Mehlman/UW Paget

Question 1

M. Paget = Osteitis Deformans

Answer 1

.

Question 2

M. Paget. Pathophysiology?

Answer 2

Idiopathic disorder of increased bone turnover.
Bone is described as having mixed osteoblastic and - clastic phases, where bone appears HETERONEGENOUS ON XRAY

Question 3

M. Paget. Buzzy vignette.
Male + over 50 yo + does not fit hat anymore + tinnitus (narrowing of acoustic foramina).

Answer 3

.

Question 4

M. Paget. What Ca, vit D, ALP, PTH?

Answer 4

Isolated increased ALP in 19/20 of questions.

One Q in 2CK was in Nbme where ALP was normal.

Question 5

M. Paget. what cardiac pathology?
what murmur?

Answer 5

High-output cardiac failure can occur due to intraosseus AV-fistulae, where patient has an S3 heart sound with high ejection fraction.

Question 6

UW. Paget.
Manifestation. Long bones?

Answer 6

bowing, bone pain, arthritis

Question 7

UW. Paget.
Manifestation. Spine?

Answer 7

spinal stenosis, radiculopathy

Question 8

UW. Paget.
Manifestation. cranial bones?

Answer 8

frontal bossing, incr. hat size, headache, cranial nerve palsies, hearing loss.

Question 9

UW. Paget.
Dx 2?

Answer 9

Xray - cortical thickening, osteolytic or mixed lytic/sclerotic lessions

Bone scan - Focal increased in uptake

Question 10

UW. Paget.
Tx 2?

Answer 10

Asymptomatic –> obervations
Symptoms or incr. risk for fractures –> bisphosphonates

Question 11

UW. what cells impaired?

Answer 11

Abnormal osteoclasts activity
Incr. bone turnover

Question 12

UW. what increased? markers

Answer 12

Elevated bone turnover markers (eg, PINP, urine hydroxyproline)
PINP = procollagen type I N-terminal propeptide.