Musculoskeletal imaging: sickle cell bone changes: 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.

Try it

Radiology · Musculoskeletal imaging: sickle cell bone changes

Sample item

A child with sickle cell anaemia has a lateral spine radiograph showing central depression of the vertebral endplates, giving a step-like or H-shaped outline. What is the cause?

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

The answer and the reasoning

D. Marrow ischaemia with endplate infarction

Sickling causes ischaemia of the central endplate, which fails to grow, giving H-shaped (Lincoln log) vertebrae. Marrow hyperplasia widens medullary spaces and also leads to a hair-on-end skull in some anaemias. Osteomalacia and osteomyelitis do not cause such symmetrical endplate steps.

Option by option

  • A. Metastatic neuroblastoma

    Neuroblastoma metastases produce lytic or mixed lesions rather than symmetrical endplate steps.

  • B. Osteomalacia with Looser zones

    Osteomalacia produces pseudofractures, not step-like endplates.

  • C. Vertebral osteomyelitis

    Osteomyelitis causes disc space loss with endplate destruction on one level.

  • D. Marrow ischaemia with endplate infarction (correct)

    Correct. Central endplate infarction from sickling produces H-shaped vertebrae.

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.

More Radiology questions

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Marrow ischaemia with endplate infarction. Sickling causes ischaemia of the central endplate, which fails to grow, giving H-shaped (Lincoln log) vertebrae.

Why is "Metastatic neuroblastoma" not the answer?

Neuroblastoma metastases produce lytic or mixed lesions rather than symmetrical endplate steps.

Why is "Osteomalacia with Looser zones" not the answer?

Osteomalacia produces pseudofractures, not step-like endplates.

Why is "Vertebral osteomyelitis" not the answer?

Osteomyelitis causes disc space loss with endplate destruction on one level.

What concept does this question test?

It tests Musculoskeletal imaging: sickle cell bone changes in Radiology. Marrow hyperplasia widens medullary spaces and also leads to a hair-on-end skull in some anaemias. Osteomalacia and osteomyelitis do not cause such symmetrical endplate steps.

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: sickle cell bone changes?

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.