Skeletal Tuberculosis MCQs

Orthopedics · 50 free questions with answers & explanations.

1. A 30-year-old man presents with painless progressive kyphosis of the thoracic spine with bilateral lower limb weakness and spasticity. MRI shows destruction of T8–T9 vertebrae with a large anterior paraspinal cold abscess and cord compression. This condition is termed:
2. In tuberculosis of the hip joint, which clinical sign refers to apparent lengthening of the limb in early disease due to adduction deformity of the hip?
3. A 20-year-old woman is found to have tuberculosis of the right knee with joint destruction on X-ray. Drug-resistant TB is excluded and she is placed on anti-tuberculosis therapy. After adequate chemotherapy, the most appropriate surgical option for a destroyed knee in a young patient is:
4. In Pott's spine, the type of paraplegia that occurs at late stage due to fibrosis and bony compression with no active TB disease is called:
5. A 35-year-old teacher presents with a painless swelling in the left groin fluctuating but without local heat or redness. Chest X-ray shows bilateral upper lobe infiltrates. Spinal X-ray shows disc space narrowing at L2–L3. The swelling most likely represents:
6. A 35-year-old presents with back pain, fever, and progressive lower limb weakness over 3 months. MRI shows D10–D11 vertebral body destruction with anterior wedging, disc space narrowing, and a large paravertebral abscess tracking to the right psoas. This is Pott's spine. The neurological complication (paraplegia) in early-onset Pott's disease is most commonly due to:
7. In tuberculosis of the hip joint, the classical deformity seen in the early active phase is described as flexion, adduction, and internal rotation. This position is adopted because:
8. A cold abscess from Pott's spine at L1–L2 level typically tracks along which muscle and presents as a swelling at which site?
9. A 30-year-old is diagnosed with TB knee. MRI shows synovial thickening, erosion of the articular cartilage, and periarticular osteoporosis. Which radiological sign on plain X-ray is classically described in TB arthritis?
10. In TB spine, the 'anterior instability' pattern requires surgical stabilization. The Hong Kong operation for cervical Pott's spine involves:
11. In Pott's spine, the neurological deficit (Pott's paraplegia) occurring after many years of apparently healed disease is called 'late-onset paraplegia' or paraplegia of healed disease. The PRIMARY mechanism is:
12. Characteristically, the earliest radiological sign of spinal tuberculosis on plain X-ray is:
13. TB dactylitis (spina ventosa) is a specific form of bone tuberculosis affecting primarily:
14. A patient with hip TB has the earliest clinical sign of hip involvement as:
15. In spinal tuberculosis (Pott's disease), the anterior column is predominantly affected because:
16. A 35-year-old man with spinal TB at T10-T11 develops acute onset paraplegia with spastic lower limbs. MRI shows epidural granulation tissue compressing the cord. The best surgical approach is:
17. In TB of the hip joint, the classical clinical finding is 'Rose thorn sign'. What does this refer to?
18. A patient with TB of the lumbar spine develops a large psoas abscess. The abscess tracks along the psoas sheath and points at the:
19. Which radiological sign specifically describes the early stages of spinal tuberculosis before frank disc space loss?
20. A 30-year-old man with Pott's spine at T9-T10 has a 'cold abscess'. MRI shows a large prevertebral collection extending to the psoas sheath and tracking down to the groin. Which of the following correctly describes the anatomical pathway of this cold abscess spread?
21. A 25-year-old woman with TB hip has a radiograph showing loss of joint space, osteoporosis, and peripheral osseous erosions but no central destruction or bony ankylosis. Which stage of TB hip does this represent, and what is the expected prognosis for the joint?
22. A patient with Pott's spine at L4-L5 develops sudden worsening of lower limb weakness and bladder disturbance despite 4 months of anti-TB therapy. MRI shows a retropulsed osseous fragment compressing the cauda equina. What is the best next step?
23. A 30-year-old presents with Pott's disease at T8-T9 with a gibbus deformity and MRC Grade 3 weakness of both lower limbs. MRI shows extensive bone destruction with a large paravertebral abscess compressing the cord anteriorly. The most appropriate surgical approach is:
24. In tuberculosis of the hip, the 'wandering acetabulum' deformity describes which radiological finding indicating advanced disease?
25. A 32-year-old presents with back pain and gibbus deformity. MRI spine shows D7-D8 vertebral body destruction with large bilateral psoas abscess but preserved disc space initially. Which feature of spinal TB is being described by the PRESERVED disc space early in disease?
26. In Pott's spine with Frankel Grade C neurological deficit (incomplete motor function preserved), which of the following is the IMMEDIATE management priority?
