Question of the Week # 155

155)  A 55 year old man presents to the clinic for progressive right hip pain. He has a history of hearing impairment. He reports pain in the right hip when walking more than 1 block and also, has difficulty putting shoes on his right foot. On examination, the range of motion is significantly limited in the right hip. An X-ray of the right hip reveals significant loss of cartilage, subchondral sclerosis and sub-chondral cysts. X-ray also reveals pagetoid changes in the right iliac wing and right femoral neck. Serum alkaline phosphatase level is 432 IU/L (n = 20 to 140 IU/L). The most appropriate initial step in managing this patient is:

A)           Bisphosphanates

B)            Acetaminophen

C)            Bisphosphanates and Acetaminoiphen

D)           Calcitonin Intranasally

E)           Oral prednisone

7 Responses

  1. A) Bisphosphanates

    • A) Bisphosphanates

  2. C

  3. C

  4. B

  5. No, I change to C, she has both features of osteoarthritis and Paget’s disease. Bisphosphonates and acetaminophen.

  6. C: Paget disease : hearing loss, bone pain, pagetoid changes + OA : X ray features . Tx bisphosphonate and acetaminophen

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: