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Paget disease mapping — SCE Rheumatology MCQ

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HardMusculoskeletal investigationsPaget disease mappingSCE Rheumatology

A 71-year-old man has skull pain and an isolated raised ALP. Examination shows reduced hearing. Skull radiograph suggests Paget disease. What is the most appropriate investigation?

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Correct answer: DRadionuclide bone scan

The best answer is “Radionuclide bone scan”. Radionuclide bone scan most directly resolves the diagnostic or staging uncertainty at this point in the pathway; the other investigations answer different questions or have lower yield. The remaining choices—“Synovial biopsy, after safety review”, “HLA-B27, after specialist assessment”, “Anti-dsDNA, with clinical reassessment”, “Urine microscopy, within a rheumatology pathway”—are credible in related rheumatology presentations, but each addresses a different diagnosis, investigation, treatment sequence or complication and does not fit the decisive findings in this stem.

Reference: Paget’s Association clinical guideline: https://pmc.ncbi.nlm.nih.gov/articles/PMC6522384/