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6. Spine MCQs

Practice Set 291 of 379

This practice set contains high-yield board review questions covering key concepts in 6. Spine. Each clinical scenario is designed to test your diagnostic and management skills relevant to this subspecialty.

Question 5801

Topic: 6. Spine

Review the anteroposterior and lateral thoracolumbar spine radiographs of this patient. The generalized flattening of the vertebral bodies observed is medically termed:



. Platybasia
. Platyspondyly
. Spondyloptosis
. Spondylolysis
. Hemivertebrae

Correct Answer & Explanation

. Platyspondyly

Explanation

Correct Answer: PlatyspondylyPlatyspondyly refers to the generalized flattening of the vertebral bodies, which is clearly visible on the provided thoracolumbar spine radiographs along with narrow disc spaces. It is a hallmark of Spondyloepiphyseal Dysplasia.

Question 5802

Topic: 6. Spine

A patient with congenital spondyloepiphyseal dysplasia is being evaluated prior to general anesthesia for a surgical procedure. Which of the following cervical spine abnormalities is most commonly associated with this condition and requires careful preoperative assessment?

. Basilar invagination
. Klippel-Feil anomaly
. Os odontoideum with atlantoaxial instability
. Cervical kyphosis
. Congenital cervical stenosis

Correct Answer & Explanation

. Os odontoideum with atlantoaxial instability

Explanation

Correct Answer: Os odontoideum with atlantoaxial instabilityPatients with Spondyloepiphyseal dysplasia congenita (SEDc) commonly present with os odontoideum, with or without atlantoaxial instability. This requires careful preoperative evaluation, especially before general anesthesia, to prevent catastrophic neurologic injury during intubation.

Question 5803

Topic: 6. Spine

A 12-year-old male presents with progressive dorsolumbar kyphosis. The lateral radiograph of his thoracolumbar spine is shown below. The characteristic shape of the vertebral bodies in this condition is classically described as:


. Picture-frame vertebrae
. Rugger-jersey spine
. Champagne-bottle vertebrae
. Bullet-shaped vertebrae
. H-shaped vertebrae

Correct Answer & Explanation

. Champagne-bottle vertebrae

Explanation

Correct Answer: Champagne-bottle vertebraeSpondyloepiphyseal dysplasia tarda (SEDt) is characterized by defective growth and typical 'champagne-bottle' shaped vertebrae, as seen in the provided radiograph.

Question 5804

Topic: Thoracolumbar Spine & Deformity

A 17-year-old boy with spondyloepiphyseal dysplasia congenita presents with worsening back deformity. Based on the typical progression of this disease and the provided radiograph, what is the most likely spinal deformity?


. Progressive dorsolumbar kyphosis with platyspondyly
. Severe structural scoliosis with vertebral fusions
. Cervical lordosis with anterior wedging
. Lumbar hyperlordosis with spondylolisthesis
. Thoracic scoliosis with rib synostosis

Correct Answer & Explanation

. Progressive dorsolumbar kyphosis with platyspondyly

Explanation

Correct Answer: Progressive dorsolumbar kyphosis with platyspondylyPatients with spondyloepiphyseal dysplasia congenita typically develop progressive dorsolumbar kyphosis with platyspondyly and deformed vertebrae, as demonstrated in the radiograph.

Question 5805

Topic: 6. Spine

A 12-year-old male presents with short stature and back pain. The lateral radiograph of the thoracolumbar spine is shown below. What is the characteristic radiographic sign seen in the vertebral bodies?




. Picture frame vertebrae
. Rugger jersey spine
. Champagne-bottle shaped vertebrae
. Bullet-shaped vertebrae
. Sandwich vertebrae

Correct Answer & Explanation

. Champagne-bottle shaped vertebrae

Explanation

Correct Answer: CThe radiograph demonstrates platyspondyly and narrow disc spaces with the characteristic 'champagne-bottle' shaped vertebrae of the lower thoracic spine, which is a hallmark finding in Spondyloepiphyseal dysplasia tarda. 'Picture frame' vertebrae are seen in Paget's disease, 'Rugger jersey' spine in renal osteodystrophy, and 'Bullet-shaped' vertebrae in achondroplasia or mucopolysaccharidoses.

