Musculoskeletal imaging: ivory vertebra: 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: ivory vertebra

Sample item

A 65-year-old man with raised alkaline phosphatase has a lateral lumbar radiograph showing an L3 vertebra that is uniformly dense, slightly enlarged, and has a thickened cortex. Which diagnosis is most likely?

ALymphoma of the vertebraBOsteoblastic metastasisCPaget diseaseDOsteopetrosis

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

The answer and the reasoning

C. Paget disease

An ivory vertebra can result from Paget disease, sclerotic metastasis or lymphoma. Enlargement of the vertebral body with cortical thickening favours Paget disease, whereas metastasis and lymphoma usually preserve vertebral size.

Option by option

A. Lymphoma of the vertebra
Lymphoma can cause an ivory vertebra but without enlargement and cortical thickening.
B. Osteoblastic metastasis
An osteoblastic metastasis causes dense bone without expansion of the vertebral body.
C. Paget disease (correct)
Correct. A dense but enlarged vertebra with a thickened cortex favours Paget disease.
D. Osteopetrosis
Osteopetrosis affects the whole skeleton from childhood, not a single vertebra in an older man.

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.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is C, Paget disease. An ivory vertebra can result from Paget disease, sclerotic metastasis or lymphoma.

Why is "Lymphoma of the vertebra" not the answer?

Lymphoma can cause an ivory vertebra but without enlargement and cortical thickening.

Why is "Osteoblastic metastasis" not the answer?

An osteoblastic metastasis causes dense bone without expansion of the vertebral body.

Why is "Osteopetrosis" not the answer?

Osteopetrosis affects the whole skeleton from childhood, not a single vertebra in an older man.

What concept does this question test?

It tests Musculoskeletal imaging: ivory vertebra in Radiology. Enlargement of the vertebral body with cortical thickening favours Paget disease, whereas metastasis and lymphoma usually preserve vertebral size.

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 Musculoskeletal imaging: ivory vertebra?

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.