WBR1141

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Internal medicine
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::41 year old man is diagnosed with a new vertebral fracture. He also complains of difficulty concentrating, fatigue, frequent bowel movements, heat intolerance, increased appetite, increased sweating, nervousness, restlessness and insomnia, from last 8 months. Ten years back, he underwent subtotal thyroidectomy, as he was suffering from graves disease. He denies family history of prostate cancer, osteomalacia and osteopetrosis. What is the most likely cause of vertebral fracture?]]
Answer A	AnswerA::Prostate cancer
Answer A Explanation	[[AnswerAExp::Early prostate cancer usually causes no symptoms. Symptoms may include frequent urination, nocturia, difficulty starting and maintaining a steady stream of urine, hematuria (blood in the urine), and dysuria (painful urination). Because the vas deferens deposits seminal fluid into the prostatic urethra, and secretions from the prostate gland itself are included in semen content, prostate cancer may also cause problems with sexual function and performance, such as difficulty achieving erection or painful ejaculation. Advanced prostate cancer can spread to other parts of the body, possibly causing additional symptoms. The most common symptom is bone pain, often in the vertebrae (bones of the spine), pelvis, or rib. Spread of cancer into other bones, such as the femur is usually to the proximal part of the bone. Prostate cancer in the spine can also compress the spinal cord, causing leg weakness and incontinence.]]
Answer B	AnswerB::Osteopetrosis
Answer B Explanation	[[AnswerBExp::Normal bone growth is achieved by a balance between bone formation by osteoblasts and bone resorption (breakdown of bone matrix) by osteoclasts. In osteopetrosis, the number of osteoclasts may be reduced, normal, or increased. Most importantly, osteoclast dysfunction mediates the pathogenesis of this disease. Despite excess bone formation, people with osteopetrosis tend to have bones that are more brittle than normal. Mild osteopetrosis may cause no symptoms, and present no problems. However, serious forms can result in stunted growth, deformity, and increased likelihood of fractures; also, patients suffer anemia, recurrent infections, and hepatosplenomegaly due to bone expansion leading to bone marrow narrowing and extramedullary hematopoiesis. It can also result in blindness, facial paralysis, and deafness, due to the increased pressure put on the nerve by the extra bone.]]
Answer C	AnswerC::Osteomalacia
Answer C Explanation	[[AnswerCExp::Osteomalacia is a generalized bone condition in which there is an inadequate mineralization of the bone. Many of the effects of the disease overlap with the more common osteoporosis, but the two diseases are significantly different. There are two main causes of osteomalacia insufficient calcium absorption from the intestine because of lack of dietary calcium or a deficiency of, or resistance to, the action of vitamin D; and phosphate deficiency caused by increased renal losses.]]
Answer D	AnswerD::Pagets disease
Answer D Explanation	[[AnswerDExp::Paget's disease manifests as an elevated alkaline phosphatase, and bone pain. Deafness in one or both ears may occur when Paget's disease affects the skull and the bone that surrounds the inner ear. When the spine is affected, nerve root compression can lead to tingling and numbness.]]
Answer E	AnswerE::Hyperthyroidism
Answer E Explanation	[[AnswerEExp::Post thyroidectomy every patient receives thyroxine supplement. Obtimal doses of thyroxine is adjusted by regular monitoring of TSH. The patient is suffering from difficulty concentrating, fatigue, frequent bowel movements, heat intolerance, increased appetite, increased sweating, nervousness, restlessness and insomnia, from last 8 months. Which is indicative of excess thyroxine dose. Thyroxine activates osteoclasts, which results in osteoporosis. Vertebral fracture is one of the most common manifestation of osteoporosis.]]
Right Answer	RightAnswer::E
Explanation	[[Explanation::Thyroxine activates osteoclasts, which results in osteoporosis. Vertebral fracture is one of the most common manifestation of osteoporosis. Educational Objective: References: http://www.wikidoc.org/index.php/Hyperthyroidism_pathophysiology http://www.ncbi.nlm.nih.gov/pubmed/24570805]]
Approved	Approved::No
Keyword	WBRKeyword::Hyperthyroidism
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::