Question 5806

Topic: 6. Spine

A 6-year-old child with known spondyloepiphyseal dysplasia congenita is scheduled for elective lower extremity surgery. Which of the following preoperative evaluations is most critical to prevent a catastrophic neurological complication?

. Echocardiogram to assess for aortic root dilation
. Flexion-extension radiographs of the cervical spine
. Pulmonary function tests
. Renal ultrasound
. MRI of the lumbar spine

Correct Answer & Explanation

. Flexion-extension radiographs of the cervical spine

Explanation

Correct Answer: BPatients with spondyloepiphyseal dysplasia congenita commonly have an os odontoideum with or without atlantoaxial instability. Prior to any surgery requiring general anesthesia and intubation, it is critical to obtain flexion-extension radiographs of the cervical spine to rule out instability, which could lead to catastrophic spinal cord injury during neck manipulation.

Question 5807

Topic: 6. Spine

A 5-year-old boy presents with the progressive spinal deformity shown in the radiograph below. Which of the following terms best describes the generalized flattening of the vertebral bodies seen in this condition?




. Platybasia
. Platyspondyly
. Spondylolisthesis
. Spondylolysis
. Hemivertebra

Correct Answer & Explanation

. Platyspondyly

Explanation

Correct Answer: BThe radiograph demonstrates progressive dorsolumbar kyphosis with platyspondyly. Platyspondyly refers to the generalized flattening of the vertebral bodies, which is a hallmark radiographic finding in spondyloepiphyseal dysplasia congenita. Platybasia refers to flattening of the skull base.

Question 5808

Topic: 6. Spine

A 17-year-old male presents with a short trunk and progressive back deformity. The lateral radiograph of his spine is shown below. What is the characteristic radiographic finding seen in the vertebral bodies of this condition?


. Picture frame vertebral bodies
. Rugger jersey spine
. Champagne-bottle shaped vertebral bodies
. Bamboo spine
. Bullet-shaped vertebrae

Correct Answer & Explanation

. Champagne-bottle shaped vertebral bodies

Explanation

Correct Answer: Champagne-bottle shaped vertebral bodiesThe radiograph demonstrates the typical 'champagne-bottle' shaped vertebral bodies characteristic of Spondyloepiphyseal Dysplasia. This is accompanied by progressive dorsolumbar kyphosis and platyspondyly. 'Picture frame' vertebrae are seen in Paget's disease, 'Rugger jersey' in renal osteodystrophy, 'Bamboo spine' in ankylosing spondylitis, and 'Bullet-shaped' vertebrae in achondroplasia or mucopolysaccharidoses.

Question 5809

Topic: 6. Spine

Patients with congenital spondyloepiphyseal dysplasia (SEDC) are at high risk for a specific cervical spine anomaly that requires careful preoperative evaluation before any surgery requiring intubation. Which of the following is the most common cervical spine manifestation in these patients?

. Basilar invagination
. Klippel-Feil anomaly
. Os odontoideum with atlantoaxial instability
. Cervical kyphosis
. Atlanto-occipital assimilation

Correct Answer & Explanation

. Os odontoideum with atlantoaxial instability

Explanation

Correct Answer: Os odontoideum with atlantoaxial instabilityIn SEDC, os odontoideum with or without atlantoaxial instability is a common and critical finding. It poses a significant risk for spinal cord compression, especially during neck extension for endotracheal intubation, making preoperative cervical spine flexion-extension radiographs mandatory.

Question 5810

Topic: 6. Spine

A patient with a known osteochondrodysplasia presents with back pain. Anteroposterior and lateral radiographs of the thoracolumbar spine are shown below. Which of the following terms best describes the generalized flattening of the vertebral bodies seen in this imaging?


. Platybasia
. Platyspondyly
. Spondylolisthesis
. Spondyloptosis
. Hemivertebrae

Correct Answer & Explanation

. Platyspondyly

Explanation

Correct Answer: PlatyspondylyPlatyspondyly refers to the generalized flattening of the vertebral bodies, which is a hallmark radiographic feature of Spondyloepiphyseal Dysplasia. The radiographs also show narrow disc spaces and the characteristic 'champagne-bottle' shaped vertebrae of the lower thoracic spine.

Question 5811

Topic: 6. Spine

Patients with Spondyloepiphyseal Dysplasia Congenita are at high risk for a specific cervical spine anomaly that requires careful preoperative evaluation before any general anesthesia. Which of the following is the most common cervical spine manifestation in these patients?

. Atlantoaxial instability due to os odontoideum
. Subaxial cervical stenosis
. Klippel-Feil anomaly (cervical fusion)
. Basilar invagination

Correct Answer & Explanation

. Atlantoaxial instability due to os odontoideum

Explanation

Correct Answer: Atlantoaxial instability due to os odontoideumIn Spondyloepiphyseal dysplasia congenita, os odontoideum with or without atlantoaxial instability is a common and critical finding. It must be evaluated prior to any surgical procedure requiring intubation to prevent catastrophic spinal cord injury.

Question 5812

Topic: 6. Spine

In Spondyloepiphyseal Dysplasia Tarda, the vertebral bodies develop a pathognomonic radiographic appearance due to defective growth. Which of the following terms best describes this characteristic vertebral shape?

. Picture-frame vertebrae
. Rugger-jersey spine
. Champagne-bottle vertebrae
. Bullet-shaped vertebrae

Correct Answer & Explanation

. Champagne-bottle vertebrae

Explanation

Correct Answer: Champagne-bottle vertebraeThe 'champagne-bottle' shaped vertebra is a classic radiographic hallmark of Spondyloepiphyseal dysplasia tarda, resulting from defective growth of the vertebral ring apophyses. 'Picture-frame' is seen in Paget's disease, 'Rugger-jersey' in renal osteodystrophy, and 'Bullet-shaped' in achondroplasia or Morquio syndrome.

Question 5813

Topic: 6. Spine

Anteroposterior and lateral thoracolumbar spine radiographs of a patient with a genetic skeletal dysplasia are shown.



In addition to the characteristic vertebral body shape, what other spinal radiographic feature is prominently demonstrated?

. Widened intervertebral disc spaces
. Platyspondyly and narrow disc spaces
. Anterior vertebral beaking
. Bamboo spine appearance

Correct Answer & Explanation

. Platyspondyly and narrow disc spaces

Explanation

Correct Answer: Platyspondyly and narrow disc spacesThe radiographs show platyspondyly (flattened vertebral bodies) and narrow disc spaces, alongside the characteristic 'champagne-bottle' shaped vertebrae of the lower thoracic spine, typical of Spondyloepiphyseal dysplasia.

Question 5814

Topic: 6. Spine

A 4-year-old child with spondyloepiphyseal dysplasia congenita (SEDC) is scheduled for a valgus osteotomy for coxa vara. Prior to intubation, what is the most critical screening study required?

. Echocardiogram
. Flexion-extension radiographs of the cervical spine
. Pulmonary function tests
. Renal ultrasound
. Ophthalmologic examination

Correct Answer & Explanation

. Flexion-extension radiographs of the cervical spine

Explanation

Patients with SEDC commonly have odontoid hypoplasia leading to atlantoaxial instability. Flexion-extension C-spine radiographs are mandatory prior to general anesthesia to avoid catastrophic spinal cord injury during intubation.

