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Paget disease of bone — SCE Rheumatology MCQ

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HardMetabolic bone diseasePaget disease of boneSCE Rheumatology

A 24-year-old woman has skull enlargement and deep aching tibial pain. Examination shows the tibia is bowed and warm. Investigations show alkaline phosphatase is raised with normal calcium. The consultant wants the next test most likely to confirm the suspected process or guide treatment. The result will change diagnosis, staging or immediate treatment. What is the most appropriate investigation?

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Correct answer: C — Bone scintigraphy

The best answer is “Bone scintigraphy”. Bone scintigraphy 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—“Serum electrophoresis, after specialist assessment”, “MRI scan, with clinical reassessment”, “Ultrasound-guided aspiration, within a rheumatology pathway”, “Urinalysis, after safety review”—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: British Society for Rheumatology clinical guidelines: https://academic.oup.com/rheumatology/pages/clinical-guidelines