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NBME 19 Answers

nbme19/Block 1/Question#46 (1.6 difficulty score)
a 73 yo man comes to the physician because of ...
calcium: no change, phosphorus: no change, alk phos increase, pth no change. πŸ”,πŸ“Ί

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submitted by okokok1(14),

The pt has Paget's disease of the bone aka Osteitis deformans. ISOLATED INCREASE IN ALK PHOS = PAGETS!!! always.

submitted by an_improved_me(18),

Feel like this question is actually pretty tough. I mean, I think of Pagets causing:

Enlarged Head (e.g. hats won't fit) Chalk stick fractures (we don't see any fractures on this guys X-rays, and his backpain is due to sclerosis of his vertebra [not fractures]) High output HF (due to AV shunts); Hearing difficulties (none of thet in his guy) Osteosarcoma

Only thing we're given is that he has verebral cortical thinning, which could be d/t lots of stuff. He's old (RF) and that's about it.