QuestionSBA
QuestionChoice
Whilst Paget's disease commonly affects the pelvis and patients often experience bone pain, they do not typically complain of muscle weakness. Patient's with Paget's disease tend to have normal phosphate and calcium levels, and a raised ALP.
10003634
d
Paget's disease
QuestionChoice
If the patient had polymyalgia rheumatica, then they would have complained of shoulder and pelvic girdle stiffness as opposed to worsening left hip pain. They would also have normal phosphate and calcium concentrations (but may have elevated ALP).
10003635
e
Polymyalgia rheumatica
QuestionChoice
Whilst patients with osteoarthritis would also present with hip pain, they would not experience muscle weakness nor would there be any changes to their phosphate, calcium or ALP levels.
10003633
c
Osteoarthritis
QuestionChoice
Polymyositis is associated with bilateral proximal muscle weakness developing over weeks to months. 5-15% of cases of polymyositis are secondary to an underlying malignancy; there are no red flag symptoms in this case. Patients who have polymyositis also tend to have a raised creatine kinase.
10003632
b
Polymyositis
QuestionChoice
Osteomalacia occurs due to inadequate levels of calcium, phosphate or vitamin D. This patient has Coeliac disease which can cause malabsorption and lead to osteomalacia. The symptoms that the patient experiences are also characteristic of this - bone pain (typically lower back, pelvis and lower extremities), myalgia, and weakness of quadriceps and gluteal muscles. Low phosphate and calcium and raised ALP point to
osteomalacia as the likely diagnosis.
10003631
a
Osteomalacia
Concept
Chapter
2693
4184
Osteomalacia
Topic
190
Musculoskeletal
13273
A 75-year-old female with a past medical history of Coeliac disease presents with worsening left hip pain. There is no recent history of falls, but she states feeling unsteady and weak when walking and getting up from sitting.


Blood tests show:


||||
|---------------------------|:-------:|------------------------------|
|Calcium|1.8 mmol/L|2.2 - 2.6|
|Phosphate|0.5 mmol/L|0.8 - 1.5|
|Alkaline Phosphatase (ALP)|148 IU/L|25 - 115|

What is the most likely diagnosis?
a