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Pathophysiology and Microbiology
1. What is the most common causative organism of spinal epidural abscesses?
a) Staphylococcus aureus
b) Escherichia coli
c) Mycobacterium tuberculosis
d) Streptococcus pneumoniae
2. Which condition is NOT a predisposing factor for the development of an epidural abscess?
a) Intravenous drug use
b) Diabetes mellitus
c) Hyperthyroidism
d) Immunosuppression
3. How do most spinal epidural abscesses originate?
a) Direct extension from osteomyelitis
b) Hematogenous spread
c) Traumatic injury
d) Post-surgical contamination
4. Which type of immune cell predominantly contributes to the inflammatory response in an epidural abscess?
a) Neutrophils
b) Macrophages
c) Lymphocytes
d) Eosinophils
5. Which anatomical location is most commonly affected in spinal epidural abscess?
a) Cervical spine
b) Thoracic spine
c) Lumbar spine
d) Sacral spine
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Clinical Presentation
6. The classic triad of spinal epidural abscess includes:
a) Fever, back pain, and neurological deficits
b) Fever, weight loss, and weakness
c) Pain, swelling, and erythema
d) Neuropathy, paralysis, and bowel dysfunction
7. Which of the following is typically the earliest symptom of a spinal epidural abscess?
a) Motor weakness
b) Severe back pain
c) Fever
d) Sensory loss
8. Neurological deficits in epidural abscess are primarily caused by:
a) Ischemia due to vascular compression
b) Direct bacterial invasion of nerves
c) Spinal cord compression
d) Autoimmune inflammation
9. What is the most common initial site of pain in spinal epidural abscess?
a) Localized to the affected vertebra
b) Diffuse throughout the back
c) Radiating to the extremities
d) Localized to the shoulders
10. Which of the following is NOT a common complication of untreated epidural abscess?
a) Quadriplegia
b) Sepsis
c) Cauda equina syndrome
d) Brain abscess
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Diagnosis
11. The gold standard imaging modality for diagnosing a spinal epidural abscess is:
a) CT scan
b) MRI with gadolinium
c) X-ray
d) Ultrasound
12. Which laboratory finding is most consistent with spinal epidural abscess?
a) Normal WBC count with elevated lactate
b) Elevated C-reactive protein (CRP)
c) Hypercalcemia
d) Low erythrocyte sedimentation rate (ESR)
13. Blood cultures in spinal epidural abscess are positive in what percentage of cases?
a) 10-20%
b) 30-50%
c) 60-70%
d) 80-90%
14. Which of the following findings on MRI suggests a diagnosis of spinal epidural abscess?
a) Hypointense signal on T1-weighted imaging with contrast enhancement
b) Hyperintense signal on T2-weighted imaging without enhancement
c) Calcifications in the epidural space
d) Diffuse fatty infiltration
15. Which of the following is a key differential diagnosis for spinal epidural abscess?
a) Metastatic spinal disease
b) Spinal cord glioma
c) Degenerative disc disease
d) All of the above
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Management
16. The first-line treatment for most cases of spinal epidural abscess is:
a) Empirical antibiotic therapy
b) Immediate surgical decompression
c) Radiation therapy
d) Corticosteroid administration
17. Which antibiotic regimen is commonly recommended for initial treatment of spinal epidural abscess?
a) Ceftriaxone and metronidazole
b) Vancomycin and cefepime
c) Amoxicillin-clavulanate
d) Linezolid and rifampin
18. The decision for surgical intervention in spinal epidural abscess is primarily based on:
a) Patient age
b) Presence of neurological deficits
c) Elevated inflammatory markers
d) Blood culture positivity
19. What is the minimum recommended duration of antibiotic therapy for spinal epidural abscess?
a) 2 weeks
b) 4 weeks
c) 6 weeks
d) 8 weeks
20. Corticosteroids may be considered in the management of spinal epidural abscess to:
a) Reduce inflammation and spinal cord compression
b) Enhance antibiotic penetration
c) Prevent secondary infections
d) Improve long-term neurological outcomes
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Prognosis
21. Which factor is most strongly associated with poor prognosis in spinal epidural abscess?
a) Delay in diagnosis
b) Older age
c) Diabetes mellitus
d) Presence of fever
22. The most common long-term sequelae of spinal epidural abscess is:
a) Chronic pain
b) Paralysis
c) Incontinence
d) Recurrent infections
23. Neurological recovery after surgical intervention for spinal epidural abscess is least likely in patients with:
a) Complete paralysis for >24 hours
b) Partial motor deficits
c) Severe back pain only
d) No neurological symptoms
24. The mortality rate associated with untreated spinal epidural abscess is approximately:
a) 10%
b) 20%
c) 40%
d) 70%
25. Early surgical intervention in spinal epidural abscess has been shown to improve which outcome?
a) Pain relief
b) Neurological recovery
c) Infection control
d) All of the above
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Advanced Concepts
26. What is the role of diffusion-weighted imaging (DWI) in diagnosing spinal epidural abscess?
a) Differentiates abscess from other masses
b) Detects spinal cord edema
c) Identifies small vessels within the abscess
d) Measures cerebrospinal fluid dynamics
27. Which of the following is a significant risk factor for spinal epidural abscess following epidural anesthesia?
a) Coagulopathy
b) Obesity
c) Allergic reactions
d) Smoking
28. In hematogenous spread of spinal epidural abscess, which site is most commonly identified as the primary source?
a) Dental abscess
b) Endocarditis
c) Skin infection
d) Urinary tract infection
29. A patient with a history of spinal instrumentation presents with back pain and fever. The most likely diagnosis is:
a) Post-surgical fibrosis
b) Spinal epidural abscess
c) Degenerative spondylosis
d) Vertebral compression fracture
30. Which biomarker is most predictive of treatment success in spinal epidural abscess?
a) C-reactive protein (CRP)
b) Erythrocyte sedimentation rate (ESR)
c) Procalcitonin
d) White blood cell count
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Case Scenarios
31. A 45-year-old diabetic male presents with severe back pain and fever. MRI reveals a thoracic epidural abscess. The next step in management is:
a) Empirical antibiotics
b) Surgical decompression
c) Epidural steroid injection
d) Observation
32. A 60-year-old woman with end-stage renal disease develops lumbar back pain and fever. Blood cultures grow Staphylococcus aureus. What should be the initial investigation?
a) CT spine
b) MRI with contrast
c) X-ray spine
d) Ultrasound spine
33. A patient with severe motor deficits due to spinal epidural abscess undergoes surgical decompression. Postoperatively, neurological improvement is minimal. The most likely reason is:
a) Residual infection
b) Delayed presentation
c) Surgical complications
d) Antibiotic resistance
34. A 50-year-old intravenous drug user presents with cervical pain, fever, and progressive quadriparesis. Blood cultures grow Staphylococcus aureus. What is the immediate priority?
a) MRI cervical spine
b) Echocardiography
c) Empirical antibiotics
d) Surgical decompression
35. A patient with spinal epidural abscess shows persistent fever despite appropriate antibiotic therapy. The most likely explanation is:
a) Multidrug-resistant bacteria
b) Missed diagnosis of osteomyelitis
c) Poor tissue penetration of antibiotics
d) Paraspinal abscess formation