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  #1  
Old 09-13-2011
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Emergency Discovered several healed fractures after car accident!

A 20 year old Hispanic female is rushed to the emergency department status post motor vehicle accident. Per the paramedics, the patient was the driver, she was not wearing a seat belt and the airbag failed to deploy. The patient reports hitting her head on the steering wheel but cannot recall other details of the accident. She is a well-dressed young woman with thin body habitus, visibly distressed and in pain. She is alert and oriented to person and place, but not time or situation. Her vitals on admission: temperature 37 C, respiratory rate 18 per minute, heart rate 95 beats per minute, blood pressure 98/65 mmHg, pulse ox 95%. Arterial blood gas: pCO2 38, pO2 100, HCO3 23, pH 7.38. Her BMI is 16 kg/meter2, she has a history of irregular periods, and her last menstrual period was 4 months ago. Urine toxicology and urine pregnancy screens are negative. She denies vomiting or laxative use. You note a deep laceration across her right forehead that extends to her left eyebrow. There is a large ecchymosis surrounding her left orbit which is exquisitely tender to palpation, likely indicating a left orbital blowout fracture given the mechanism of injury. She sustained multiple fractures in her left arm, which were confirmed by X-ray. The radiologist also noted several older healed fractures of her distal radius. What is the likely cause of these older fractures?

A. Hypogonadism
B. Chronic metabolic acidosis
C. Diet rich in calcium
D. Primary osteoporosis
E. Low sodium diet
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  #2  
Old 09-13-2011
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Hey buddy Ricko...........can I ask you what is the source of questions u post?
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  #3  
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A. Hypogonadism
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  #4  
Old 09-13-2011
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osteoporosis...

she is anorexic with BMI of 16...osteoporosis n stress fractures r common
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Old 09-13-2011
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She likely has Anorexia Nervosa given her BMI of 16 and history of ammenorrhea. She developed secondary osteoporosis due to HYPOGONADISM (low estrogen states).
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Old 09-13-2011
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A. Hypogonadism
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Old 09-13-2011
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hYPOGONADISM

such a loooong question
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Old 09-13-2011
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A.it is anorexia nervousa because of the BMI that can lead to decrease in GnHR so secondary hypogonadism and also leads to osteoprosis......

Last edited by shima; 09-14-2011 at 07:42 AM.
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Old 09-13-2011
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A. Hypogonadism
__________________
Knowing is not enough; we must apply.
Willing is not enough; we must do.
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  #10  
Old 09-13-2011
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Hypogonadism
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Old 09-13-2011
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hypogonadism
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  #12  
Old 09-13-2011
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Quote:
Originally Posted by usmle2011 View Post
hYPOGONADISM

such a loooong question
yup hypogonadism and the long question
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  #13  
Old 09-16-2011
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Default

its taken from harrisons
The correct answer is A.
This patient is likely anorexic, as suggested by her BMI < 18 and her history of amenorrhea and irregular menstrual periods. Patients with anorexia nervosa do not produce enough GnRH to adequately stimulate the anterior pituitary to secrete FSH and LH -- the lack of an LH surge to precipitate ovulation frequently causes amenorrhea. Inadequate FSH and LH also leads to insufficient estrogen levels (ie, hypogonadism) in anorexic patients (just as if they were postmenopausal). Estrogen deficiency →
1) ↑ osteoclast activity (bone resorption)
2) ↓ osteoblast activity (bone formation)
Anorexic patients may become osteoporotic secondary to their hypogonadism, and are thus at increased risk for fracture. In addition to hypogonadism (eg, anorexia nervosa, hypopituitarism), causes of secondary osteoporosis include:
- Drugs (eg, heparin)
- Hypercortisolism (hence glucocorticoids are contraindicated in patients with osteoporosis)
- ↓ bone stress secondary to ↓ gravity (eg, space travel)
- Chronic renal failure → chronic metabolic acidosis → excess H+ is buffered by bone → osteoporosis

While chronic metabolic acidosis is a cause of secondary osteoporosis, the arterial blood gas values are within normal limits so we can rule out this answer choice.

Primary osteoporosis comes in two flavors: Postmenopausal (Type I) and Senile (Type II). The patient in question is neither postmenopausal nor old enough to qualify for senile osteoporosis.

A diet rich in calcium would likely promote bone formation and make fractures less likely in this patient. Likewise, a low Na diet would also promote bone mineral density (versus a high Na diet → ↑ Ca loss in urine → ↓ bone mineral density).
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  #14  
Old 09-16-2011
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thanx!!!!!!!!nice Question
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  #15  
Old 09-16-2011
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A. Hypogonadism
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