Archive Of Standardized Exam Questions: Paget Disease Of Bone


This page is dedicated to organizing various examples of standardized exam questions whose answer is Paget disease of bone. While this may seem a odd practice, it is useful to see multiple examples of how Paget disease of bone will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


When it comes to standardized exams, each condition has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for Paget disease of bone

  • Bone pain
  • Increased ALP
  • Bone biopsy showing mosaic pattern of lamellar bone. 

Question # 1

70-year-old male comes to the clinic because of left side pain. He explains that the pain has been present for about several months and it has always been a moderate severity. He denies any past history of trauma, and denies any associated weight change or loss of appetite. His past medical history is unremarkable. He denies using any tobacco products, alcohol, or illegal drugs. His temperature is 98.9°F, his blood pressure is 135/85 mmHg, and his respirations are 12/min. A physical exam reveals no abnormalities of The lower back or hips. There is a normal pain-free range of motion in both hips. The patient has a mildly altered gait. The patient’s lower extremities are unremarkable with regards to reflexes, motor, and sensation. He has strong pedal pulses bilaterally. The patient’s alkaline phosphatase levels are elevated, however other routine labs are unremarkable. X-ray studies reveals cortical thickening in the left femur. Bone scintigraphy shows increased radio tracer uptake in multiple spots, including the left femur. What is the likely diagnosis in this patient?


Many questions on standardized exams go beyond simply recognizing the underlying condition. Often there are specific testable facts regarding some aspect of the disease’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:

Cause: environmental factors + gene mutations that result in excessive RANK and NF-kappaB activation. This leads to osteoclast differential and activity. 


Page Updated: 02.21.2017