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  #1  
Old 03-05-2013
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Default nice question

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
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Old 03-06-2013
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im thinking A) bisphosphonates
because it is Pagets Disease of bone ??
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Old 03-06-2013
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Quote:
Originally Posted by Heparin123 View Post
im thinking A) bisphosphonates
because it is Pagets Disease of bone ??
He also has subchondral cysts and subchondral sclerosis which is typically seen in osteoarthritis...hence treat with both biphosphonates and acetaminophen
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Old 03-06-2013
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Ahh Ok, nice one.
I didn't even pay attn to the subchondral cysts.
THnx!
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Old 03-06-2013
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C) Bisphosphanates and Acetaminoiphen
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