Metabolic bone disease: Paget disease and sarcoma: 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 and sarcoma

Sample item

A 72-year-old man with known Paget disease of the pelvis develops a rapid increase in pain and a soft tissue swelling over the affected bone. Which complication is most likely?

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

The answer and the reasoning

C. Osteosarcoma arising in pagetic bone

Secondary sarcoma develops in a small percentage of long-standing, extensive Paget disease. Sudden worsening pain, swelling and a rising alkaline phosphatase should prompt imaging and biopsy. Most are osteosarcomas with a poor prognosis.

Option by option

  • A. Osteoarthritis of the hip joint

    Arthritis causes joint pain and does not give a soft tissue mass over the bone.

  • B. Pathological fracture through a stress crack

    A fracture gives sudden pain after a minor injury but not a growing soft tissue mass.

  • C. Osteosarcoma arising in pagetic bone (correct)

    Correct. Sudden pain and a soft tissue mass in pagetic bone indicate sarcomatous change.

  • D. Acute osteomyelitis

    Osteomyelitis would be accompanied by fever and is not typical in Paget disease.

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, Osteosarcoma arising in pagetic bone. Secondary sarcoma develops in a small percentage of long-standing, extensive Paget disease.

Why is "Osteoarthritis of the hip joint" not the answer?

Arthritis causes joint pain and does not give a soft tissue mass over the bone.

Why is "Pathological fracture through a stress crack" not the answer?

A fracture gives sudden pain after a minor injury but not a growing soft tissue mass.

Why is "Acute osteomyelitis" not the answer?

Osteomyelitis would be accompanied by fever and is not typical in Paget disease.

What concept does this question test?

It tests Metabolic bone disease: Paget disease and sarcoma in Orthopaedics. Sudden worsening pain, swelling and a rising alkaline phosphatase should prompt imaging and biopsy. Most are osteosarcomas with a poor prognosis.

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 and sarcoma?

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.