Spine: atypical scoliosis needing MRI: 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: atypical scoliosis needing MRI

Sample item

A 12-year-old boy has a left thoracic curve with a Cobb angle of 25 degrees, headache, and unequal abdominal reflexes on the two sides. Which investigation is the most appropriate next step?

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

The answer and the reasoning

A. MRI of the brain and whole spine

A left thoracic curve, early male presentation, headache or abnormal neurology suggests an underlying neural axis problem such as Chiari malformation or syringomyelia. MRI of the brain and spine is needed before treating the curve as idiopathic.

Option by option

  • A. MRI of the brain and whole spine (correct)

    Correct. Atypical features call for MRI of the neural axis to look for Chiari malformation or syrinx.

  • B. Flexion-extension lateral radiographs

    Dynamic radiographs assess instability and do not show the cord or brainstem.

  • C. Bone scan with technetium

    A bone scan is useful for painful scoliosis suggesting osteoid osteoma and does not image the neural axis.

  • D. CT scan of the lumbar spine

    CT of the lumbar spine does not image the thoracic curve or the neural axis adequately.

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 A, MRI of the brain and whole spine. A left thoracic curve, early male presentation, headache or abnormal neurology suggests an underlying neural axis problem such as Chiari malformation or syringomyelia.

Why is "Flexion-extension lateral radiographs" not the answer?

Dynamic radiographs assess instability and do not show the cord or brainstem.

Why is "Bone scan with technetium" not the answer?

A bone scan is useful for painful scoliosis suggesting osteoid osteoma and does not image the neural axis.

Why is "CT scan of the lumbar spine" not the answer?

CT of the lumbar spine does not image the thoracic curve or the neural axis adequately.

What concept does this question test?

It tests Spine: atypical scoliosis needing MRI in Orthopaedics. MRI of the brain and spine is needed before treating the curve as idiopathic.

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: atypical scoliosis needing MRI?

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.