27. Tuberculous dactylitis (spina ventosa) in a 3-year-old child primarily involves which bone structure?
28. A 35-year-old presents with low-grade fever and lower back pain for 6 months. MRI shows vertebral end-plate erosion, disc space narrowing, and anterior epidural granulation tissue at L1-L2 with a psoas abscess. This is Pott's spine. Which radiological feature distinguishes spinal TB from pyogenic spondylodiscitis?
29. A 28-year-old with Pott's spine at T8-T9 develops sudden onset paraplegia with preserved bladder sensation. MRI shows a large anterior epidural granuloma compressing the cord without bony collapse. What is the most appropriate initial intervention?
30. The 'cold abscess' of skeletal tuberculosis lacks classical signs of inflammation. This is because:
31. A 30-year-old man with spinal tuberculosis at T8-T9 develops acute paraplegia. MRI shows cord compression from a paravertebral abscess with early kyphotic deformity. He has been on ATT for 6 weeks. The pott's paraplegia in this case is MOST LIKELY 'paraplegia of onset' or 'early paraplegia.' What is the primary indication for surgical decompression in this scenario?
32. A patient with thoracic spine tuberculosis develops progressive kyphosis and paraplegia. MRI shows cord compression from an epidural abscess at T7–T8 with vertebral collapse. The Pott's paraplegia in this case is BEST classified as:
33. The classic triad of Pott's spine on X-ray (vertebral tuberculosis) consists of which three findings?
34. A 28-year-old man from a TB-endemic region presents with progressive thoracic kyphosis, paraparesis, and an extradural soft tissue mass at T8–T9 level on MRI. The 'paradoxical disc sparing' seen early in TB spondylitis occurs because:
35. A 40-year-old woman with thoracic Pott's disease and paraplegia of 3 weeks duration (ASIA B) undergoes anterior decompression, bone grafting, and posterior instrumented fusion. What is the earliest reliable clinical indicator of neurological recovery post-surgery?
36. In Pott's disease (spinal tuberculosis), which neurological complication can develop decades after apparent clinical cure of the infection?
37. The preferred surgical approach for drainage of a large psoas abscess tracking from a lumbar Pott's disease to the femoral triangle is:
38. A 28-year-old presents with progressive lower back pain, constitutional symptoms and a gibbus deformity at the thoracolumbar junction. MRI reveals a paradiscal lesion with end-plate erosion at T12–L1, paravertebral cold abscess, and mild cord compression. The most feared complication that mandates surgical intervention in spinal tuberculosis is:
39. A 40-year-old has Pott's disease at L1–L2 with a psoas abscess tracking to the iliac fossa. Neurological examination shows paraparesis (MRC grade 3/5 in both lower limbs). After confirming drug-sensitive TB on culture, the indication for surgical decompression is best characterised as:
40. Regarding the natural history of untreated vertebral TB (Pott's disease), the 'cold abscess' formation characteristic of spinal TB is due to:
41. A patient with Pott's disease at L1–L2 presents with severe kyphosis and bilateral lower limb weakness (Frankel Grade C). MRI shows cord compression from posterior kyphosis with a gibbus. The most appropriate surgical approach for decompression and deformity correction is:
42. In skeletal tuberculosis, the 'paradoxical reaction' refers to:
43. A 35-year-old man with spinal tuberculosis at T8–T9 has developed progressive paraplegia over 3 weeks. MRI shows an anterior epidural granuloma compressing the cord. He is unable to walk. He has been on anti-TB chemotherapy for 2 weeks. The most appropriate treatment is:
44. A 35-year-old presents with Pott's spine with paraplegia of sudden onset after years of back pain and a kyphotic deformity. MRI shows vertebral body collapse at T10–T11 with large anterior and posterior epidural abscess. The paraplegia is most likely due to:
45. In spinal tuberculosis (Pott's disease), which imaging feature on MRI is most specific for tuberculosis compared to pyogenic spondylodiscitis?
46. A 28-year-old woman presents with chronic hip pain and radiograph shows erosion of the acetabulum and femoral head with reduced joint space. 'Wandering acetabulum' sign is present. This is characteristic of:
47. A 35-year-old man with HIV presents with back pain, vertebral collapse, and a large paraspinal swelling at the L2 level. CT shows a psoas abscess with calcifications. Neurological examination is normal. The first-line management is:
48. Which hip sign in tuberculosis of the hip indicates flexion-adduction-external rotation contracture — the hip is held in the position that maximises joint capacity and minimises pressure?
49. A 35-year-old presents with progressive kyphosis, fever, and lower limb weakness. MRI shows vertebral body destruction predominantly at the anterior column of two adjacent vertebrae with a large paravertebral abscess and disc space loss. The most specific radiological sign of tubercular spondylitis distinguishing it from pyogenic spondylodiscitis is:
50. A patient with Pott's spine at T8-T9 level presents with lower limb spastic paraplegia. The appropriate surgical treatment for this neurological deficit when there is active disease with cord compression from anterior granulation/abscess is: