Pass MRCP Header

MRCP PACES Home MRCP Featured Article MRCP Previous Issues MRCP Forum Here MRCP Blog Here MRCP Support Here



Make a better site!


QuickScroll  Case 1 | Case 2

Case ID: 1
Created: 1 Nov 2008

Examine this gentleman lower limbs .


( Photo source:


     You might get this case in your short station during your MRCP PACES. You won't get the diagnosis if you do not know the condition. They might show you a few ways how do patients with Paget's disease of bone present, but I think the common scenario will be lower limbs deformity and skull deformity. It is named after Sir James Paget. OK, this condition is associated with excessive bone breakdown and formation.

If you encounter this case in your MRCP PACES, of course, describe the lower limbs abnormality ( bow leg, etc) to the examiners, and you must proceed further to look for other complications of Paget's disease as below,

1) Check for hearing impairment.

2) Check cardiovascular system because patients might have heart failure.

3) Check for lower limbs neurology because you might find spinal cord compression due to vertebral bone involvement.

4) Always look for skull abnomaly. Sometimes you may find funny protrusion ( enlarged bone) over the skull and rarely patient may be blind due to compression of Optic nerve.

5) Always look for possibility of Sarcoma ( due to malignant change of this disease!)

Common questions examiners would ask you

arrow1) What are classical findings of X ray bone in patients with Paget's disease?

arrow2) How do you diagnose Paget's disease of bone?

arrow3) How do you manage this patient?

Diagnosis: This gentleman has Paget's disease of bone.

Extra points:

1) Learn more about Paget's Disease of bone at


Created: 1Nov 2008

Interesting Images in Clinical Medicine.


Case History:

    Mr Ali is a 45-year old Malay gentleman with hypertension and chronic smoking. He went for a normal medical check up and was told to have abnormal CXR. Please describe the CXR shown above. What is the abnormality and what is the probable diagnosis??

To see previous issues, click here! To send a quick comment, click here!