Differential Diagnosis (DDx) by Signs and Symptoms—Primarily Spine and Other

Question 1

Which one of the following does not present as a spinal epidural mass?
● A. Bone fracture
● B. Extramedullary hematopoiesis
● C. Vertebral Paget disease
● D. Bony compression secondary to incompetence of odontoid process or transverse atlantal ligament
● E. Cervical or thoracic spinal stenosis

Answer 1

E. Cervical or thoracic spinal stenosis

Question 2

A 17-year-old male patient presents with insidious asymmetrical painless wasting of the distal UE muscles. What is the most likely diagnosis?
● A. Epidural lipomatosis
● B. Vertebral Paget disease
● C. OPLL
● D. Hirayama disease
● E. Idiopathic spinal cord herniation

Answer 2

D. Hirayama disease

Question 3

All are signs of ALS except?
● A. It is an upper and lower motor neuron disease
● B. Slight spasticity of LEs
● C. Atrophic weakness of the hands and forearms
● D. Fasciculations in the UE
● E. Loss of sphincter control

Answer 3

E. Loss of sphincter control

Question 4

What is the most common cause of sciatica?
● A. Diskitis
● B. Spinal stenosis
● C. Lumbar disk herniation
● D. Tumor
● E. None of the above

Answer 4

C. Lumbar disk herniation

Question 5

A patient presents with pain in the sciatic distribution and weakness of external rotation and abduction of the hip. On clinical examination, Freiberg test and Pace test are positive.
What is the most likely diagnosis?
● A. Piriformis syndrome
● B. Femoral neuropathy
● C. Diabetic neuropathy
● D. Sacral tumor
● E. Herniated lumbar intervertebral disk

Answer 5

A. Piriformis syndrome

Question 6

What is the most common etiology of pure motor hemiplegia?
● A. Ischemic lacunar infarct
● B. Tumor of motor strip
● C. Brainstem ischemic infarct
● D. Foramen magnum lesions
● E. Acute subdural hematoma

Answer 6

A. Ischemic lacunar infarct

Question 7

Which of the following conditions presents with descending paralysis with ophthalmoplegia?
● A. Guillain-Barre syndrome
● B. Tick borne paralysis
● C. Myasthenia gravis
● D. Spinal infections
● E. Ascending hematomyelia

Answer 7

D. Spinal infections

Question 8

In sacral plexus lesions, which of the following muscles will be spared on EMG?
● A. Gluteus maximus
● B. Gluteus medius
● C. Gluteus minimus
● D. Piriformis
● E. Both A and B

Answer 8

E. Both A and B

Question 9

Which of the following feature suggests L4 radiculopathy?
● A. Iliopsoas weakness
● B. Quadriceps weakness
● C. Preservation of power in thigh adductors
● D. Sensory loss in anterior thigh
● E. Intact sensations from knee to medial malleolus

Answer 9

B. Quadriceps weakness

Question 10

In patients with foot drop, which of the following muscles must be spared to differentiate common peroneal nerve palsy from L4–L5 radiculopathy?
● A. Anterior tibialis
● B. Posterior tibialis
● C. Extensor digitorum longus
● D. Extensor hallucis longus
● E. None of the above

Answer 10

B. Posterior tibialis

Question 11

Which of the following is not an etiology of Lhermitte’s sign?
● A. Multiple sclerosis
● B. Cervical spondylosis
● C. Subacute combined degeneration
● D. Central cord syndrome
● E. Anterior cord syndrome

Answer 11

E. Anterior cord syndrome

Question 12

All of the following are the congenital causes of myelopathy except?
● A. Arnold Chiari malformation
● B. Tethered cord or syringomyelia
● C. Cervical or thoracic spine stenosis
● D. Neurenteric cyst or hereditary spastic paraplegia
● E. Cord compression that occurs with some mucopolysaccharidoses

