Falls and Fracture Prevention — MCQs
What is the gold standard for the diagnosis of osteoporosis?
Treatment of post menopausal osteoporosis are all EXCEPT
In an accident case, after the arrival of medical team, all should be done in early management except;
A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?
Non-hormonal drug to prevent postmenopausal osteoporosis is:
79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?
A female is on hormone replacement therapy for her menopausal symptoms. She is worried about her bone strength because her mom and sister had osteoporosis after the age of 50. All are given for prevention of osteoporosis along with hormonal replacement therapy, EXCEPT:
All of the following are part of Glasgow Coma Scale except
The drug that causes fall in elderly patients with postural hypotension is:-
A 70-year-old man presents with a hip fracture after a fall. What type of fracture is most common in this scenario?
Falls and Fracture Prevention Indian Medical PG Practice Questions and MCQs
Question 1: What is the gold standard for the diagnosis of osteoporosis?
- A. Dual energy X-ray absorptiometry (Correct Answer)
- B. Single energy X-ray absorptiometry
- C. Ultrasound
- D. Quantitative computed tomography
Explanation: ***Dual energy X-ray absorptiometry*** - **DXA** is the current **gold standard** for diagnosing osteoporosis and assessing fracture risk due to its high precision and accuracy in measuring **bone mineral density (BMD)**. - It measures BMD at clinically relevant sites such as the **lumbar spine** and **hip**, providing T-scores and Z-scores for comparison. *Single energy X-ray absorptiometry* - **SXA** measures BMD at peripheral sites but is **less accurate** and comprehensive than DXA for diagnosing osteoporosis. - It has **limited utility** as a diagnostic tool for osteoporosis at the hip or spine, which are critical sites for fracture risk. *Ultrasound* - **Quantitative ultrasound (QUS)** can assess bone quality but is primarily used for **screening** and is not accurate enough for definitive diagnosis or treatment monitoring of osteoporosis. - It does **not provide direct bone mineral density measurements** comparable to DXA for diagnostic purposes. *Quantitative computed tomography* - **QCT** can measure volumetric bone density and is useful for assessing **trabecular bone**, but involves higher radiation exposure than DXA. - It is **more expensive** and less readily available than DXA, making it a secondary option for osteoporosis diagnosis.
Question 2: Treatment of post menopausal osteoporosis are all EXCEPT
- A. Estrogen
- B. Magnesium and Zinc (Correct Answer)
- C. Calcium, Vit D supplementation
- D. Raloxifene
Explanation: ***Magnesium and Zinc*** - While **magnesium** and **zinc** are essential for overall health, their role as primary therapeutic agents for established postmenopausal osteoporosis is **unproven** and is not standard treatment. - They are considered **trace elements** and their deficiency can affect bone health, but supplementation alone is not sufficient to treat osteoporosis. *Estrogen* - **Estrogen replacement therapy** was historically used for postmenopausal osteoporosis due to its role in preventing bone loss, but its use is now limited due to **adverse effects** like increased risk of breast cancer and cardiovascular events [1]. - It is still considered in select cases for symptom relief and bone health, but generally at the lowest effective dose for the shortest duration [1]. *Calcium, Vit D supplementation* - **Calcium and Vitamin D supplementation** are fundamental components of osteoporosis management by supporting bone mineralization and calcium homeostasis [2]. - Adequate intake is critical for both **prevention** and **treatment**, often used in conjunction with other pharmacologic agents [2]. *Raloxifene* - **Raloxifene** is a **selective estrogen receptor modulator (SERM)** that acts as an estrogen agonist on bone, thereby reducing bone resorption and increasing bone mineral density [1]. - It is used in the treatment and prevention of postmenopausal osteoporosis, with the added benefit of reducing the risk of invasive breast cancer [1].
Question 3: In an accident case, after the arrival of medical team, all should be done in early management except;
- A. Glasgow coma scale
- B. Check BP (Correct Answer)
- C. Stabilization of cervical vertebrae
- D. Check Respiration
Explanation: ***Check BP*** - In the **immediate/early management** of trauma (primary survey), while circulation assessment is crucial, the **initial assessment of circulation** focuses on: - **Pulse rate and quality** (radial, carotid) - **Capillary refill time** - **Skin color and temperature** - **Active hemorrhage control** - **Formal blood pressure measurement** with a cuff, while important, is typically recorded during or after these rapid initial assessments, as it takes more time to obtain an accurate reading. - In the context of this question, among the four options listed, BP measurement is relatively less immediate compared to the other life-saving priorities (airway protection, breathing assessment, C-spine stabilization, and GCS). - **Note:** This is a nuanced distinction - BP is assessed during primary survey, but the other three options have more immediate life-threatening implications if not addressed. *Glasgow coma scale* - **GCS assessment** is part of the **"D" (Disability)** step in the ATLS primary survey. - It is performed early to assess neurological status and level of consciousness. - GCS <8 indicates need for **definitive airway protection** (intubation). - This is a critical early assessment that guides immediate management decisions. *Stabilization of cervical vertebrae* - **C-spine immobilization** is part of the **"A" (Airway)** step - "Airway with cervical spine protection." - It is performed **simultaneously** with airway assessment using a **rigid cervical collar**. - This is the **first priority** in trauma management to prevent secondary spinal cord injury. - All trauma patients should be assumed to have C-spine injury until proven otherwise. *Check Respiration* - **Respiratory assessment** is part of the **"B" (Breathing)** step in the ATLS primary survey. - This involves checking: - **Respiratory rate and pattern** - **Chest wall movement** - **Air entry bilaterally** - **Signs of tension pneumothorax or flail chest** - This is an immediate life-saving priority and must be assessed early.
