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Orthopedic Prometric MCQs - Chapter 3 Part 1

Orthopedic Prometric MCQs - Chapter 3 Part 25

25 Apr 2026 17 min read 2 Views
Orthopedic Prometric MCQs - Chapter 3 Part 25

Welcome to Chapter 3 Part 25 of our comprehensive Orthopedic Prometric Exam Simulator. This interactive test features 20 high-yield multiple-choice questions designed to help you prepare for the Saudi Prometric (SCFHS), DHA, HAAD, SLE, and OMSB orthopedic surgery exams.

Use the Study Mode to view detailed explanations instantly, or switch to Exam Mode to test your speed and accuracy under simulated testing conditions.

Prometric Exam Simulator


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Question 1

The natural history of an asymptomatic thoracic disk herniation is:





Explanation

The natural history of an asymptomatic thoracic disk herniation is to remain asymptomatic and exhibit little change in size. In a series of 48 asymptomatic thoracic disk herniations, Wood found that all disks remained asymptomatic at follow-up with little fluctuation in size of the disk.

Question 2

A 48-year-old man presents with acute onset of unilateral, anterior band-like chest pain after lifting heavy machinery at work. The history and physical examination and the magnetic resonance image confirm a T9-T10 thoracic disk herniation. The best initial treatment for this patient is:





Explanation

Brown et al retrospectively reviewed the natural history of symptomatic thoracic disk herniations and found 77% of patients did well with nonsurgical management. The patients returned to their previous level of activity following activity modification and physical therapy.

Question 3

The most common site of a thoracic disk herniation requiring surgery is from levels:





Explanation

T8-T11 is the most common site of disk herniation that requires surgery. A review of 71 patients with 82 thoracic disk herniations undergoing surgery found that 66% of disks were between T8-T11. The most common disk level was T9-T10, which represented 26% of the herniations.C orrect Answer: T8- T11

Question 4

The most common location for a thoracic disk herniation is:





Explanation

The most common locations for a thoracic disk herniation are centrolateral (94%) and lateral (6%). Disks classified as centrolateral have the bulk of the disk herniation medial to the lateral margin of the thecal sac.

Question 5

A 38-year-old construction worker falls from a scaffolding and sustains a pure flexion-compression injury to T12. In this type of injury, which portion of the vertebral body fails first:





Explanation

Failure occurs first at the end plate. The intact intervertebral disk has limited compressibility. Therefore, when the compressive forces exceed the disk compressibility, the load is transmitted to the contiguous bone. The end plate will rupture first followed by the subcortical cancellous vertebral bone.

Question 6

An absolute indication for surgical management of thoracolumbar burst fractures is:





Explanation

Patients with a neurologic deficit or a progressive neurologic deficit should undergo operative decompression. C ontroversy exists as to the amount of kyphosis and canal compression that is considered acceptable. Support can be found in the literature for both operative and nonoperative management of neurologically intact burst fractures. Each patient must be evaluated on a case by case basis and followed closely after injury.

Question 7

A 12-year-old girl presents with back pain of 3 monthsâ duration. She is a Risser stage 2. She displays a left thoracic curve of 27° on radiographs. The next study obtained in the work-up should be:





Explanation

Left thoracic curves are unusual in idiopathic scoliosis. A magnetic resonance image of the thoracic spine is mandatory in the work-up to rule out diastematomyelia, tethered spinal cord, spinal tumor, or other type of congenital anomaly.

Question 8

The most common organism responsible for vertebral column infection is:





Explanation

Staphylococcus aureus accounts for more than 50% of spinal infections and often results from hematogenous dissemination. Gram-negative organisms are more common following genitourinary procedures or urinary tract infections. Staphylococcus epidermidis can complicate spinal surgical wounds, and polymicrobial infection is more common in these circumstances.

Question 9

Symptoms of spinal infection may include all of the following except:





Explanation

Neck or back pain associated with spinal infection is relentless and constant. The pain is not usually associated with activity. There may be night pain as well. Other symptoms and signs are variable, requiring a high degree of suspicion. Fever occurs less than 50% of the time and neurological deficit less than 10% of the time. Paraspinal muscle spasms may result in decreased range of motion or torticollis.

Question 10

Which test is most specific for diagnosing spinal column infection:





Explanation

Vertebral biopsy, either via open or computed tomography-guided means, is most specific even though false-negative rates for closed and open biopsies are 30% and 14%, respectively. A patients white blood count may be normal even in acute spinal infection. Although often elevated, erythrocyte sedimentation rate and carbon-reactive protein are nonspecific tests. Blood cultures are negative in more than 75% of patients.

Question 11

Which of the following describes the magnetic resonance image (MRI) appearance of vertebral osteomyelitis:





Explanation

Magnetic resonance image (MRI) carries a 95% accuracy rate. Infected disk and vertebral bone appear on MRI with decreased signal onT1 images and increased signal on T2 images. Gadoliniun enhancement is useful in differentiating spinal infection or abscess from epidural scar in the postoperative setting.

Question 12

Appropriate treatment for spinal infection may include all the following except:





Explanation

Spinal stability appears to improve healing of spinal infection. C hronic, persistent infections may require removal of hardware. Antibiotics and immobilization are the mainstays of treatment. Neurological deficit from epidural abscess or kyphotic collapse may require operative decompression.

Question 13

Which of the following is not a surgical indication in the treatment of spinal column infection:





Explanation

Uncomplicated spinal osteomyelitis and diskitis are treated nonoperatively. Operative debridement, decompression, and stabilization may be useful in cases of abscess, sepsis, neurological deficit, and progressive deformity.

Question 14

Which of the following is more characteristic of tuberculoid rather than pyogenic spinal infection:





Explanation

Spinal tuberculosis typically follows an indolent course early on despite radioqraphic findings out of proportion to the exam. Pyogenic and tuberculoid spinal infections involve the thoracic spine more commonly than the cervical spine. Both spinal infections may result in bony destruction, elevated erythrocyte sedimentation rates, and may or may not present with constitutional symptoms.

Question 15

Which of the following is a risk factor for neurological deficit associated with tuberculoid spinal infection:





Explanation

Tuberculosis in the cervical spine of children younger than 10 years of age carries a significantly lower risk of paralysis than in older patients (17% vs 81%).

Question 16

All of the following organisms may cause granulomatous opportunistic spinal infection in immunocompromised patients except:





Explanation

Staphylococcal infection is typically pyogenic, not granulomatous.

Question 17

Antibiotic treatment for spinal tuberculosis includes all of the following except:





Explanation

A four-drug regimen against spinal tuberculosis is recommended because of the high prevalence of organism resistance. Cefotaxime is a cephalosporin not active against mycobacterial infection.

Question 18

What percentage of spinal infections have concurrent positive blood cultures:





Explanation

Even though the majority of spinal infections are considered hematogenous in origin, only 25% of infections occur with positive blood cultures.

Question 19

The treatment of choice for spinal epidural abscess is:





Explanation

It is generally believed that pockets of pus, whether they are epidural, paravertebral, or psoas abscesses, must be drained in addition to antimicrobial therapy.

Question 20

Which of the following antibiotics would not be useful in staphylococcal vertebral osteomyelitis:





Explanation

Aminoglycosides, such as tobramycin, are active against gram-negative organisms. First- and second-generation cephalosporins are alternatives to semisynthetic penicillins that may be useful if the organism is not resistant. Ciprofloxicin has also been considered a possible alternative to penicillins against gram-positive vertebral osteomyelitis.

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Dr. Mohammed Hutaif
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Prof. Dr. Mohammed Hutaif
Consultant Orthopedic & Spine Surgeon
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