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Paget disease — SCE Rheumatology MCQ

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HardMetabolic bone diseasePaget diseaseSCE Rheumatology

A patient with Paget disease of the skull has progressive hearing loss despite biochemical treatment response. Which assessment is most appropriate?

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Correct answer: C — Formal audiology and cranial-nerve assessment

The best answer is “Formal audiology and cranial-nerve assessment”. Skull Paget disease can cause conductive or sensorineural hearing impairment and other cranial neuropathies, so formal audiology and focused neurological assessment are appropriate. The remaining choices—“Routine coronary angiography, within a rheumatology pathway”, “Serial rheumatoid-factor testing, after safety review”, “Skin biopsy of the scalp”, “Electromyography of both legs”—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/