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  #1  
Old 02-22-2013
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Default Musculoskeletal problem

72 year old man presents with weakness and increasing pain in his lower back. Lumbar spine and pelvis are tender to palpation, and radiographs show multiple vertebral fractures in these structures. Total calcium level is 6.7 mg/dL, total phosphate level is 2.4 mg/dL, and parathyroid hormone level is 83 pg/mL. Bone densitometry demonstrates osteoporosis. History and physical examination are otherwise unremarkable apart from poor dentition and a some what disheveled appearance. Which of the following is most likely the underlying etiology of the patientís condition?

A. Osteoporosis
B. Pagetís disease
C. Vitamin D deficiency
D. Chronic renal failure
E. Osteoclast abnormality
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  #2  
Old 02-22-2013
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Vitamin D Deficiency
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  #3  
Old 02-22-2013
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Looks like Vitamin D deficiency.

I have seen this question somewhere before? Don't remember where though.May be an NBME ?

Or may be this is just a twisted form of it.Not sure.

Nice Question though.Thanks
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Old 02-23-2013
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Quote:
Originally Posted by Doctor Ali View Post
72 year old man presents with weakness and increasing pain in his lower back. Lumbar spine and pelvis are tender to palpation, and radiographs show multiple vertebral fractures in these structures. Total calcium level is 6.7 mg/dL, total phosphate level is 2.4 mg/dL, and parathyroid hormone level is 83 pg/mL. Bone densitometry demonstrates osteoporosis. History and physical examination are otherwise unremarkable apart from poor dentition and a some what disheveled appearance. Which of the following is most likely the underlying etiology of the patientís condition?

A. Osteoporosis
B. Pagetís disease
C. Vitamin D deficiency
D. Chronic renal failure
E. Osteoclast abnormality
Vit D defeciency...
Ca low, Phosphorus low and PTH level little high are pointers...
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  #5  
Old 02-23-2013
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Default qtn"

i wanted to ask sumthing regarding this qtn, there is not mentioned normal levels of ca, phosphate and pth in this qtn, then how cum we will cum to know whether they r decreased or increased? do we have to memorise the normal levels of these all ions and hormones? i m confused abt this
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Old 02-23-2013
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^ Yes. most of easy to memorize. otherwise you can use the Lab values menu to confirm.
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Old 02-23-2013
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A. Osteoporosis: Ca N, Phosphate N, PTH N, bone mass <
B. Paget’s disease Ca N, Phosphate N, PTH N, abnormal bone structure
C. Vitamin D deficiency Ca <, Phosphate <, PTH <, soft bones
D. Chronic renal failure Ca <, Phosphate >, PTH >
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  #8  
Old 02-23-2013
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Default vit. D defficiency

Quote:
Originally Posted by BritneySpears View Post
A. Osteoporosis: Ca N, Phosphate N, PTH N, bone mass <
B. Pagetís disease Ca N, Phosphate N, PTH N, abnormal bone structure
C. Vitamin D deficiency Ca <, Phosphate <, PTH <, soft bones
D. Chronic renal failure Ca <, Phosphate >, PTH >
i guess in Vit.D defficiency - Ca <, Phosphate <,PTH >, soft bones
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  #9  
Old 02-23-2013
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yeah, sorry 'bout that
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  #10  
Old 02-23-2013
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Correct Answer Correct answer is C

Correct answer is C, Vitamin D deficiency.

This patient has Vitamin D deficiency. In Vitamin D deficiency, the lab values would be:

1. Decrease Ca2+
2. Decrease PO4-
3. Increase PTH - secondary hyperparathyroidism
4. Total phosphate level is decreased



In Chronic renal disease, the lab values would be:

1. Secondary hyperparathyroidism
2. Decrease Ca2+
3. Increasev PO4-
4. hypovitaminosis D
5. Increase alkaline phosphatase
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