explanation: ***31*** - There are 31 pairs of **spinal nerves** that emerge from the spinal cord. - These pairs are organized into cervical (8), thoracic (12), lumbar (5), sacral (5), and coccygeal (1) segments, each serving specific regions of the body. *30* - This number is incorrect; the total number of **spinal nerve pairs** is higher than 30. - Focusing on individual segments, like the 8 cervical nerves, shows that the total adds up differently. *33* - While there are 33 vertebrae during development (some fuse in the sacrum and coccygeal), the number of **spinal nerve pairs** is 31, not 33. - The number of spinal nerves does not directly correlate with the number of individual vertebral bones in adulthood. *28* - This number is significantly lower than the actual count of **spinal nerve pairs**. - The human spinal cord gives rise to a greater number of nerves to innervate the entire body.
Question 3: False among the following
- A. Teardrop fracture involves C5-C6 vertebrae
- B. Hangman fracture involves Axis
- C. Clay Shoveler's fracture involves C6 vertebrae (Correct Answer)
- D. Jefferson's fracture involves Atlas
Explanation: ***Clay Shoveler's fracture involves C6 vertebrae*** - A **Clay Shoveler's fracture** typically involves the **spinous processes of C6, C7 or T1**, meaning C6 is often involved. - This fracture is usually stable and results from forced neck flexion or direct trauma, often affecting lower cervical or upper thoracic vertebrae. *Teardrop fracture involves C5-C6 vertebrae* - **Teardrop fractures** are severe and unstable fractures of the cervical spine, often occurring at **C2 or C5-C7 (not exclusively C5-C6)**. - They are named for the characteristic triangular fragment of bone detached from the anterior aspect of the vertebral body and can be either flexion or extension type, with flexion teardrop fractures being particularly unstable due to posterior ligamentous disruption. *Hangman fracture involves Axis* - A **Hangman's fracture** is a fracture of the **C2 (Axis) pedicles**, typically due to hyperextension and distraction. - While it involves C2, the statement implies it solely involves the "Axis" which is broad, but specifically it's the pedicles of C2. *Jefferson's fracture involves Atlas* - A **Jefferson's fracture** is a burst fracture of the **C1 (Atlas) ring**, typically caused by an axial load on the head. - This fracture involves the Atlas, as stated, and is often unstable due to disruption of the transverse atlantal ligament in severe cases.
Question 4: Which vertebra is known as vertebra prominens due to its long and prominent spinous process:
- A. C2
- B. C7 (Correct Answer)
- C. T2
- D. L3
Explanation: ***C7*** - The **seventh cervical vertebra (C7)** is often referred to as the **vertebra prominens** because its spinous process is distinctly longer and more prominent than those of the other cervical vertebrae. - This prominence makes it easily **palpable** at the base of the neck, serving as a key anatomical landmark. *C2* - The spinous process of **C2 (axis)** is bifid and significantly shorter than that of C7. - While important for head rotation, its length does not compare to the palpable prominence of C7. *T2* - **Thoracic vertebrae** generally have long spinous processes that project inferiorly, but **T2's spinous process** is not the longest overall. - The processes get progressively longer moving down the thoracic spine until about T7. *L3* - **Lumbar vertebral spinous processes** are broad, thick, and relatively blunt, projecting horizontally. - While robust, the spinous process of **L3** is not as long or prominent as that of C7.
Question 5: Which of the following is least useful for diagnosing spondylolisthesis?
- A. X-ray spine lateral view
- B. MRI
- C. CT scan
- D. X-ray spine AP view (Correct Answer)
Explanation: ***X-ray spine AP view*** - An **AP (Anterior-Posterior) view** of the spine is least useful for diagnosing spondylolisthesis because it does not adequately demonstrate the **forward slippage** of one vertebra over another. - This view primarily visualizes the spine in the **coronal plane**, making it difficult to assess the **sagittal displacement** characteristic of spondylolisthesis. *X-ray spine lateral view* - A **lateral view** of the spine is highly useful as it directly shows the **sagittal alignment** and can clearly demonstrate the **anterior displacement** of a vertebral body. - It is often the **initial imaging modality** for suspecting and classifying spondylolisthesis severity. *MRI* - **MRI** is excellent for evaluating **soft tissue structures**, such as the spinal cord, nerve roots, and intervertebral discs, which can be compressed or damaged by spondylolisthesis. - While it can visualize the slippage, it is usually reserved for assessing **neurological compromise** or if surgical planning requires detailed soft tissue information. *CT scan* - **CT scans** provide detailed **bony anatomy** and are highly effective in visualizing the pars interarticularis defects (spondylolysis) often associated with spondylolisthesis. - It offers superior detail compared to plain X-rays for assessing the **extent of bone displacement** and associated degenerative changes.
