Musculoskeletal imaging: winking owl sign: 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: winking owl sign

Sample item

A smoker with lung cancer has back pain. An AP lumbar radiograph shows one oval pedicle ring missing while the opposite pedicle and the spinous process are intact. Which sign is this?

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

The answer and the reasoning

C. Winking owl sign

Destruction of a pedicle by a lytic metastasis removes the normal oval cortical ring on the AP view, so the vertebra resembles an owl with one eye closed. It is a classic sign of vertebral metastasis.

Option by option

  • A. Rugger jersey sign

    The rugger jersey sign is alternating endplate sclerosis and lucent bands in the spine.

  • B. Scottie dog collar sign

    The Scottie dog collar sign is a pars interarticularis defect seen on an oblique lumbar view.

  • C. Winking owl sign (correct)

    Correct. Loss of one pedicle outline from lytic metastasis gives the winking owl sign.

  • D. Picture frame sign

    The picture frame sign is cortical thickening around a vertebral body in Paget disease.

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 C, Winking owl sign. Destruction of a pedicle by a lytic metastasis removes the normal oval cortical ring on the AP view, so the vertebra resembles an owl with one eye closed.

Why is "Rugger jersey sign" not the answer?

The rugger jersey sign is alternating endplate sclerosis and lucent bands in the spine.

Why is "Scottie dog collar sign" not the answer?

The Scottie dog collar sign is a pars interarticularis defect seen on an oblique lumbar view.

Why is "Picture frame sign" not the answer?

The picture frame sign is cortical thickening around a vertebral body in Paget disease.

What concept does this question test?

It tests Musculoskeletal imaging: winking owl sign in Radiology. It is a classic sign of vertebral metastasis.

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: winking owl sign?

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.