Endocrinology and diabetes: Paget disease of bone: practice question

A General Medicine 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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General Medicine · Endocrinology and diabetes: Paget disease of bone

Sample item

A 65-year-old man has increasing head size and bone pain. Serum calcium and phosphate are normal and ALP is markedly elevated. X-ray of the skull shows thickened bone with patchy density. What is the treatment of choice?

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

The answer and the reasoning

D. Bisphosphonate

Paget disease is increased bone remodelling with disorganised bone, a raised ALP and normal calcium. Bisphosphonates such as zoledronate suppress turnover and are the treatment of choice for symptomatic or high-risk disease. Complications include deafness, fractures and osteosarcoma.

Option by option

  • A. Vitamin D with calcium alone

    Calcium with vitamin D does not control the remodelling.

  • B. Calcitonin as sole long-term therapy

    Calcitonin is a weaker alternative used when bisphosphonates cannot be given.

  • C. Teriparatide

    Teriparatide stimulates bone formation and is used for osteoporosis, not Paget disease.

  • D. Bisphosphonate (correct)

    Correct. Bisphosphonates suppress the overactive osteoclast turnover.

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 General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Bisphosphonate. Paget disease is increased bone remodelling with disorganised bone, a raised ALP and normal calcium.

Why is "Vitamin D with calcium alone" not the answer?

Calcium with vitamin D does not control the remodelling.

Why is "Calcitonin as sole long-term therapy" not the answer?

Calcitonin is a weaker alternative used when bisphosphonates cannot be given.

Why is "Teriparatide" not the answer?

Teriparatide stimulates bone formation and is used for osteoporosis, not Paget disease.

What concept does this question test?

It tests Endocrinology and diabetes: Paget disease of bone in General Medicine. Bisphosphonates such as zoledronate suppress turnover and are the treatment of choice for symptomatic or high-risk disease. Complications include deafness, fractures 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 Endocrinology and diabetes: Paget disease of bone?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine 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.