Musculoskeletal imaging: metabolic bone disease: practice question

A Radiology 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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Radiology · Musculoskeletal imaging: metabolic bone disease

Sample item

A woman with hypercalcaemia and a raised parathyroid hormone has radiographs of the hands showing erosion along the radial side of the middle phalanges, and a skull with a mottled 'pepper-pot' appearance. What is the diagnosis?

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

The answer and the reasoning

B. Primary hyperparathyroidism with subperiosteal resorption

Subperiosteal bone resorption, most characteristic on the radial side of the middle phalanges, is the pathognomonic sign of hyperparathyroidism, along with a 'salt and pepper' skull, loss of the lamina dura of teeth, brown tumours and, in renal osteodystrophy, a 'rugger-jersey' spine. Osteopetrosis shows dense bones, and rickets shows widened growth plates with cupping.

Option by option

  • A. Paget disease of bone

    Paget disease shows thickened, sclerotic bone with a cotton-wool skull but normal calcium.

  • B. Primary hyperparathyroidism with subperiosteal resorption (correct)

    Correct. Subperiosteal resorption and a pepper-pot skull indicate hyperparathyroidism.

  • C. Rickets

    Rickets shows physeal widening and cupping in growing children, with low or normal calcium.

  • D. Osteopetrosis

    Osteopetrosis shows uniformly dense bones with a 'bone-in-bone' appearance.

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 Radiology question

What is the answer to this Radiology question?

The best answer is B, Primary hyperparathyroidism with subperiosteal resorption. Subperiosteal bone resorption, most characteristic on the radial side of the middle phalanges, is the pathognomonic sign of hyperparathyroidism, along with a 'salt and pepper' skull, loss of the lamina dura of teeth, brown tumours and, in renal osteodystrophy, a 'rugger-jersey' spine.

Why is "Paget disease of bone" not the answer?

Paget disease shows thickened, sclerotic bone with a cotton-wool skull but normal calcium.

Why is "Rickets" not the answer?

Rickets shows physeal widening and cupping in growing children, with low or normal calcium.

Why is "Osteopetrosis" not the answer?

Osteopetrosis shows uniformly dense bones with a 'bone-in-bone' appearance.

What concept does this question test?

It tests Musculoskeletal imaging: metabolic bone disease in Radiology. Osteopetrosis shows dense bones, and rickets shows widened growth plates with cupping.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Musculoskeletal imaging: metabolic bone disease?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology 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.