Musculoskeletal imaging: acute osteomyelitis on radiograph: 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: acute osteomyelitis on radiograph

Sample item

A 10-year-old with fever and three days of leg pain after a skin infection has a plain radiograph of the tibia. What is the earliest abnormality expected in acute haematogenous osteomyelitis?

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

The answer and the reasoning

C. Deep soft-tissue swelling with loss of fat planes

In the first days only deep soft-tissue swelling with obliteration of fat planes may be seen. Bone changes such as lysis and periosteal reaction appear after about 7 to 14 days, so MRI is used when the radiograph is normal and suspicion is high.

Option by option

  • A. Sequestrum with involucrum

    Sequestrum and involucrum are features of established or chronic osteomyelitis.

  • B. Lytic metaphyseal destruction

    Lytic destruction needs loss of about 30 to 50 percent of bone mineral and appears after roughly 10 to 14 days.

  • C. Deep soft-tissue swelling with loss of fat planes (correct)

    Correct. Deep soft-tissue swelling with effaced fat planes is the earliest plain film sign.

  • D. Lamellated periosteal new bone

    Periosteal reaction develops after the first week as pus lifts the periosteum.

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, Deep soft-tissue swelling with loss of fat planes. In the first days only deep soft-tissue swelling with obliteration of fat planes may be seen.

Why is "Sequestrum with involucrum" not the answer?

Sequestrum and involucrum are features of established or chronic osteomyelitis.

Why is "Lytic metaphyseal destruction" not the answer?

Lytic destruction needs loss of about 30 to 50 percent of bone mineral and appears after roughly 10 to 14 days.

Why is "Lamellated periosteal new bone" not the answer?

Periosteal reaction develops after the first week as pus lifts the periosteum.

What concept does this question test?

It tests Musculoskeletal imaging: acute osteomyelitis on radiograph in Radiology. Bone changes such as lysis and periosteal reaction appear after about 7 to 14 days, so MRI is used when the radiograph is normal and suspicion is high.

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: acute osteomyelitis on radiograph?

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.