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Retired NBME 19 Answers

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submitted by โˆ—an_improved_me(91)
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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.

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chaosawaits  "Picture-frame vertebra" is apparently a sign of Paget's in which the cortex of the vertebral body is thickened, not thinner. The only other cancer that is going to cause thickening of the vertebral body is prostate cancer, which will do so in a diffuse, patchy arrangement. A keyword for prostate cancer is "ivory vertebra." Furthermore, there is no answer choice that indicates prostate cancer, which would have decreased calcium levels. +



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submitted by โˆ—okokok1(38)
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The pt has Paget's disease of the bone aka Osteitis deformans. ISOLATED INCREASE IN ALK PHOS = PAGETS!!! always.

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