Musculoskeletal imaging: painful scoliosis with neurological signs: 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: painful scoliosis with neurological signs

Sample item

A 12-year-old girl has a painful left thoracic scoliosis and absent abdominal reflexes. The radiograph shows a 30 degree curve. What is the next best investigation?

ADEXA scanBUltrasound of the spineCMRI of the whole spineDRepeat standing radiograph in six months

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

The answer and the reasoning

C. MRI of the whole spine

A left thoracic curve with pain or neurological signs is atypical for idiopathic scoliosis and suggests an intraspinal cause such as syrinx, Chiari malformation or tumour. MRI of the neuraxis is therefore indicated before any treatment.

Option by option

A. DEXA scan
DEXA measures bone density and does not explain scoliosis with neurological signs.
B. Ultrasound of the spine
Spinal ultrasound is limited to infants before the posterior elements ossify.
C. MRI of the whole spine (correct)
Correct. Atypical features with neurological signs call for MRI of the neuraxis to exclude syrinx, Chiari malformation or tumour.
D. Repeat standing radiograph in six months
Observation with a repeat radiograph would delay diagnosis of a possible intraspinal lesion.

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, MRI of the whole spine. A left thoracic curve with pain or neurological signs is atypical for idiopathic scoliosis and suggests an intraspinal cause such as syrinx, Chiari malformation or tumour.

Why is "DEXA scan" not the answer?

DEXA measures bone density and does not explain scoliosis with neurological signs.

Why is "Ultrasound of the spine" not the answer?

Spinal ultrasound is limited to infants before the posterior elements ossify.

Why is "Repeat standing radiograph in six months" not the answer?

Observation with a repeat radiograph would delay diagnosis of a possible intraspinal lesion.

What concept does this question test?

It tests Musculoskeletal imaging: painful scoliosis with neurological signs in Radiology. MRI of the neuraxis is therefore indicated before any treatment.

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: painful scoliosis with neurological signs?

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.