6. Spine MCQs

A 60-year-old man with Ankylosing Spondylitis presents to the emergency department after a low-energy fall from a standing height. He reports new-onset severe lower back pain but is neurologically intact. Standard AP and lateral radiographs of the lumbar spine are unremarkable. What is the next most appropriate step in management?

An 8-year-old boy presents with diffuse bone pain, poor wound healing, and bleeding gums. Radiographs show a thickened metaphyseal band (Frankel line) and an adjacent radiolucent zone (Trummerfeld zone). A deficiency in which of the following biochemical processes is most likely responsible?

A 65-year-old male presents with progressive hand clumsiness, gait instability, and hyperreflexia in both lower extremities. MRI shows severe cervical stenosis at C4-C5. Which of the following physical examination findings is most specific for cervical myelopathy?

A 25-year-old male sustains a burst fracture of L1 after a fall. He has no neurologic deficits. Which radiographic finding is the strongest indication for operative stabilization rather than non-operative management?

A 55-year-old patient with end-stage renal disease on hemodialysis presents with bone pain. Radiographs reveal subperiosteal bone resorption of the radial aspect of the middle phalanges and a 'rugger-jersey' spine. Which of the following pathophysiologic sequences best explains these findings?

A 7-year-old boy with a highly restricted diet presents with gingival bleeding, petechiae, and bone pain. Radiographs of his knees show a dense zone of provisional calcification (Frankel line) and a radiolucent zone adjacent to it (Trummerfeld zone). The underlying biochemical defect involves impaired:

A 6-year-old child presents with short stature, corneal clouding, and severe genu valgum. Radiographs of the cervical spine reveal hypoplasia of the odontoid process. Urinalysis demonstrates high levels of keratan sulfate. What is the most likely diagnosis?

A 45-year-old recent immigrant presents with chronic back pain, intermittent night sweats, and a progressive kyphotic deformity of the thoracic spine. MRI demonstrates destruction of the T8 and T9 vertebral bodies with relative sparing of the intervertebral disc initially, along with a large paraspinal fluid collection. What is the most likely diagnosis?

A 45-year-old man with a 15-year history of ankylosing spondylitis presents to the emergency department after a low-speed motor vehicle collision complaining of severe lower neck pain. Neurological exam is normal. Plain radiographs are difficult to interpret due to pre-existing deformity. What is the most appropriate next step?

A 55-year-old woman with severe, long-standing rheumatoid arthritis is scheduled for an elective total knee arthroplasty. Before clearing her for surgery, the anesthesiologist requests specific imaging to assess the risk of a catastrophic complication during intubation. Which imaging study is required?

A 42-year-old man presents to the emergency department with acute lower back pain, bilateral sciatica, and perineal numbness. He reports difficulty initiating urination. Which of the following clinical findings is considered the most sensitive for diagnosing cauda equina syndrome?

A 72-year-old female on warfarin for atrial fibrillation requires emergency surgical decompression for cauda equina syndrome. Her INR is 3.5. What is the most effective therapy for the rapid reversal of her anticoagulation?

A 40-year-old man with long-standing ankylosing spondylitis presents with insidious onset of dyspnea. Pulmonary function tests demonstrate a normal FEV1/FVC ratio but decreased total lung capacity. Which pulmonary complication is most characteristic of this underlying disease?

A 32-year-old male with known spinal tuberculosis at T8-T9 presents with new-onset lower extremity weakness and hyperreflexia. The neurological deficit in Pott's disease is most commonly directly caused by which of the following?

A 45-year-old immigrant presents with a 6-month history of insidious mid-back pain, low-grade fevers, and recent-onset lower extremity weakness. MRI reveals destruction of the T8 and T9 vertebral bodies with relative preservation of the intervertebral disc initially, along with a large paraspinal fluid collection. What is the most likely diagnosis?

A 60-year-old woman with a 25-year history of severe rheumatoid arthritis is scheduled for elective total knee arthroplasty. She reports occasional neck stiffness but no radicular pain. Which of the following preoperative imaging studies is mandatory prior to general anesthesia?

A 45-year-old man with ankylosing spondylitis and a classic bamboo spine presents for elective bilateral total hip arthroplasty. Preoperative pulmonary function testing is performed. What pattern of lung disease is most expected in this patient?

A 65-year-old man presents with deteriorating handwriting, frequent dropping of objects, and a broad-based, unsteady gait. Examination reveals a positive Hoffmann sign and hyperreflexia in both lower extremities. MRI demonstrates severe cervical stenosis at C4-C5 with a hyperintense signal within the spinal cord on T2-weighted images. What is the most appropriate definitive management?

A 45-year-old male is involved in a motor vehicle collision and sustains a traumatic spondylolisthesis of the axis (Hangman's fracture). What is the primary mechanism of this injury?

A 45-year-old male presents with acute lower back pain, bilateral sciatica, and new-onset urinary retention. An MRI reveals a massive L4-L5 central disc herniation. To maximize the chance of neurologic recovery, surgical decompression should ideally be performed within what timeframe?