kpmle2
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A 68-year-old man is referred to you for evaluation of radiographic findings in the pelvis. He presented to the emergency department 1 week ago with abdominal pain, and a radiograph of the kidneys, ureters, and bladder showed sclerotic changes in the left hemipelvis that are typical for Paget’s disease of bone; the abdominal pain resolved.
The patient has no family history of Pagets disease and no bone pain. On physical examination, he has a full range of motion in both hips and no angioid streaks are observed on funduscopic examination. A recent measurement of serum acid phosphatase concentration was normal.
Which of the following would be most appropriate for this patient?
A. Measurement of serum alkaline phosphatase and a bone scan
B. Radiographs of his skull and long bones and measurement of a bone-specific alkaline phosphatase and urinary hydroxyproline
C. Bone biopsy of the left iliac crest
D. Treatment with no further work-up
E. No treatment and no further work-up
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| neurom
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A. Bone scan is to determine the extent of skeletal involvement, alkaline phosphatase is to determine the activity of disease.
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| tamerbashir
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B
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| Justice
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B
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| Ivonne
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Plain RX are less sensitive than bone scan in the dx of paget disease. Bone scan would be more sensitive and less radiation for the patient.
The hidroxyproline assay is difficult to perform and not widely available.
The specific alkaline phosphatasa is 85% sensitive while the total alkaline phosphase is 75% sensitive. I think the specific one is ordered if monostotic disease or addicional liver problem. Not sure about last statement.
so will go with A
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| drduck
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diagnosis of pagets,
The biochemical findings in Paget's disease reflect the cellular events occurring throughout the skeleton of affected patients. Measurement of collagen cross-link degradation products in urine provides a specific measurement of skeletal matrix degradation. Urinary N-telopeptide, pyridinoline, and deoxypyridinoline have all been used as measures of skeletal matrix resorption. Serum tartrate–sensitive acid phosphatase, released by osteoclasts, is another index of bone resorption in Paget's disease research laboratories.
Osteoblast activity can be assessed by measurement of total serum alkaline phosphatase activity, serum bone-specific alkaline phosphatase concentration, serum osteocalcin concentration, and serum type 1 carboxy-terminal procollagen peptide concentration. The most useful of these are the total serum alkaline phosphatase and bone-specific alkaline phosphatase determinations. Total serum alkaline phosphatase measurements are routinely used to monitor disease activity in the clinic.
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| drduck
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seems like B is the answer
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| cool doctor
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I will go with A
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| kpmle2
Forum Guru
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The correct answer is A
Radiographic evidence of bone involvement does not necessarily reflect metabolically active Paget’s disease. A radionuclide bone scan and measurement of the total serum alkaline phosphatase will determine the extent of the Pagets disease and allow identification of active lesions. The active pagetic bone lesions are associated with an elevated serum alkaline phosphatase activity and avid uptake of the scanning agent. Burned out’ pagetic lesions are seen with normal or near-normal serum alkaline phosphatase activity and little or no uptake on bone scan. The bone scan is more sensitive than bone radiographs because the bone scan will detect many pagetic lesions not visualized on standard radiographs. Radiographs should be taken of bones affected by Pagets disease. In most cases, markers of bone resorption (bone-specific alkaline phosphatase and urinary hydroxyproline) add little information to the total serum alkaline phosphatase activity. Bone biopsy is rarely indicated, as the characteristic radiographic and laboratory findings are diagnostic in most instances. A decision about treatment or observation should be based on the results of the bone scan and measurement of the serum alkaline phosphatase activity.
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