Spine: intramedullary versus extramedullary tumours: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Spine: intramedullary versus extramedullary tumours

Sample item

A man has a slowly progressive cord syndrome with loss of pain and temperature sensation in a cape-like distribution, preserved sensation in the sacral dermatomes and early upper limb wasting. What does this suggest?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. An intramedullary spinal cord tumour

Intramedullary tumours such as ependymoma and astrocytoma disrupt the central grey matter and crossing spinothalamic fibres first, producing dissociated sensory loss with sacral sparing because the sacral fibres lie peripherally. Extramedullary lesions tend to cause root pain and a Brown-Sequard picture with spasticity. MRI with contrast confirms the diagnosis.

Option by option

  • A. An extradural abscess

    An abscess presents acutely with fever and pain.

  • B. An intradural extramedullary meningioma

    Extramedullary tumours cause radicular pain and asymmetric long tract signs.

  • C. A lumbar disc prolapse

    A lumbar disc does not cause cape-like loss in the upper body.

  • D. An intramedullary spinal cord tumour (correct)

    Correct. Dissociated sensory loss with sacral sparing points to an intramedullary lesion.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is D, An intramedullary spinal cord tumour. Intramedullary tumours such as ependymoma and astrocytoma disrupt the central grey matter and crossing spinothalamic fibres first, producing dissociated sensory loss with sacral sparing because the sacral fibres lie peripherally.

Why is "An extradural abscess" not the answer?

An abscess presents acutely with fever and pain.

Why is "An intradural extramedullary meningioma" not the answer?

Extramedullary tumours cause radicular pain and asymmetric long tract signs.

Why is "A lumbar disc prolapse" not the answer?

A lumbar disc does not cause cape-like loss in the upper body.

What concept does this question test?

It tests Spine: intramedullary versus extramedullary tumours in Orthopaedics. Extramedullary lesions tend to cause root pain and a Brown-Sequard picture with spasticity. MRI with contrast confirms the diagnosis.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Spine: intramedullary versus extramedullary tumours?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.