Spine & Arthritis

Topics in this chapter

• Degenerative Spine Disorders
• Inflammatory Spinal Arthritis
• Spinal Cord And Nerve Compression
• Spinal Infections And Spondylodiscitis
• Spinal Trauma And Vertebral Fractures
• Osteoporosis And Fragility Fractures
• Pediatric Spinal Deformities
• Spine Surgery And Orthopaedic Management

Practice questions

1. Question 1Q-0371C5

   A 32-year-old male presents with chronic inflammatory lower back pain, morning stiffness lasting more than one hour, and bilateral gluteal pain that alternates sides. Radiography of the pelvis reveals bilateral sacroilitis. Which of the following is the hallmark genetic association for this condition?

   1. A.HLA-B27
   2. B.HLA-DR4
   3. C.HLA-B51
   4. D.HLA-DQ2
   See the answer and solution
2. Question 2Q-E8DDCC

   A 65-year-old female presents with severe low back pain radiating down the right posterior leg that worsens with walking and standing, and improves significantly with sitting or forward lumbar flexion. Imaging reveals degenerative facet hypertrophy and ligamentum flavum thickening causing spinal canal stenosis. What is the pathognomonic term for this symptom complex?

   1. A.Neurogenic claudication
   2. B.Vascular claudication
   3. C.Cauda equina syndrome
   4. D.Arachnoiditis ossificans
   See the answer and solution
3. Question 3Q-53452C

   A 45-year-old man who is an intravenous drug user presents with persistent, severe axial neck pain and low-grade fever. Examination reveals localized tenderness over the lower cervical spine and painful range of motion. Laboratory tests show an elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). What is the most sensitive and specific imaging modality for early diagnosis of this condition?

   1. A.Plain radiography
   2. B.Computed tomography (CT) scan
   3. C.Magnetic resonance imaging (MRI)
   4. D.Technetium-99m bone scan
   See the answer and solution
4. Question 4Q-4E12FB

   A 70-year-old postmenopausal woman presents with sudden onset severe acute back pain after lifting a light grocery bag. She has a history of prolonged corticosteroid use. Physical examination reveals localized tenderness at the mid-thoracic spine with no neurological deficits. Plain radiographs show anterior wedging of the T12 vertebral body. What is the most appropriate initial management for this fragility fracture?

   1. A.Immediate open decompression and instrumented fusion
   2. B.Conservative management with analgesics, bracing, and anti-osteoporotic therapy
   3. C.External halo-vest immobilization for 12 weeks
   4. D.High-dose intravenous pulsed corticosteroids
   See the answer and solution
5. Question 5Q-A41BF0

   A 28-year-old male with ankylosing spondylitis of 15 years duration experiences a sudden increase in severe cervical pain after a low-energy minor fall from a standing height. Radiographs demonstrate a complete transverse fracture running through the ossified anterior and posterior elements of the C6 vertebra. Which of the following best describes the structural mechanical vulnerability in these patients?

   1. A.The spine acts like a long, rigid, osteoporotic bone lever arm prone to brittle fracture.
   2. B.Ligamentous laxity allows excessive translation without bony injury.
   3. C.Hypertrophy of the ligamentum flavum buffers all impact forces.
   4. D.Micro-fractures of the sacroiliac joint protect the cervical spine from high stresses.
   See the answer and solution