Billy Step 1 Questions # 32 - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-16-2012
billy's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 444
Threads: 109
Thanked 369 Times in 208 Posts
Reputation: 379
Arrow Billy Step 1 Questions # 32

A 75-year-old woman has experienced increasing pain in the back, right chest, left shoulder, and left upper thigh for the
past 6 months. The pain is dull but constant. She has now developed a sudden, severe, sharp pain in the left thigh. On
physical examination, she is afebrile. She has intense pain on palpation of the upper thigh, and the left leg is shorter than
the right. A radiograph of the left leg shows a fracture through the upper diaphyseal region of the femur in a 5-cm lytic area
that extends through the entire thickness of the bone. A bone scan shows multiple areas of increased uptake in the left
femur, pelvis, vertebrae, right third and fourth ribs, upper left humerus, and left scapula. Laboratory studies show serum
Na+, 140 mmol/L; K+, 4.1 mmol/L; Cl−, 99 mmol/L; CO2, 26 mmol/L; glucose, 78 mg/dL; creatinine, 0.9 mg/dL; total protein,
6.7 g/dL; albumin, 4.5 g/dL; total bilirubin, 1 mg/dL; AST, 28 U/L; ALT, 22 U/L; and alkaline phosphatase, 202 U/L. What is
the most likely diagnosis?


□ (A) Hyperparathyroidism
□ (B) Metastatic carcinoma
□ (C) Multiple myeloma
□ (D) Osteochondromatosis
□ (E) Osteomyelitis
□ (F) Paget disease of bone
□ (G) Polyostotic fibrous dysplasia
Reply With Quote Quick reply to this message
The above post was thanked by:
lichen70 (06-15-2015), vnagubandi (10-17-2012)



  #2  
Old 10-16-2012
venky2600's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,186
Threads: 119
Thanked 815 Times in 434 Posts
Reputation: 825
Send a message via Yahoo to venky2600
Post

b) metastatic carcinoma???
Reply With Quote Quick reply to this message
  #3  
Old 10-16-2012
koolkiller88's Avatar
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 864
Threads: 62
Thanked 370 Times in 224 Posts
Reputation: 380
Default

F. Paget disease of bone???
__________________
One day i will infect these microbes and they will search for "Anti-MEbiotic"....
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #4  
Old 10-16-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,039
Threads: 189
Thanked 557 Times in 318 Posts
Reputation: 567
Default my answer :)

(F) Paget disease of bone
Reply With Quote Quick reply to this message
  #5  
Old 10-16-2012
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 7
Threads: 5
Thanked 2 Times in 2 Posts
Reputation: 12
Default

C????
Reply With Quote Quick reply to this message
  #6  
Old 10-16-2012
nishaa's Avatar
USMLE Forums Veteran
 
Steps History: 1+CK+CS
Posts: 203
Threads: 32
Thanked 124 Times in 50 Posts
Reputation: 134
Default

i think its Pagets disease of bone . only ALP is elevated
Reply With Quote Quick reply to this message
  #7  
Old 10-17-2012
Lara's Avatar
USMLE Forums Addict
 
Steps History: Not yet
Posts: 183
Threads: 29
Thanked 66 Times in 48 Posts
Reputation: 76
Default

Multiple myeloma
__________________
One Step At a time
Reply With Quote Quick reply to this message
  #8  
Old 10-17-2012
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 185
Threads: 58
Thanked 57 Times in 24 Posts
Reputation: 76
Default

what source is this question from?

Quote:
Originally Posted by billy View Post
A 75-year-old woman has experienced increasing pain in the back, right chest, left shoulder, and left upper thigh for the
past 6 months. The pain is dull but constant. She has now developed a sudden, severe, sharp pain in the left thigh. On
physical examination, she is afebrile. She has intense pain on palpation of the upper thigh, and the left leg is shorter than
the right. A radiograph of the left leg shows a fracture through the upper diaphyseal region of the femur in a 5-cm lytic area
that extends through the entire thickness of the bone. A bone scan shows multiple areas of increased uptake in the left
femur, pelvis, vertebrae, right third and fourth ribs, upper left humerus, and left scapula. Laboratory studies show serum
Na+, 140 mmol/L; K+, 4.1 mmol/L; Cl−, 99 mmol/L; CO2, 26 mmol/L; glucose, 78 mg/dL; creatinine, 0.9 mg/dL; total protein,
6.7 g/dL; albumin, 4.5 g/dL; total bilirubin, 1 mg/dL; AST, 28 U/L; ALT, 22 U/L; and alkaline phosphatase, 202 U/L. What is
the most likely diagnosis?