Question 5815

Topic: 6. Spine

A 25-year-old male with spondyloepiphyseal dysplasia tarda presents for evaluation of progressive back pain. Lateral radiographs of the thoracolumbar spine are likely to demonstrate:

. Anterior beaking of the vertebral bodies
. Posterior scalloping of the vertebral bodies
. Heaped-up bone at the posterior middle and posterior third of the vertebral endplates
. Bamboo spine appearance
. Picture frame vertebrae

Correct Answer & Explanation

. Heaped-up bone at the posterior middle and posterior third of the vertebral endplates

Explanation

SED tarda is characterized radiographically by a distinctive "heaped-up" mound of bone located at the posterior central to posterior third of the superior and inferior vertebral endplates.

Question 5816

Topic: 6. Spine

A child with a known diagnosis of spondyloepiphyseal dysplasia congenita develops upper motor neuron signs, including hyperreflexia and a positive Babinski sign. What is the most appropriate next step in management?

. Immediate administration of high-dose corticosteroids
. MRI of the brain and cervical spine
. Physical therapy for gait training
. EMG and nerve conduction studies
. Lumbar puncture

Correct Answer & Explanation

. MRI of the brain and cervical spine

Explanation

Upper motor neuron signs in a patient with SEDC strongly suggest cervical myelopathy due to atlantoaxial instability from odontoid hypoplasia. An urgent MRI of the cervical spine is required to evaluate for cord compression.

Question 5817

Topic: 6. Spine

What distinguishes the clinical presentation of Pseudoachondroplasia from Spondyloepiphyseal Dysplasia (SED)?

. Pseudoachondroplasia is evident at birth
. Pseudoachondroplasia features a normal craniofacial appearance
. SED patients lack spinal involvement
. SED primarily affects the appendicular skeleton over the axial skeleton
. Pseudoachondroplasia presents with atlantoaxial instability

Correct Answer & Explanation

. Pseudoachondroplasia features a normal craniofacial appearance

Explanation

Pseudoachondroplasia typically presents after age 2 with short-limb dwarfism and normal facial features, whereas SEDC presents at birth with short-trunk dwarfism and frequently involves craniofacial features (e.g., flat midface, cleft palate).

Question 5818

Topic: 6. Spine

A patient with spondyloepiphyseal dysplasia congenita requires an atlantoaxial fusion due to symptomatic instability. Which of the following factors makes cervical spine surgery particularly challenging in this population?

. Hyperostosis of the cervical laminae
. Absent posterior elements and severe canal stenosis
. Inadequate bone stock for graft incorporation and anomalous vertebral artery anatomy
. Rigid cervical kyphosis
. Associated dural ectasia

Correct Answer & Explanation

. Inadequate bone stock for graft incorporation and anomalous vertebral artery anatomy

Explanation

Patients with SEDC have hypoplastic bone, incomplete ossification, and small posterior elements. This makes hardware fixation and obtaining a solid bony fusion extremely challenging.

Question 5819

Topic: 6. Spine

A 6-year-old girl with SEDC is evaluated for progressive spinal deformity. Which spinal deformity is most classically associated with the natural history of this condition?

. Hyperlordosis of the lumbar spine
. Progressive thoracolumbar kyphoscoliosis
. Cervical hyperlordosis
. Scheuermann's kyphosis
. Ankylosing spondylitis

Correct Answer & Explanation

. Progressive thoracolumbar kyphoscoliosis

Explanation

Patients with SEDC frequently develop progressive thoracolumbar kyphoscoliosis due to platyspondyly and ligamentous laxity. The deformity often progresses during childhood and may require surgical stabilization.

Question 5820

Topic: 6. Spine

A 5-year-old girl with Spondyloepiphyseal Dysplasia Congenita is scheduled to undergo strabismus surgery under general anesthesia. Which of the following pre-operative orthopedic evaluations is absolutely mandatory?

. Echocardiogram
. Pulmonary function tests
. Renal ultrasound
. Flexion-extension cervical spine radiographs
. MRI of the brain

Correct Answer & Explanation

. Flexion-extension cervical spine radiographs

Explanation

Patients with SED Congenita have a high incidence of odontoid hypoplasia, leading to atlantoaxial instability. Flexion-extension cervical spine radiographs are mandatory before any procedure requiring intubation to prevent catastrophic spinal cord injury.

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