WBR1143

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	USMLE Step 2 CK
Main Category	Internal medicine
Sub Category	Endocrine, Endocrine
Prompt	The patient is moving to Nepal for next 4 years, which of the following tests you will recommend to follow up with a new primary care doctor?
Answer A	X ray survey of entire body
Answer A Explanation	X ray survey of entire body is not indicated, not only it causes excess radiation exposure but also, it will not be helpful to monitor the change in the bone density.
Answer B	Bone density scan
Answer B Explanation	[[AnswerBExp::Dual-energy X-ray absorptiometry is considered the gold standard for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old, healthy adult women reference population. This is translated as a T-score. Normal: T-score ≥ 1.0 Osteopenia: T-score < −1.0to −2.5 Osteoporosis: T-score ≤ −2.5 Severe osteoporosis: T-score ≤ −2.5 with fragility fracture A bone density scan is used to monitor osteoporosis irrespective of it's etiology.]]
Answer C	MRI
Answer C Explanation	MRI is not indicated, and will not be helpful in the change in the bone density. If osteoporosis results in fracture nerve entrapment, a MRI is done to dignose and manage bone compression.
Answer D	CAT scan
Answer D Explanation	CAT scan is not indicated, it can cause excess radiation exposure. Osteoporosis is followed up with a bone density scan or DXA.
Answer E	PET scan
Answer E Explanation	The PET scan is indicated to identify metastasis in the body. Osteoporosis is followed up with a bone density scan or DXA.
Right Answer	B
Explanation	Osteoporosis is followed up with bone density scan or DXA. Educational Objective: References: http://www.ncbi.nlm.nih.gov/pubmed/18334497
Approved	No
Keyword	Hyperthyroidism, osteoporosis
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