Question 1833
{"accessible":true,"alternatives":[{"id":9106,"text":"bone metastases"},{"id":9107,"text":"multiple myeloma"},{"id":9108,"text":"Paget disease"},{"id":9109,"text":"secondary hyperparathyroidism"}],"archived":false,"correctAlternativeId":9109,"explanation":"\u003cp\u003eThis skull radiograph demonstrates:\u003c/p\u003e\u003cul\u003e\n\u003cli\u003e\u003cp\u003e\u0026nbsp;multiple sclerotic areas alternated with tiny lucencies scattered throughout the skull\u0026nbsp;giving the classical \"salt and pepper sign\"\u0026nbsp;or \"pepper pot skull\", due to\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eresorption of trabecular bone\u003c/p\u003e\u003c/li\u003e\n\u003cli\u003e\u003cp\u003e\u0026nbsp;loss of distinction between internal and external tables of the skull\u003c/p\u003e\u003c/li\u003e\n\u003cli\u003e\u003cp\u003edepressed glass appearance and dotted ossification\u003c/p\u003e\u003c/li\u003e\n\u003c/ul\u003e\u003cp\u003eThese radiographic\u0026nbsp;findings in a patient with end-stage renal failure with increased parathyroid hormone (not mentioned in the question) are highly suggestive of secondary hyperparathyroidism.\u003c/p\u003e","id":1833,"imageUrl":"https://prod-images-static.radiopaedia.org/multiple_choice_questions/322/salt-and-pepper-skull__1__big_gallery.jpeg","imageAttribution":{"kind":"case","rID":72736},"imageAttributionCaseInfo":{"title":"Salt and pepper skull","contributor_name":"Dra. María Ferretti Diez","contributor_param":"maria-ferretti-diez","case_rid":72736,"case_param":"salt-and-pepper-skull"},"firstQuestionPath":"/questions/2495","nextQuestionPath":"/articles/hyperparathyroidism/questions/1832","relatedArticles":[{"id":9555,"title":"Multiple myeloma","link":"/articles/multiple-myeloma-1?lang=us"},{"id":16626,"title":"Bone metastases","link":"/articles/bone-metastases-1?lang=us"},{"id":1824,"title":"Paget disease (bone)","link":"/articles/paget-disease-bone?lang=us"},{"id":21561,"title":"Salt and pepper sign (skull)","link":"/articles/salt-and-pepper-sign-skull-1?lang=us"}],"alsoUsedIn":[],"stem":"\u003cp\u003eA 60-year-old man known for end-stage renal failure.\u0026nbsp;What is the most likely bone disease shown on his lateral skull radiograph?\u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/1833"}],"attemptsPercentages":[{"alternativeId":"9107","percentage":9},{"alternativeId":"9109","percentage":73},{"alternativeId":"9108","percentage":17},{"alternativeId":"9106","percentage":2}],"promptToLogin":false,"questionManager":false,"articleId":"hyperparathyroidism"}