Question 6: Identify the condition shown in the image:
- A. Renal osteodystrophy
- B. Spondylolisthesis
- C. Tuberculosis (TB)
- D. Spondylolysis (Correct Answer)
Explanation: ***Spondylolysis*** * The image shows a **break in the pars interarticularis** of a vertebra, indicated by the arrow, which is characteristic of spondylolysis. * This condition is a **stress fracture** or defect in the pars interarticularis, a bony segment connecting the superior and inferior articular facets. *Renal osteodystrophy* * Renal osteodystrophy refers to a spectrum of **bone abnormalities** that occur in chronic kidney disease, not a specific vertebral fracture pattern. * It typically involves features such as **osteomalacia**, **osteitis fibrosa cystica**, or **osteoporosis**, which are not directly depicted as a fracture in this image. *Spondylolisthesis* * Spondylolisthesis is the **anterior slippage** of one vertebral body over another, which can be caused by bilateral spondylolysis but is not directly shown as a slip in this specific image. * The image distinctly highlights the **fracture line** itself, rather than the displacement of the vertebral body. *Tuberculosis (TB)* * Spinal tuberculosis (Pott's disease) typically presents with **destruction of vertebral bodies**, disc space narrowing, and often a **paravertebral abscess**. * The image does not show these features; instead, it demonstrates a clear **bony defect** in the pars interarticularis.
Question 7: 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 8: The best view to visualize zygomatic arches is
- A. Skull PA view
- B. Jug Handle view (Correct Answer)
- C. Orthopantamogram
- D. Occipito mental view
Explanation: ***Jug Handle view*** - The **Jug Handle view**, also known as the **submentovertex (SMV) view**, is optimal for visualizing the entire course of both **zygomatic arches**, projecting them free from superimposition by other facial bones. - This projection requires the patient's head to be tilted back so that the central ray passes through the neck and enters the skull vertically, allowing for a clear, unobstructed image of the arches. *Skull PA view* - A **PA (posteroanterior) skull view** primarily demonstrates the frontal bone, orbits, and nasal cavity. - While it shows portions of the zygoma, the **zygomatic arches are often superimposed** by other cranial structures, making detailed assessment difficult. *Orthopantamogram* - An **Orthopantamogram (OPG)** is a panoramic dental X-ray that provides a broad view of the maxilla, mandible, and temporomandibular joints. - It offers a **limited or distorted view of the zygomatic arches**, as its primary purpose is dental assessment, not detailed facial bone evaluation. *Occipito mental view* - The **occipitomental view**, also known as the **Waters' view**, is excellent for visualizing the **maxillary sinuses**, orbits, and nasal bones. - While it shows the **zygomaticomaxillary complex**, it does not provide a true tangential projection of the entire zygomatic arch, which is often partially obscured by other structures.
Question 9: Earliest investigation for diagnosis of Ankylosing spondylitis:
- A. CT scan
- B. Bone scan
- C. X-ray
- D. MRI STIR sequence (Correct Answer)
Explanation: ***MRI STIR sequence*** - An **MRI STIR (Short Tau Inversion Recovery) sequence** is highly sensitive for detecting early inflammatory changes in the **sacroiliac joints** and spine, such as **bone marrow edema**, which is a hallmark of early ankylosing spondylitis. - It can identify disease activity and structural changes *before* they are visible on conventional X-rays, making it the earliest diagnostic tool. *CT scan* - While a **CT scan** provides excellent detailed images of bone, it is not as sensitive as MRI for detecting early inflammatory changes like **bone marrow edema** in the sacroiliac joints. - It involves significant **radiation exposure** and is typically used for more advanced structural assessment rather than early diagnosis. *Bone scan* - A **bone scan** (scintigraphy) shows areas of increased bone turnover but is **not specific** for ankylosing spondylitis and has lower spatial resolution compared to MRI. - It can indicate inflammation or increased metabolic activity but cannot differentiate specific causes or provide detailed anatomical information as effectively as MRI. *X-ray* - **X-rays** are often the initial imaging modality due to their accessibility, but they only show **structural changes** (like erosions, sclerosis, or fusion) in the sacroiliac joints and spine at a later stage of the disease. - Early inflammatory changes, such as **bone marrow edema**, are typically not visible on plain radiographs, leading to a delay in diagnosis compared to MRI.
Question 10: 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.
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