N4B1Q29 Hip pain

Prep for USMLE Forum

» Log in | Register

Forum

Step 1

Match

Prep4USMLE Forum » USMLE Step 1 Forum » Pathology Forum

N4B1Q29 Hip pain

Author

16 Posts

Cedrick
Forum Fanatic
avatar

Topics: 322
Posts: 1,990

06/20/06 - 01:54 PM

A 67 year old woman comes to the physician because of an 18 months history of progressive left hip pain
the pain is characterized as boring and aching
it is not relived by rest and worsens with ambulation
She walks with a limp because of pain
She became "hard of hearing" over the past 5 years and has passed two kidney stones in the last 6 months
She has pain when direct pressure is applied over the greater trochanter of the left femur and femoral shaft
there is also pain and limited range of motion of the left hip with flexion and external rotation
Serum calicium and phosphorus cencentartion are within the reference range,serum alkaline phosphatase activity is markedly increased and urinary hydroxyproline excretion is increased
which of the following is the most likely diagnosis ?

a.-Osteitis deformans [Pagets disease}
b.-Osteoarthritis
c.-Osteomalacia
d.-Osteomyelitis
e.-Osteoporosis
f.-Rheumatoid arthritis

smiling face

robin082006
Forum Hero
avatar

Topics: 471
Posts: 5,123

06/20/06 - 03:01 PM

Among choices, A is the best with increased Alkaline phosphatase.

B is the second choice but cannot explain increased alkaline phosphatase.

___________________
The Key to Succeed is Patience.

nadiabarati

06/20/06 - 03:11 PM

mjl1717
Forum Hero
avatar

Topics: 958
Posts: 5,465

06/20/06 - 06:24 PM

robin082006 wrote:
Among choices, A is the best with increased Alkaline phosphatase.

B is the second choice but cannot explain increased alkaline phosphatase.

this echoes my deepest thoughts.
also sounds like there is some otosclerosis.

___________________
Smell the coffee! "Is That an Osler move??"

Cedrick
Forum Fanatic
avatar

Topics: 322
Posts: 1,990

06/20/06 - 06:37 PM

B

Big joint and age of patient

sridevibandaru24
Forum Guru

Topics: 33
Posts: 434

06/20/06 - 06:40 PM

mjl1717
Forum Hero
avatar

Topics: 958
Posts: 5,465

06/20/06 - 06:43 PM

on second thought clinicallly it sounds like OA- I can see the hydroxyproline but I guess the alk phos is non specific.

___________________
Smell the coffee! "Is That an Osler move??"

docarchana
Forum Guru

Topics: 70
Posts: 515

08/31/06 - 11:33 AM

increased urinary hydroxyproline points to pagets

fox
Forum Guru
avatar

Topics: 70
Posts: 727

08/31/06 - 04:12 PM

Guys...pagets Ds is known to involve the temporal bone & present with deafness.This presentation is not seen with any of the other choces like OA etc. Inc alk phosphatase & hydroxyproline & the elderly age group further corroborates this. Hence I would go for A (pagets)

___________________
Aim High

Cedrick
Forum Fanatic
avatar

Topics: 322
Posts: 1,990

09/07/06 - 11:27 AM

#10

vanshita
Forum Guru
avatar

Topics: 30
Posts: 912

09/07/06 - 01:35 PM

#11

in pagets disease increased osteoclast and osteoblast activity

alkaline phosphatase indicate osteoblastic activity

hydroxyproine indicate osteolytic activity

answer is A

klimt
Forum Guru

Topics: 27
Posts: 605

10/01/06 - 10:54 AM

#12

I go for A too, mainly because of ALP

___________________
Traveler, there are no roads. Roads are made by walking.

fongch
Forum Elite
avatar

Topics: 71
Posts: 316

10/23/06 - 05:50 PM

#13

I vote for A becauese the presentation of hearing loss.

ManuNastai

10/26/06 - 07:59 AM

#14

How sure are you, Cedrick, on our response? Is it sure? I mean, did you found it in some book or question bank answer or is it your choine?

this doesn't sound like OA or Paget's to me!!!

vallia
Forum Guru

Topics: 98
Posts: 889

10/27/06 - 04:45 AM

#15

I go with A because loss of hearing and increase ALP, and pain

___________________
fight possessed

drfax
Forum Elite
avatar

Topics: 21
Posts: 250

10/27/06 - 12:53 PM

#16

A.
increase in ALP and hydroxyproline is the key ,

___________________
My best friends are these Gentlemen :Why & How.

You don't have permission to post.