MSK imaging: Paget disease: 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.

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Radiology · MSK imaging: Paget disease

Sample item

An elderly man has a raised alkaline phosphatase and a skull radiograph showing patchy sclerosis with enlargement of the vault ('cotton wool' appearance). What is the diagnosis?

AHyperparathyroidismBOsteopetrosisCMultiple myelomaDPaget disease of bone

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

The answer and the reasoning

D. Paget disease of bone

Paget disease produces thickened bone with coarse trabeculae and cortical thickening, with a cotton wool skull. In the spine it gives a picture frame vertebra or ivory vertebra. Complications include fractures, deafness, high output heart failure and osteosarcoma.

Option by option

A. Hyperparathyroidism
Hyperparathyroidism gives a salt-and-pepper skull.
B. Osteopetrosis
Osteopetrosis is a genetic disorder of uniformly dense bones in younger patients.
C. Multiple myeloma
Myeloma has punched-out lesions with a normal ALP.
D. Paget disease of bone (correct)
Correct. Cotton wool skull with a raised ALP indicates 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.

Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, Paget disease of bone. Paget disease produces thickened bone with coarse trabeculae and cortical thickening, with a cotton wool skull.

Why is "Hyperparathyroidism" not the answer?

Hyperparathyroidism gives a salt-and-pepper skull.

Why is "Osteopetrosis" not the answer?

Osteopetrosis is a genetic disorder of uniformly dense bones in younger patients.

Why is "Multiple myeloma" not the answer?

Myeloma has punched-out lesions with a normal ALP.

What concept does this question test?

It tests MSK imaging: Paget disease in Radiology. In the spine it gives a picture frame vertebra or ivory vertebra. Complications include fractures, deafness, high output heart 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 MSK imaging: Paget disease?

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.