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Review Question - QID 295

QID 295 (Type "295" in App Search)
A 53-year-old woman with a history of Paget's disease and bilateral total hip arthroplasties presents with left hip pain and dysuria. An AP pelvic radiograph and CT scan are shown in Figure A and B. What is the next most appropriate step in management?
  • A
  • B

Revise the left hip total arthroplasty with a cemented stem

3%

59/1797

Open reduction and internal fixation of the acetabular fracture

5%

93/1797

Rest, IV bisphosphanates and follow-up in 6 weeks

10%

183/1797

Radiation therapy

5%

84/1797

Technetium Tc 99 and CT of the chest, abdomen and pelvis

76%

1363/1797

  • A
  • B

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This question has a lot of bells and whistle distraction. Fundamentally, it is a question about what you do when you see a lytic lesion in the pelvis of a person with a risk for tumor, in this case Paget's disease. The images show a skeletal tumor of unknown origin. Therefore, you can discount every “treatment” answer. First, you need to diagnose her.

Rougraff et al prospectively obtained medical history, physical examination, routine laboratory analysis, plain radiography of the involved bone and the chest, whole-body technetium-99m-phosphonate bone scintigraphy, and computed tomography of the chest, abdomen, and pelvis and found this diagnostic strategy discovered the primary site 85% of the time. In contrast, the biopsy alone (without the workup) discovered the primary tumor only 35% of the time.

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