Metabolic bone disease: Paget disease: practice question

A Orthopaedics 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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Orthopaedics · Metabolic bone disease: Paget disease

Sample item

A 70-year-old man notes that his hat size has increased and he has hearing loss and bowing of the tibia. Serum alkaline phosphatase is markedly raised, while calcium and phosphate are normal. What is the diagnosis and the treatment?

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

The answer and the reasoning

C. Paget disease of bone, treated with a bisphosphonate such as zoledronic acid

Paget disease is a focal disorder of excessive osteoclastic resorption followed by disorganised new bone formation, producing a thickened skull, deformity, deafness and fractures. Alkaline phosphatase is raised while calcium and phosphate are normal. Bisphosphonates reduce activity and pain. Complications include high-output cardiac failure and osteosarcoma.

Option by option

  • A. Multiple myeloma, treated with calcium supplements

    Myeloma has lytic lesions and normal alkaline phosphatase, and calcium supplements would be harmful.

  • B. Hyperparathyroidism, treated with parathyroidectomy

    Hyperparathyroidism has raised calcium.

  • C. Paget disease of bone, treated with a bisphosphonate such as zoledronic acid (correct)

    Correct. A mosaic of resorption and formation causes enlargement and deformity, and bisphosphonates suppress it.

  • D. Osteomalacia, treated with calcitriol alone

    Osteomalacia has low or normal calcium and phosphate, with Looser zones.

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 Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Paget disease of bone, treated with a bisphosphonate such as zoledronic acid. Paget disease is a focal disorder of excessive osteoclastic resorption followed by disorganised new bone formation, producing a thickened skull, deformity, deafness and fractures.

Why is "Multiple myeloma, treated with calcium supplements" not the answer?

Myeloma has lytic lesions and normal alkaline phosphatase, and calcium supplements would be harmful.

Why is "Hyperparathyroidism, treated with parathyroidectomy" not the answer?

Hyperparathyroidism has raised calcium.

Why is "Osteomalacia, treated with calcitriol alone" not the answer?

Osteomalacia has low or normal calcium and phosphate, with Looser zones.

What concept does this question test?

It tests Metabolic bone disease: Paget disease in Orthopaedics. Alkaline phosphatase is raised while calcium and phosphate are normal. Bisphosphonates reduce activity and pain. Complications include high-output cardiac failure and osteosarcoma.

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 Metabolic bone disease: Paget disease?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics 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.