Menu

6. Spine MCQs

Practice Set 72 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 1421

Topic: 6. Spine

Which of the following laboratory findings are consistent with ankylosing spondylitis:

. Elevated erythrocyte sedimentation rate (ESR), positive antinuclear antibody (ANA), negative rheumatoid factor (RF), and HLADR4
. Normal ESR, negative ANA, negative RF, and HLA-B27
. Elevated ESR, negative ANA, positive RF, and HLA-B27
. Elevated ESR, negative ANA, negative RF, and positive HLA-B27
. Normal ESR, positive ANA, positive RF, and HLA-B27

Correct Answer & Explanation

. Elevated ESR, negative ANA, negative RF, and positive HLA-B27

Explanation

Diagnostic work-up for an inflammatory autoimmune condition should include an erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), rheumatoid factor (RF), haplotype, and Lyme titer. The laboratory results most consistent with ankylosing spondylitis are an elevated ESR at the time of an acute exacerbation, negative ANA and RF, and a haplotype of HLAB27.

Question 1422

Topic: Thoracolumbar Spine & Deformity

Which of the following clinical features distinguishes homocystinuria from Marfan syndrome:

. Lens dislocation
. Scoliosis
. Chest wall abnormalities
. Tall stature
. Delayed intellectual development

Correct Answer & Explanation

. Delayed intellectual development

Explanation

Patients with Marfan syndrome do not typically have defects in intellectual functioning, while patients with homocystinuria typically do show signs of delayed intellectual development. Patients with Marfan syndrome and homocystinuria both develop lens dislocations, scoliosis, chest wall abnormalities, and tall stature.

Question 1423

Topic: 6. Spine

Patients with homocystinuria undergoing lower extremity and spinal surgery must be warned of an increased risk of which complication:

. Aortic root dissection
. High output heart failure
. Venous thromboembolic disease
. Prolonged ventilator dependence
. Spontaneous pneumothorax

Correct Answer & Explanation

. Venous thromboembolic disease

Explanation

Arterial and venous thromboembolic disease is common in patients with homocystinuria. Patients are at increased risk for this major complication when undergoing any surgical procedure. Unlike patients with Marfan syndrome, patients with homocystinuria do not develop aortic root dilation, aneurysms, mitral valve prolapse with high output heart failure, or spontaneous pneumothoraces. Underlying lung pathology is not a feature of homocystinuria, therefore, these patients are not at an increased risk for prolonged ventilatory support.

Question 1424

Topic: Thoracolumbar Spine & Deformity

Which of the following features differentiates Marfan syndrome from Ehlers-Danlos syndrome (EDS):

. Joint hypermobility
. Scoliosis
. Lens dislocation
. Vascular problems
. Joint dislocations

Correct Answer & Explanation

. Lens dislocation

Explanation

Patients with Ehlers-Danlos syndrome (EDS) and Marfan syndrome may have joint hypermobility, scoliosis, vascular problems, and recurrent joint instability. Patients with Marfan syndrome also develop lens dislocations, and while some patients with EDS exhibit eye problems, it is related to ocular globe fragility. Lens dislocation is not a feature of EDS.

Question 1425

Topic: 6. Spine

A 65-year-old male with cervical spondylosis complains of deteriorating handwriting and frequent tripping. Examination shows a positive Hoffmann's sign. MRI reveals critical stenosis at C5-C6. What is the primary pathological mechanism driving his upper motor neuron signs?

. Ischemia of the anterior horn cells
. Compression of the spinothalamic tract
. Compression of the corticospinal tract
. Injury to the dorsal root ganglion
. Compression of the dorsal columns

Correct Answer & Explanation

. Compression of the corticospinal tract

Explanation

A positive Hoffmann's sign and gait disturbances indicate cervical myelopathy with upper motor neuron involvement. This is primarily caused by compression of the descending corticospinal tracts in the spinal cord.

Question 1426

Topic: 6. Spine

A 70-year-old woman presents with bilateral leg pain and cramping that worsens with standing but improves when pushing a shopping cart. Which physical examination finding best differentiates neurogenic claudication from vascular claudication?

. Diminished pedal pulses
. Presence of a stocking-glove sensory loss pattern
. Relief of symptoms with lumbar flexion
. Relief of symptoms by standing stationary
. Skin color changes in the lower extremities

Correct Answer & Explanation

. Relief of symptoms with lumbar flexion

Explanation

Neurogenic claudication is highly responsive to changes in spinal posture; lumbar flexion (e.g., sitting or leaning on a shopping cart) increases the canal volume and relieves symptoms. Vascular claudication is relieved simply by resting, regardless of spinal posture.

Question 1427

Topic: 6. Spine

A 45-year-old male presents with acute severe lower back pain and bilateral radiculopathy. Which of the following clinical findings is the most sensitive for the diagnosis of cauda equina syndrome?

. Unilateral foot drop
. Absence of the Achilles reflex
. Urinary retention
. Loss of rectal tone
. Saddle anesthesia

Correct Answer & Explanation

. Urinary retention

Explanation

Urinary retention is considered the most sensitive symptom of cauda equina syndrome. A post-void residual volume of less than 100 to 200 mL makes the diagnosis of cauda equina syndrome highly unlikely.

Question 1428

Topic: 6. Spine

A 65-year-old man presents with progressive hand clumsiness and gait instability. Examination demonstrates a positive Hoffmann sign and lower extremity hyperreflexia. MRI shows severe cervical stenosis at C4-C5 with a T2 hyperintense signal in the spinal cord. What is the primary pathophysiologic mechanism corresponding to this T2 signal change?

. Edema and myelomalacia
. Acute hemorrhage
. Demyelinating plaque
. Syringomyelia
. Tumor infiltration

Correct Answer & Explanation

. Edema and myelomalacia

Explanation

In cervical spondylotic myelopathy, T2 hyperintensity in the spinal cord typically represents edema, inflammation, or irreversible myelomalacia secondary to chronic compression and ischemia. This finding often correlates with disease severity and potentially poorer post-surgical outcomes.

Question 1429

Topic: Thoracolumbar Spine & Deformity

A 35-year-old male falls from a ladder and sustains an L2 burst fracture. Imaging shows 40% canal compromise. He is neurologically intact, and MRI confirms an intact posterior ligamentous complex. According to the Thoracolumbar Injury Classification and Severity Score (TLICS), what is his total score and the generally recommended management?

. Score 2; Non-operative management
. Score 4; Operative management
. Score 5; Operative management
. Score 7; Operative management
. Score 1; Non-operative management

Correct Answer & Explanation

. Score 2; Non-operative management

Explanation

Under the TLICS system, a burst fracture scores 2 points, intact neurological status is 0 points, and an intact posterior ligamentous complex is 0 points, resulting in a total score of 2. A score of 3 or less is an indication for non-operative management.

Question 1430

Topic: 6. Spine

A 45-year-old male sustains a C5-C6 bilateral interfacetal dislocation from a motor vehicle accident. He is awake, alert, cooperative, and has a complete C5 spinal cord injury (ASIA A). What is the most appropriate initial step in management before surgical stabilization?

. Immediate MRI of the cervical spine
. Closed reduction via awake cranial traction
. Administration of high-dose methylprednisolone
. Anterior cervical discectomy and fusion (ACDF) without prior reduction
. Posterior open reduction and fusion

Correct Answer & Explanation

. Closed reduction via awake cranial traction

Explanation

In an awake, alert, and cooperative patient with a cervical facet dislocation and a neurological deficit, urgent closed reduction using cranial traction is indicated. MRI is required before reduction only if the patient is uncooperative, obtunded, or fails closed reduction.

Question 1431

Topic: 6. Spine

A 45-year-old male presents with acute onset saddle anesthesia, bilateral lower extremity weakness, and urinary retention following a heavy lifting injury. To maximize the chance of complete neurologic recovery, surgical decompression should ideally be performed within what timeframe from symptom onset?

. 12 hours
. 24 hours
. 48 hours
. 72 hours
. 1 week

Correct Answer & Explanation

. 48 hours

Explanation

The patient has cauda equina syndrome, an absolute orthopedic emergency. Surgical decompression within 48 hours of symptom onset is associated with significantly better outcomes for the recovery of bladder and motor functions.

Question 1432

Topic: 6. Spine

A 65-year-old male presents with deteriorating handwriting, difficulty buttoning his shirt, and frequent stumbling. Physical examination reveals a positive Hoffmann sign and hyperreflexia in both lower extremities. What is the most sensitive imaging modality for diagnosing the underlying etiology?

. CT scan of the cervical spine without contrast
. MRI of the cervical spine
. Electromyography (EMG) of the upper extremities
. Plain radiographs with flexion/extension views
. Somatosensory evoked potentials (SSEP)

Correct Answer & Explanation

. MRI of the cervical spine

Explanation

The clinical presentation is classic for cervical spondylotic myelopathy. MRI of the cervical spine is the gold standard and most sensitive imaging modality for visualizing spinal cord compression and myelomalacia.

Question 1433

Topic: 6. Spine
A 13-year-old gymnast presents with progressive lower back pain. Radiographs reveal a grade III L5-S1 isthmic spondylolisthesis. She has failed conservative management and reports radicular pain in the L5 distribution. What is the recommended surgical intervention?
. Pars interarticularis repair (Buck's procedure)
. L5 laminectomy without fusion
. In situ posterolateral fusion from L4 to S1
. L5-S1 posterior spinal fusion with instrumentation and reduction
. Anterior cervical discectomy and fusion

Correct Answer & Explanation

. L5-S1 posterior spinal fusion with instrumentation and reduction

Explanation

High-grade (Grade III-V) isthmic spondylolisthesis in adolescents typically requires surgical stabilization. L5-S1 posterior fusion with instrumentation is the standard approach, with or without partial reduction depending on the slip angle and surgeon preference.

Question 1434

Topic: 6. Spine

A 62-year-old man presents with dropping objects and a stiff gait. Exam shows hyperreflexia in the lower extremities and a positive Hoffmann sign.

T2-weighted MRI of the cervical spine is most likely to demonstrate which of the following?

. A syrinx in the central cord
. High signal intensity within the spinal cord at the level of maximal compression
. Disk herniation with foraminal nerve root compression
. Ossification of the anterior longitudinal ligament
. Hypertrophy of the uncinate processes only

Correct Answer & Explanation

. High signal intensity within the spinal cord at the level of maximal compression

Explanation

The clinical presentation is classic for cervical spondylotic myelopathy. MRI typically shows spinal stenosis and may show high T2 signal intensity within the cord, reflecting edema, myelomalacia, or gliosis at the level of compression.

Question 1435

Topic: 6. Spine

A 45-year-old man presents with acute onset of severe lower back pain, bilateral sciatica, saddle anesthesia, and urinary retention following a heavy lifting episode. MRI reveals a massive L4-L5 central disc herniation. What is the most critical next step in management?

. Immediate intravenous corticosteroids and observation
. Urgent surgical decompression (lumbar laminectomy and discectomy)
. Epidural steroid injection
. Lumbar traction and physical therapy
. Oral gabapentin and early mobilization

Correct Answer & Explanation

. Urgent surgical decompression (lumbar laminectomy and discectomy)

Explanation

This patient presents with Cauda Equina Syndrome, an absolute surgical emergency. Urgent surgical decompression, ideally within 24 to 48 hours, is required to optimize the recovery of bowel, bladder, and sexual function.

