Bone: Paget disease: practice question

A Pathology 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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Pathology · Bone: Paget disease

Sample item

A 68-year-old man reports an increase in hat size, hearing loss and bone pain. Serum alkaline phosphatase is markedly raised, while calcium and phosphate are normal. What is the characteristic histology of the affected bone?

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

The answer and the reasoning

B. Jigsaw mosaic pattern of lamellar bone with prominent cement lines

Paget disease of bone passes through an osteolytic phase, a mixed phase and a sclerotic phase of disordered remodelling. The resulting bone is thick but weak, with a mosaic pattern of lamellar bone joined by haphazard cement lines. Complications include deafness from foramina narrowing, high-output heart failure and, rarely, osteosarcoma.

Option by option

  • A. Woven bone trabeculae in a whorled fibrous stroma

    Woven bone in whorled fibrous stroma indicates fibrous dysplasia, giving a Chinese letter pattern.

  • B. Jigsaw mosaic pattern of lamellar bone with prominent cement lines (correct)

    Correct. A mosaic of lamellar bone with prominent cement lines is the hallmark of Paget disease.

  • C. Widened osteoid seams with Looser zones

    Widened osteoid seams and Looser zones indicate osteomalacia.

  • D. Cystic spaces lined by osteoclast-rich brown tumours

    Osteoclast-rich brown tumours indicate hyperparathyroid 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 Pathology question

What is the answer to this Pathology question?

The best answer is B, Jigsaw mosaic pattern of lamellar bone with prominent cement lines. Paget disease of bone passes through an osteolytic phase, a mixed phase and a sclerotic phase of disordered remodelling.

Why is "Woven bone trabeculae in a whorled fibrous stroma" not the answer?

Woven bone in whorled fibrous stroma indicates fibrous dysplasia, giving a Chinese letter pattern.

Why is "Widened osteoid seams with Looser zones" not the answer?

Widened osteoid seams and Looser zones indicate osteomalacia.

Why is "Cystic spaces lined by osteoclast-rich brown tumours" not the answer?

Osteoclast-rich brown tumours indicate hyperparathyroid bone disease.

What concept does this question test?

It tests Bone: Paget disease in Pathology. The resulting bone is thick but weak, with a mosaic pattern of lamellar bone joined by haphazard cement lines. Complications include deafness from foramina narrowing, high-output heart failure and, rarely, 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 Bone: Paget disease?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.