Answer 12

C. Cervical or thoracic spine stenosis

Question 13

Which of the following are the possible causes of myelopathy?
● A. Congenital
● B. Acquired
● C. Neoplastic (primary spine tumors, carcinomatous meningitis, or epidural metastasis)
● D. Vascular (spinal cord infarction, vascular malformation)
● E. All of the above

Answer 13

E. All of the above

Question 14

Causes of sciatica include congenital (meningeal cyst, conjoined nerve root), acquired (spinal stenosis, juxtafacet cyst, nerve root sheath cyst), infections, neoplastic, inflammatory, and vascular. What is the most common cause of sciatica?
● A. Radiculopathy due to herniated lumbar disk
● B. Bone or soft tissue tumors along the course of sciatic nerve
● C. Diskitis
● D. Spinal stenosis, spondylosis/spondylolysis/spondylolisthesis
● E. Nerve root sheath cyst

Answer 14

A. Radiculopathy due to herniated lumbar disk

Question 15

Which of the following are the points to differentiate femoral neuropathy from L4 radiculopathy?
● A. Distribution of sensory loss in femoral neuropathy is anterior thigh, while in case of L4 radiculopathy, it is dermatome from knee to medial malleolus sparing anterior thigh
● B. Iliopsoas is weak in case of femoral neuropathy while it is normal in case of L4 radiculopathy
● C. Thigh adductors are normal in case of femoral neuropathy while it may be weak in case of L4 radiculopathy
● D. Quadriceps are weak in case of both femoral neuropathy and in L4 radiculopathy
● E. All of the above

Answer 15

E. All of the above

Question 16

Following are the possible causes of acute paraplegia or quadriplegia except?
● A. In infancy spinal muscular atrophy, spinal cord injury, congenital myopathies, infantile botulism
● B. Traumatic spinal cord injury
● C. Congenital (achondroplasia, syringomyelia)
● D. Spinocerebellar degeneration
● E. Metabolic (thallium poisoning, central pontine myelinolysis)
● F. Infections
● G. Peripheral neuromuscular disorders (GBS, myopathies)

Answer 16

D. Spinocerebellar degeneration

Question 17

Following are the causes of hemiplegia or hemiparesis due to insult within the brain except?
● A. Lesions of the contralateral internal capsule
● B. Lesions of the brain stem
● C. Lesions of the cervicomedullary junction
● D. Unilateral spinal cord lesion
● E. Brain tumor or traumatic epidural or subdural hematoma

Answer 17

D. Unilateral spinal cord lesion

Question 18

Which of the following are the differentials of ascending paralysis?
● A. GBS
● B. Tick-borne paralysis
● C. Spinal infection
● D. Patients with a prior spinal cord injury which can be due to ascending hematomyelia or post-traumatic syringomyelia
● E. All of the above

Answer 18

E. All of the above

Question 19

Chronic low-back pain is pain in back after 3 months. What are the causes of chronic low-back pain?
● A. Degenerative conditions like spinal stenosis, degenerative spondylolisthesis
● B. Spondyloarthropathies like ankylosing spondylitis
● C. Osteitis condensans ilii which is increased density in the ilium which is usually found in pregnant women
● D. Psychological overlay
● E. All of the above

Answer 19

E. All of the above

Question 20

Foot drop is because of weakness of anterior tibialis muscle which is innervated by deep peroneal nerve. What is the most common cause of foot drop?
● A. L4/L5 radiculopathy
● B. Common peroneal nerve palsy
● C. Parasagittal lesion in the brain
● D. Lumbosacral plexus neuropathy
● E. Muscular dystrophy

Answer 20

A. L4/L5 radiculopathy

Question 21

Lhermitte’s sign is electric shock like sensation radiating down the spine usually provoked by neck flexion. Which of the following are the etiologies in which this sign can be positive?
● A. Multiple sclerosis
● B. Cervical spondylosis
● C. Cervical cord tumor
● D. Cervical disk herniation
● E. Chiari type 1 malformation
● F. All of the above

Answer 21

F. All of the above