Question 1436

Topic: 6. Spine

A 15-year-old gymnast presents with lower back pain exacerbated by spinal extension. Radiographs show a bilateral defect in the pars interarticularis of L5 with a 25% anterior translation of L5 over S1. Neurological examination is normal. What is the most appropriate initial management?

. L5-S1 in situ posterolateral spinal fusion
. Activity modification, core strengthening, and physical therapy
. Pars defect repair (Buck's or Scott's technique)
. Translaminar screw fixation
. Laminectomy and discectomy

Correct Answer & Explanation

. Activity modification, core strengthening, and physical therapy

Explanation

This patient has an isthmic spondylolisthesis (Grade I). Initial management in a neurologically intact adolescent with a low-grade slip is conservative, consisting of activity restriction, bracing if acute, and core stabilization exercises.

Question 1437

Topic: 6. Spine

A 45-year-old man presents to the emergency department with acute saddle anesthesia, bilateral radiculopathy, and urinary retention secondary to a massive L4-L5 disc herniation. Current literature suggests that decompression within what time frame from the onset of symptoms provides the most significant improvement in urologic outcomes?

. 12 hours
. 24 hours
. 48 hours
. 72 hours

Correct Answer & Explanation

. 48 hours

Explanation

Cauda Equina Syndrome is a surgical emergency. Evidence strongly indicates that surgical decompression performed within 48 hours of symptom onset is associated with the best chance of significant urologic and neurologic recovery.

Question 1438

Topic: 6. Spine

A 24-year-old female sustains a Levine-Edwards Type IIA traumatic spondylolisthesis of the axis (Hangman's fracture). What is the mechanism of injury, and what is a critical consideration in her management?

. Hyperextension-axial loading; requires immediate rigid cervical traction.
. Flexion-distraction; application of cervical traction is strictly contraindicated.
. Flexion-compression; best managed with an anterior cervical plate.
. Hyperextension-distraction; application of a soft collar is adequate.

Correct Answer & Explanation

. Flexion-distraction; application of cervical traction is strictly contraindicated.

Explanation

A Levine-Edwards Type IIA Hangman's fracture involves a flexion-distraction injury resulting in severe angulation without significant translation. Cervical traction is contraindicated as it can cause over-distraction and catastrophic spinal cord injury.

Question 1439

Topic: 6. Spine

A 65-year-old male presents with deteriorating fine motor skills, gait instability, and bilateral Hoffman's signs. MRI demonstrates cervical spondylotic myelopathy. Which specific MRI finding is considered the most reliable indicator of a poor postoperative neurological prognosis?

. T1-weighted hypointensity within the spinal cord
. T2-weighted hyperintensity within the spinal cord
. Loss of normal cervical lordosis
. Multi-level anterior cord compression
. Cerebrospinal fluid flow void disruption

Correct Answer & Explanation

. T1-weighted hypointensity within the spinal cord

Explanation

Myelomalacia, indicated by a focal T1 hypointensity within the spinal cord, suggests permanent cystic or gliotic changes. This finding correlates heavily with poor postoperative neurological recovery compared to isolated T2 hyperintensity.

Question 1440

Topic: Thoracolumbar Spine & Deformity

A 40-year-old falls from a height and sustains an L1 thoracolumbar burst fracture. Which of the following criteria most strongly mandates surgical stabilization rather than conservative management with a TLSO brace?

. 10 degrees of focal kyphosis
. 20% loss of anterior vertebral body height
. Intact posterior ligamentous complex (PLC)
. Greater than 50% canal compromise combined with a progressive neurological deficit
. Isolated widened interpedicular distance without facet subluxation

Correct Answer & Explanation

. Greater than 50% canal compromise combined with a progressive neurological deficit

Explanation

Absolute indications for surgical intervention in thoracolumbar burst fractures include progressive neurological deficits. Other strong indications include disruption of the posterior ligamentous complex (PLC), >30 degrees of kyphosis, or >50% loss of vertebral height.

Test Yourself

Switch to an interactive, timed exam simulation to truly master this topic.

On this Page