Infectious diseases: spinal tuberculosis imaging: practice question

A General Medicine 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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General Medicine · Infectious diseases: spinal tuberculosis imaging

Sample item

A 40-year-old man has back pain, low-grade fever and a gibbus. MRI of the thoracic spine shows destruction of adjacent vertebral bodies with a paravertebral abscess. Which feature favours tuberculosis over pyogenic spondylodiscitis?

AAbsence of paraspinal collectionBSingle-level involvement of one end plateCRelative preservation of the intervertebral disc until lateDEarly destruction of the disc space

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

The answer and the reasoning

C. Relative preservation of the intervertebral disc until late

Tuberculous spondylitis spreads under the anterior longitudinal ligament and spares the disc until late because the organism lacks proteolytic enzymes. Pyogenic infection destroys the disc early.

Option by option

A. Absence of paraspinal collection
A paraspinal abscess is common in tuberculosis and its absence would not favour it.
B. Single-level involvement of one end plate
A single end plate focus does not distinguish between them.
C. Relative preservation of the intervertebral disc until late (correct)
Correct. A relatively preserved disc with large paraspinal abscess favours tuberculosis.
D. Early destruction of the disc space
Early disc destruction is typical of pyogenic infection.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Relative preservation of the intervertebral disc until late. Tuberculous spondylitis spreads under the anterior longitudinal ligament and spares the disc until late because the organism lacks proteolytic enzymes.

Why is "Absence of paraspinal collection" not the answer?

A paraspinal abscess is common in tuberculosis and its absence would not favour it.

Why is "Single-level involvement of one end plate" not the answer?

A single end plate focus does not distinguish between them.

Why is "Early destruction of the disc space" not the answer?

Early disc destruction is typical of pyogenic infection.

What concept does this question test?

It tests Infectious diseases: spinal tuberculosis imaging in General Medicine. Pyogenic infection destroys the disc early.

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 Infectious diseases: spinal tuberculosis imaging?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.