Metabolic bone disease: lytic phase of 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: lytic phase of Paget disease

Sample item

In the early lytic phase of Paget disease, a long bone radiograph shows an advancing front of radiolucency along the shaft. How is this described?

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

The answer and the reasoning

D. A V-shaped blade of grass or flame lesion

In the lytic phase osteoclastic resorption advances along the shaft as a V-shaped lucent front, called the blade of grass or flame sign. The skull shows osteoporosis circumscripta, and later sclerotic phases show cortical thickening and a cotton-wool appearance.

Option by option

  • A. A bone-within-bone appearance

    Bone-within-bone is seen in osteopetrosis.

  • B. A sunburst periosteal reaction

    Sunburst periosteal reaction is seen in osteosarcoma.

  • C. Multiple punched-out lesions

    Multiple punched-out lesions are typical of myeloma.

  • D. A V-shaped blade of grass or flame lesion (correct)

    Correct. A flame-shaped advancing lucent front is typical of the lytic phase.

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 D, A V-shaped blade of grass or flame lesion. In the lytic phase osteoclastic resorption advances along the shaft as a V-shaped lucent front, called the blade of grass or flame sign.

Why is "A bone-within-bone appearance" not the answer?

Bone-within-bone is seen in osteopetrosis.

Why is "A sunburst periosteal reaction" not the answer?

Sunburst periosteal reaction is seen in osteosarcoma.

Why is "Multiple punched-out lesions" not the answer?

Multiple punched-out lesions are typical of myeloma.

What concept does this question test?

It tests Metabolic bone disease: lytic phase of Paget disease in Orthopaedics. The skull shows osteoporosis circumscripta, and later sclerotic phases show cortical thickening and a cotton-wool appearance.

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: lytic phase of 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.