Ear and audiology: Paget disease of the temporal bone: practice question

A ENT 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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ENT · Ear and audiology: Paget disease of the temporal bone

Sample item

A 68-year-old man has bone pain, an increasing hat size and a raised serum alkaline phosphatase. He has progressive bilateral mixed hearing loss. What is the underlying diagnosis?

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

The answer and the reasoning

C. Paget disease of bone

Paget disease of the temporal bone causes sensorineural loss from cochlear involvement and conductive loss from ossicular fixation, giving a mixed pattern. The raised alkaline phosphatase with normal calcium and enlarging skull clinch the diagnosis. Bisphosphonates are used.

Option by option

  • A. Otosclerosis

    Otosclerosis occurs in younger adults with normal alkaline phosphatase and conductive loss.

  • B. Osteopetrosis

    Osteopetrosis is a rare disorder of dense brittle bone, usually presenting in childhood with marrow failure.

  • C. Paget disease of bone (correct)

    Correct. Skull enlargement, bone pain and high alkaline phosphatase with mixed loss indicate Paget disease.

  • D. Presbycusis

    Presbycusis is a symmetric sensorineural loss of ageing without bone 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 ENT question

What is the answer to this ENT question?

The best answer is C, Paget disease of bone. Paget disease of the temporal bone causes sensorineural loss from cochlear involvement and conductive loss from ossicular fixation, giving a mixed pattern.

Why is "Otosclerosis" not the answer?

Otosclerosis occurs in younger adults with normal alkaline phosphatase and conductive loss.

Why is "Osteopetrosis" not the answer?

Osteopetrosis is a rare disorder of dense brittle bone, usually presenting in childhood with marrow failure.

Why is "Presbycusis" not the answer?

Presbycusis is a symmetric sensorineural loss of ageing without bone disease.

What concept does this question test?

It tests Ear and audiology: Paget disease of the temporal bone in ENT. The raised alkaline phosphatase with normal calcium and enlarging skull clinch the diagnosis. Bisphosphonates are used.

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 Ear and audiology: Paget disease of the temporal bone?

Learn tuning fork results and audiogram patterns by sketching them. Then use the flashcards and the other ENT 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.