Rosh Internal Medicine Boost Practice Exam

In a patient with chronic back pain and elevated alkaline phosphatase, which imaging result is most likely to be seen?

1. Lytic lesions

2. Sclerotic lesions

3. Fractures

4. Joint effusions

The correct answer is: Lytic lesions

In the context of a patient presenting with chronic back pain and elevated alkaline phosphatase levels, the most anticipated imaging result is the presence of lytic lesions. Elevated alkaline phosphatase is indicative of increased bone turnover, which can occur in a variety of conditions, including metabolic bone diseases and malignancies. Lytic lesions typically signify areas of bone destruction, which might be associated with conditions such as multiple myeloma, metastatic cancers, or infections. In these situations, the pathology involves the breakdown of bone tissue, leading to lytic changes that are often visible on imaging studies. While sclerotic lesions may indicate areas of increased bone density, such as seen in osteoblastoma or certain metastatic conditions, the combination of chronic back pain along with elevated alkaline phosphatase strongly suggests an active process of bone degradation, thus making lytic lesions the most plausible finding in this scenario. Fractures and joint effusions are also relevant in certain conditions but are not the primary imaging findings typically associated with elevated alkaline phosphatase and chronic back pain. Fractures may arise from chronic conditions but do not directly correlate with the biochemical markers noted in the question. Similarly, joint effusions are more related to inflammatory or arthritic conditions rather than directly linked