□ (A) Hyperparathyroidism
□ (B) Metastatic carcinoma
□ (C) Multiple myeloma
□ (D) Osteochondromatosis
□ (E) Osteomyelitis
□ (F) Paget disease of bone
□ (G) Polyostotic fibrous dysplasia
Reply With Quote Quick reply to this message
  #9  
Old 10-17-2012
trupti's Avatar
USMLE Forums Scout
 
Steps History: Not yet
Posts: 75
Threads: 3
Thanked 44 Times in 21 Posts
Reputation: 54
Default

Quote:
Originally Posted by billy View Post
A 75-year-old woman has experienced increasing pain in the back, right chest, left shoulder, and left upper thigh for the
past 6 months. The pain is dull but constant. She has now developed a sudden, severe, sharp pain in the left thigh. On
physical examination, she is afebrile. She has intense pain on palpation of the upper thigh, and the left leg is shorter than
the right. A radiograph of the left leg shows a fracture through the upper diaphyseal region of the femur in a 5-cm lytic area
that extends through the entire thickness of the bone. A bone scan shows multiple areas of increased uptake in the left
femur, pelvis, vertebrae, right third and fourth ribs, upper left humerus, and left scapula. Laboratory studies show serum
Na+, 140 mmol/L; K+, 4.1 mmol/L; Cl−, 99 mmol/L; CO2, 26 mmol/L; glucose, 78 mg/dL; creatinine, 0.9 mg/dL; total protein,
6.7 g/dL; albumin, 4.5 g/dL; total bilirubin, 1 mg/dL; AST, 28 U/L; ALT, 22 U/L; and alkaline phosphatase, 202 U/L. What is
the most likely diagnosis?


□ (A) Hyperparathyroidism
□ (B) Metastatic carcinoma
□ (C) Multiple myeloma
□ (D) Osteochondromatosis
□ (E) Osteomyelitis
□ (F) Paget disease of bone
□ (G) Polyostotic fibrous dysplasia
F.Paget's disease ...Other options can be ruled out based on assumptions of normal proteins(a/g)ratio as mentioned in the stem,sr.calcium and sr.PTH..as its not mentioned in the positive lab findings..LYTIC PHASE OF PAGET'S??ONLY SR.ALP IS RAISED..waiting for the correct ans yet...
Reply With Quote Quick reply to this message
  #10  
Old 10-17-2012
billy's Avatar
USMLE Forums Guru
 
Steps History: Not yet
Posts: 444
Threads: 109
Thanked 369 Times in 208 Posts
Reputation: 379
Correct Answer B is correct

An elevated alkaline phosphatase level in an older adult should raise the suspicion of bone metastases, particularly
when there is a “pathologic” fracture resulting from a bone lesion, rather than a fracture from trauma. Likely primary sites
include the breast (in women), prostate (in men), lung (in smokers), kidney, and thyroid. Hyperparathyroidism can lead to
osteitis fibrosa cystica with lytic lesions that are usually small, involve just cortex, and appear first in phalanges. Multiple
myeloma can produce lytic bone lesions, but the patient's serum gamma globulin level is not elevated. Osteochondromas
are exostoses and do not produce lytic bone lesions. Osteomyelitis is usually more limited without such discrete areas of
lysis. Paget disease of bone is characterized by osteolysis coupled with bone formation, but without lytic lesions. Fibrous
dysplasia coupled with café-au-lait spots on skin and with endocrinopathies is known as McCune-Albright syndrome; this
is a rare condition that occurs in young girls.
Reply With Quote Quick reply to this message
The above post was thanked by:
nishaa (10-17-2012), Talal Hussain (10-18-2012), vnagubandi (10-17-2012)
  #11  
Old 10-17-2012
Teona's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 331
Threads: 39
Thanked 308 Times in 117 Posts
Reputation: 318
Default

Quote:
Originally Posted by billy View Post
A 75-year-old woman has experienced increasing pain in the back, right chest, left shoulder, and left upper thigh for the
past 6 months. The pain is dull but constant. She has now developed a sudden, severe, sharp pain in the left thigh. On
physical examination, she is afebrile. She has intense pain on palpation of the upper thigh, and the left leg is shorter than
the right. A radiograph of the left leg shows a fracture through the upper diaphyseal region of the femur in a 5-cm lytic area
that extends through the entire thickness of the bone. A bone scan shows multiple areas of increased uptake in the left
femur, pelvis, vertebrae, right third and fourth ribs, upper left humerus, and left scapula. Laboratory studies show serum
Na+, 140 mmol/L; K+, 4.1 mmol/L; Cl−, 99 mmol/L; CO2, 26 mmol/L; glucose, 78 mg/dL; creatinine, 0.9 mg/dL; total protein,
6.7 g/dL; albumin, 4.5 g/dL; total bilirubin, 1 mg/dL; AST, 28 U/L; ALT, 22 U/L; and alkaline phosphatase, 202 U/L. What is
the most likely diagnosis?


□ (A) Hyperparathyroidism
□ (B) Metastatic carcinoma
□ (C) Multiple myeloma
□ (D) Osteochondromatosis
□ (E) Osteomyelitis
□ (F) Paget disease of bone
□ (G) Polyostotic fibrous dysplasia
I would choose B) Metastatic carcinoma.
Reply With Quote Quick reply to this message



Reply

Tags
Musculoskeletal-, Pathology-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Billy Step 1 Questions # 31 billy USMLE Step 1 Forum 3 10-17-2012 11:07 AM
Billy Step 1 Questions # 24 billy USMLE Step 1 Forum 7 10-10-2012 11:57 AM
Billy Step 1 Questions #13 billy USMLE Step 1 Forum 5 10-09-2012 01:32 PM
Billy Step 1 Questions # 14 billy USMLE Step 1 Forum 6 10-09-2012 08:39 AM
Billy Step 1 Questions #6 billy USMLE Step 1 Forum 7 10-03-2012 12:53 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)