Special Conditions Affecting Spine Flashcards
A patient presents with pain in the back, joint pain, and multiple nerve root compressive symptoms (due to expansion of woven bone, osteoid tissue). Lab work shows elevated alkaline phosphatase and urinary hydroxyproline. CT of spine shows hypertrophic changes at the facet joints and X-rays show cortical thickening, sclerotic changes, and osteolytic areas. Which of the following is correct regarding Paget’s disease?
● A. It is a disorder of osteoclasts causing increased rate of bone resorption
● B. Reactive osteoblastic activity with overproduction of new, weaker, woven bone
● C. Initial hot phase
● D. Cold phase in the last
● E. All of the above
E. All of the above
A patient presents to neurosurgical OPD with complaints of nonradiating low back pain, morning back stiffness, hip pain with swelling, which is exacerbated by inactivity and improved with exercise. X-ray of this patient shows bridging of syndesmophytes between vertebral bodies creating the so-called bamboo spine appearance and sacroiliitis as well. RA factor in serum of this patient is negative. This patient is diagnosed using Modified New York criteria. What is the diagnosis in this case?
● A. Rheumatoid arthritis
● B. Reiter’s syndrome
● C. Forestier’s disease
● D. Ankylosing spondylitis
● E. Metastatic prostate cancer
D. Ankylosing spondylitis
The most common surgical intervention in ankylosing spondylitis is orthopedic total hip arthroplasty, while the most frequent fracture site in ankylosing spondylitis is which of the following?
● A. Lumbar spine
● B. Thoracolumbar spine
● C. Cervical spine
● D. Thoracic spine
● E. Lumbar sacral junction
C. Cervical spine
A 55-year-old male patient presents to OPD with signs of myelopathy and positive Hoffmann’s sign. His MRI shows a hypointense signal from C3 to C6 level on T2WI which is obliterating CSF signal with cord compression anteriorly. His CT of cervical spine shows calcified anterior longitudinal ligament behind c4, c5, and c6 vertebral bodies. What is the most common location of OPLL in spine (which is 70 to 75%)?
● A. Cervical
● B. Thoracic
● C. Lumbar
● D. Both cervical and thoracic
● E. None of the above
A. Cervical
Which of the following is included in the pathological classification of ossified posterior longitudinal ligament?
● A. Segmental (39%), confined to the space behind the vertebral bodies
● B. Continuous (17%), extending from vertebral body to vertebral body spanning the disk space
● C. Mixed (25%), combined elements of both A and B
● D. Other variants (5%), a rare type of OPLL that is contiguous with the end plates and is confined to the disk space
● E. All of the above
E. All of the above
Which of the following statements is correct regarding Nurick grade of disability from cervical spondylosis?
● A. Grade 0: signs or symptoms of root involvement without myelopathy
● B. Grade 1: myelopathy but no difficulty in walking
● C. Grade 2: slight difficulty in walking, able to work
● D. Grade 3: difficulty in walking but not needing assistance, unable to work full time
● E. Grade 4: able to walk only with assistance or walker
● F. Grade 5: chair bound or bed ridden
● G. All of the above
G. All of the above
A patient presents to neurosurgical OPD with complaints of backache and anterior wedging of at least 5 degrees of more than or equal to three adjacent thoracic vertebral bodies. Associated findings in Scheuermann’s kyphosis include the following except?
● A. End plate irregularities
● B. Posterior narrowing of disk space
● C. Schmorl’s nodes
● D. Scoliosis
● E. Spondylolysis in 50%
B. Posterior narrowing of disk space
Rheumatoid arthritis (RA) most commonly involves cervical spine (in 44–88% cases of RA) which can be atlantoaxial subluxation, basilar impression, or subaxial subluxation. Which of the following is included in the Ranawat classification of myelopathy in RA?
● A. Class 1: no neural deficit
● B. Class 2: subjective weakness + hyperreflexia + dysesthesia
● C. Class 3: objective weakness plus long tract signs
● D. Class 3A, ambulatory, and class 3 B, quadriparetic and nonambulatory
● E. All of the above
E. All of the above
Spinal cord infarction can be due to atherosclerosis of radicular arteries in elderly patients, clamping of aorta during surgery, trauma, hypotension, aortic dissection, or embolization of spinal arteries. Acute anterior spinal cord syndrome, which results in motor paralysis below the level of injury, loss of pain
and temperature with preserved vibratory and position sense, and loss of sphincter control, is because of involvement of which artery?
● A. Anterior spinal artery
● B. Posterior spinal artery
● C. Radicular arteries
● D. Abdominal aorta
● E. None of the above
A. Anterior spinal artery
Noncontrast CT scan is probably the most sensitive test for detecting pneumorrhachis as well as air in other body compartments. What are the surgical indications of pneumorrhachis (air in the spinal canal)?
● A. Intracranial hypo-/hypertension refractory to medical management
● B. Significant or persistent CSF leak
● C. Evidence of unidirectional ball valve (tension pneumorrhachis) near at-risk nervous tissue
● D. Herniation or serious injury of adjacent structures (for example, lungs) into the spinal cord
● E. All of the above
E. All of the above
Paget’s disease may be asymptomatic or present with pain, radiculopathy, and compression of cranial nerves as they pass through skull foramina. Which of the following is the most commonly affected cranial nerve?
● A. III
● B. VI
● C. VII
● D. VIII
● E. X
D. VIII
Paget’s disease depicts ivory bone. The treatment of the disease includes calcitonin derivatives that mainly act by which of the following mechanisms?
● A. Osteoclast activity reduction
● B. Osteoclast activity stimulation
● C. Osteoblast activity reduction
● D. Osteoblast activity stimulation
● E. Inhibition of intestinal calcium absorption
A. Osteoclast activity reduction
Ankylosing spondylitis gives rise to bamboo spine, Andersen lesions, and kyphosis. By definition, which joint is always affected?
● A. Scapulohumeral joint
● B. Sacroiliac joint
● C. Ankle joint
● D. Small joints at wrist
● E. Costovertebral
B. Sacroiliac joint
Which of the following is a test for monitoring ongoing physical therapy and is done by measuring distraction between skin marks on the back before and after forward flexion to detect reduced mobility of the spine due to fusion?
● A. Schober test
● B. Patrick test
● C. Lhermitte sign
● D. Hoover test
● E. Ankylosing test
A. Schober test
What is the most common level affected by ossified posterior longitudinal ligament?
● A. Cervical
● B. Midthoracic
● C. Thoracolumbar
● D. Lumbar
● E. Lumbosacral
A. Cervical
