USMLE Forum Archives - USMLE Step 2 CK - IM 32
IM 32
TheOne - 02-23-07 18:05
65-year-old woman with a history of hypertension comes for a followup visit regarding her elevated cholesterol. As part of screening for adverse effects of the HMG-CoA reductase inhibitor she was prescribed, a set of liver function tests is ordered. The woman has been healthy for most of her life. She is active and has a good diet and exercise plan. The liver function tests reveal:
Serum alkaline phosphatase 610 U/L
Serum alanine aminotransferase (ALT) 10 U/L
Serum aspartate aminotransferase (AST) 15 U/L
Total serum bilirubin 0.6 mg/dL
Gamma-glutamyl transpeptidase level and total calcium level are within normal limits. Upon further questioning, the woman denies any abdominal pain, nausea, vomiting, or other gastrointestinal symptoms. An extensive review of systems reveals only slightly diminished hearing and a mild, bilateral chronic tinnitus. Which of the following is the most likely diagnosis?
A. Osteomalacia
B. Osteitis fibrosa cystica
C. Osteogenesis imperfecta
D. Osteitis deformans
E. Osteopenia
TheOne - 02-23-07 18:05
65-year-old woman with a history of hypertension comes for a followup visit regarding her elevated cholesterol. As part of screening for adverse effects of the HMG-CoA reductase inhibitor she was prescribed, a set of liver function tests is ordered. The woman has been healthy for most of her life. She is active and has a good diet and exercise plan. The liver function tests reveal:
Serum alkaline phosphatase 610 U/L
Serum alanine aminotransferase (ALT) 10 U/L
Serum aspartate aminotransferase (AST) 15 U/L
Total serum bilirubin 0.6 mg/dL
Gamma-glutamyl transpeptidase level and total calcium level are within normal limits. Upon further questioning, the woman denies any abdominal pain, nausea, vomiting, or other gastrointestinal symptoms. An extensive review of systems reveals only slightly diminished hearing and a mild, bilateral chronic tinnitus. Which of the following is the most likely diagnosis?
A. Osteomalacia
B. Osteitis fibrosa cystica
C. Osteogenesis imperfecta
D. Osteitis deformans
E. Osteopenia
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#3
Correct
TheOne - 03-07-07 08:40 The correct answer is D. This patient has Paget disease, or osteitis deformans. Paget disease is a focal disorder of bone remodeling that results in increased bone turnover and abnormal bone architecture. Patients are often asymptomatic but may present with gross skeletal abnormalities (bowing, long-bone fractures, increased skull circumference), deafness, nerve compression syndromes, or simply an abnormally
elevated alkaline phosphatase. Serum calcium and phosphorus levels are usually normal. Treatment is with antiresorptive agents, such as the bisphosphonates.
Buzz Words: High Alkaline phosphatase + Normal Serum Ca & P.
#5
Re: IM 32 babbu5508 - 07-06-10 23:06 D. Osteitis deformans or pagets disease of bone characterised by elevated ALP, bony pains and nerve compressions which may cause deafness.
#6
Re: IM 32 bingousmle - 07-09-10 14:43 this patient has pagets disease or osteitis deformans clues are decreased hearing and tinnitus with raised alkaline phosphatase levels
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