Question of the Week # 184

Q184) A 10 year old boy is evaluated in the emergency room after he tripped over and fell during a basketball game. There is no history of loss of consciousness. He denies any injury except some pain in the occipital area of the skull. He also reports chronic fatigue. A routine skull x-ray is obtained for evaluation and is shown below:

Which of the following is most likely to be associated with these incidental skull x-ray findings ?

A) Monoclonal gammopathy

B) Pituitary tumor

C) Hemolysis

D) Paget disease

E) Glioma

13 Responses

stefan, on July 14, 2011 at 3:41 am said:

ccccccccccc

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jay, on October 10, 2011 at 6:26 pm said:

This one baffles me but its seems you want me to look at his skull and that would only mean Pagets since there are no other findings.

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Jay Hershman, on October 11, 2011 at 2:12 pm said:

HEMOLYSIS seems to be the answer. I looked up the answer and there is much more to this question than what you gave me. These question (i hope) r not on the exam. You need to be an expert in the feild to get these correct. I study with doctors of many specialties and they say its too difficult to answer.

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- usmlegalaxy, on October 12, 2011 at 12:21 am said:
  
  Radiology images will be tested on your exam. You need not be an expert to recognize “hair-on-end” appearance on the skull – as these are taught at medical school level and also, in USMLE Step I pathophysiology. Most characteristic Radiology images do show up on the exam. So, these questions are often tested on the exam.
  
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  - Atashak, on February 17, 2012 at 10:22 pm said:
    
    D
mital, on February 18, 2012 at 6:26 am said:

classic hair on end apperance. thallesemia

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zoe, on March 3, 2012 at 4:15 am said:

ccc

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manuelchiky, on March 23, 2012 at 2:10 am said:

C………..

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Dr.Taifur Hasan, on April 30, 2012 at 1:11 pm said:

D) Paget disease

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Emorydoc, on August 29, 2013 at 2:36 pm said:

D, cotton woll skill changes on radiography

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emerald, on November 17, 2013 at 5:10 pm said:

typical hair on end appearance in Thalassemia, answer is C

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Kishore, on January 14, 2014 at 5:18 pm said:

Hair on end appearance of Thalassemia

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gaby, on February 16, 2014 at 9:53 pm said:

C. “crewcut” – skull on x ray, due to erythroid hyperplasia, seen in Thalassemias.

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