6. Spine MCQs

A 45-year-old intravenous drug user presents with severe back pain, fever, and progressive bilateral lower extremity weakness and bowel incontinence over 24 hours. MRI confirms a large dorsal epidural fluid collection with peripheral enhancement at T10. What is the most appropriate management?

A 35-year-old immigrant presents with back pain, night sweats, and a progressive thoracic kyphosis. MRI reveals destruction of the T8 and T9 vertebral bodies with a large paraspinal abscess, but the T8-T9 intervertebral disc space is remarkably preserved. What is the most likely pathogen?

An infant is diagnosed with Morquio syndrome (Mucopolysaccharidosis Type IVA). Orthopedic evaluation is requested. What is the most critical musculoskeletal complication that requires urgent screening in this patient?

A 30-year-old man presents with chronic back pain, night sweats, and weight loss. MRI of the spine reveals destruction of the T8 and T9 vertebral bodies with relative preservation of the intervertebral disc and a large paravertebral abscess. What is the most likely diagnosis?

A 28-year-old male is diagnosed with Gorham-Stout disease involving the thoracic spine and ribs.

He develops sudden onset dyspnea. What is the most common life-threatening complication associated with his condition?

A 30-year-old male with a complete T6 spinal cord injury from an accident 3 months ago develops sudden swelling, warmth, and restricted range of motion in his right hip. Deep vein thrombosis is ruled out. Serum alkaline phosphatase is significantly elevated. What is the most sensitive early imaging modality to confirm the suspected diagnosis?

A 14-year-old boy with known Gorham's disease of the thoracic spine and ribs develops sudden-onset respiratory distress.

Chest radiograph reveals a large pleural effusion. What is the most likely nature of this effusion and its pathogenesis?

A 2-year-old boy with achondroplasia presents for evaluation. His parents are concerned about his prominent forehead and spinal curvature. On exam, he has a thoracolumbar kyphosis. What is the expected natural history of this spinal deformity?

A 6-year-old boy presents with short stature, waddling gait, and joint pain. Radiographs reveal delayed, irregular ossification of the capital femoral epiphyses bilaterally. To differentiate between Multiple Epiphyseal Dysplasia (MED) and Spondyloepiphyseal Dysplasia (SED), which radiographic finding is most diagnostic of SED?

A 19-year-old patient is diagnosed with Gorham-Stout disease affecting the clavicle, scapula, and upper ribs. Which of the following is a potentially fatal complication uniquely associated with this disease location?

A child with diastrophic dysplasia presents for routine orthopedic follow-up. He exhibits the classic features of short-limbed dwarfism, cauliflower ears, and hitchhiker thumbs. Which spinal deformity must be closely monitored due to its potential for rapid progression and neurologic compromise?

A 6-year-old child presents with a waddling gait and bilateral hip pain. Radiographs demonstrate delayed and irregular ossification of the capital femoral epiphyses bilaterally. To differentiate Multiple Epiphyseal Dysplasia (MED) from Spondyloepiphyseal Dysplasia (SED), which radiographic feature is most specific to MED?

A 19-year-old patient with known Gorham-Stout disease of the thoracic spine and ribs develops sudden respiratory distress.

What is the most common life-threatening complication associated with this specific anatomical involvement?

A 25-year-old male presents with progressive shoulder pain and weakness. Radiographs demonstrate progressive dissolution of the proximal humerus without reactive bone formation, as shown in the image.

What is the most common life-threatening complication if this disease process involves the ribs or thoracic spine?

A 21-year-old male with confirmed Gorham-Stout disease involving the clavicle, scapula, and upper ribs is admitted to the intensive care unit. Which of the following is the most common life-threatening complication associated with this specific anatomic pattern of the disease?

A 70-year-old male undergoes a spine radiograph for back pain.

The image shows an enlarged, densely sclerotic "picture frame" vertebral body. What complication is he at highest risk of developing directly related to this specific vertebral change?

A 70-year-old man is incidentally found to have an enlarged, dense vertebral body on a radiograph, presenting as a "picture frame" vertebra with thickened endplates.

Which of the following is the most likely diagnosis?

A patient presents with generalized bone sclerosis. A classic radiographic sign seen in the vertebral bodies of this condition is often described as:

A 60-year-old male with chronic back pain undergoes a lumbar spine radiograph. A single, enlarged vertebral body with prominent cortical thickening on all margins and central relative lucency is noted. What is the classical eponymous term for this finding in Paget's disease?

In Spondyloepiphyseal Dysplasia Congenita (SEDC), what is the most critical preoperative assessment required before any surgical intervention involving general anesthesia?