155) A 55 year old man presents to the clinic for progressive right hip pain. He has a history of hearing impairment. He reports pain in the right hip when walking more than 1 block and also, has difficulty putting shoes on his right foot. On examination, the range of motion is significantly limited in the right hip. An X-ray of the right hip reveals significant loss of cartilage, subchondral sclerosis and sub-chondral cysts. X-ray also reveals pagetoid changes in the right iliac wing and right femoral neck. Serum alkaline phosphatase level is 432 IU/L (n = 20 to 140 IU/L). The most appropriate initial step in managing this patient is:
A) Bisphosphanates
B) Acetaminophen
C) Bisphosphanates and Acetaminoiphen
D) Calcitonin Intranasally
E) Oral prednisone
Archer USMLE Step 3 Blog 
A) Bisphosphanates
A) Bisphosphanates
C
C
B
No, I change to C, she has both features of osteoarthritis and Paget’s disease. Bisphosphonates and acetaminophen.
C: Paget disease : hearing loss, bone pain, pagetoid changes + OA : X ray features . Tx bisphosphonate and acetaminophen