Question 4: A Patient falls down often with behavioral change and enuresis. What is the condition associated with him?
- A. Normal pressure hydrocephalus (NPH) (Correct Answer)
- B. Parkinson's disease (PD)
- C. Alzheimer's disease (AD)
- D. Frontotemporal dementia (FTD)
Explanation: ***Normal pressure hydrocephalus (NPH)*** - NPH is characterized by the classic triad of symptoms: **gait disturbance** (leading to falls), **dementia/behavioral changes**, and **urinary incontinence** (enuresis) [1]. - These symptoms arise from the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles without a corresponding increase in intracranial pressure [2]. *Parkinson's disease (PD)* - While PD causes **gait instability** and falls, its primary symptoms include **bradykinesia**, **rigidity**, and **resting tremor**, which are not mentioned. - Behavioral changes can occur later in the disease, but **enuresis** is not a hallmark symptom. *Alzheimer's disease (AD)* - AD primarily presents with **progressive memory loss** and cognitive decline, not gait disturbances or enuresis as early or prominent features. - Falls usually occur much later due to advanced cognitive impairment and not as an initial triad component. *Frontotemporal dementia (FTD)* - FTD is characterized by early and prominent **behavioral and personality changes** or language difficulties. - While falls can occur due to executive dysfunction, **gait disturbance** and **enuresis** as part of a triad are not typical presenting features.
Question 5: Non-hormonal drug to prevent postmenopausal osteoporosis is:
- A. Alendronate (Correct Answer)
- B. Estrogen
- C. Raloxifene
- D. Teriparatide
Explanation: ***Alendronate*** - **Alendronate** is a **bisphosphonate**, a class of non-hormonal drugs that inhibit **osteoclast** activity, thereby reducing bone resorption and increasing bone density. - It is a first-line treatment for **postmenopausal osteoporosis** and is effective in preventing fractures. *Estrogen* - **Estrogen** is a **hormonal therapy** used to prevent postmenopausal osteoporosis. - However, its use is associated with increased risks of **thromboembolism**, stroke, and certain cancers. *Raloxifene* - **Raloxifene** is a **selective estrogen receptor modulator (SERM)**. - While it has estrogen-like effects on bone, it is technically considered a **hormonal agent** because its mechanism of action involves interacting with estrogen receptors. *Teriparatide* - **Teriparatide** is a **parathyroid hormone (PTH) analog**, making it a **hormonal agent** that stimulates **osteoblast** activity to promote new bone formation. - It is an anabolic agent typically reserved for severe osteoporosis or those who have failed other therapies due to its injectable administration and higher cost.
Question 6: 79 yrs old lady had fall, the following X-ray was taken. Which of the following is treatment?
- A. Hip spica
- B. Nailing
- C. Hemiahroplasty (Correct Answer)
- D. Total Hip Replacement
Explanation: ***Hemiarthroplasty*** - The X-ray shows a **displaced femoral neck fracture** in an elderly patient, which typically has a high risk of **avascular necrosis** of the femoral head due to disruption of blood supply. - Hemiarthroplasty involves replacing only the **femoral head and neck** with a prosthetic component, leaving the acetabulum intact, which is suitable for elderly patients with good acetabular cartilage and less active lifestyles. *Hip spica* - A hip spica cast is primarily used for **pediatric femur fractures** or certain types of hip dislocations in children, not for displaced femoral neck fractures in elderly adults. - This method would not provide stable fixation or address the high risk of **avascular necrosis** associated with these fractures in older patients. *Nailing* - Nailing (intramedullary nailing) is typically used for **intertrochanteric fractures** or subtrochanteric fractures, where the fracture line is distal to the femoral neck. - For displaced femoral neck fractures, nailing alone may not provide adequate stability and carries a higher risk of **non-union** or **avascular necrosis** compared to arthroplasty in elderly patients. *Total Hip Replacement* - Total hip replacement involves replacing both the **femoral head and the acetabulum** with prosthetic components. - While an option for femoral neck fractures, it is generally reserved for younger, more active patients or those with pre-existing **acetabular pathology** like arthritis, as it is a more extensive and complex procedure than hemiarthroplasty.
Question 7: A female is on hormone replacement therapy for her menopausal symptoms. She is worried about her bone strength because her mom and sister had osteoporosis after the age of 50. All are given for prevention of osteoporosis along with hormonal replacement therapy, EXCEPT:
- A. Calcium
- B. Vitamin-E (Correct Answer)
- C. Vit.D
- D. None of the options
Explanation: ***Vitamin-E*** - **Vitamin-E** is an **antioxidant** vitamin that primarily protects cells from oxidative damage. - It does not play a direct role in **bone metabolism** or the prevention of osteoporosis. *Calcium* - **Calcium** is a fundamental component of bone tissue and is essential for maintaining **bone density** [1]. - Adequate calcium intake is crucial for **osteoporosis prevention**, especially in postmenopausal women [1], [2]. *Vit.D* - **Vitamin D** is essential for **calcium absorption** in the gut and its incorporation into bones. - Without sufficient Vitamin D, calcium cannot be effectively utilized, leading to compromised **bone health**. *None of the options* - This option is incorrect because Vitamin E does not contribute to osteoporosis prevention, making it the correct answer to the "EXCEPT" question. - Calcium and Vitamin D are both vital for bone strength, so stating that none of the options fit would be inaccurate [1].
Question 8: All of the following are part of Glasgow Coma Scale except
- A. Motor response
- B. Eye opening
- C. Verbal response
- D. Deep tendon reflexes (Correct Answer)
Explanation: The **Glasgow Coma Scale (GCS)** assesses neurological function based on **eye opening**, **verbal response**, and **motor response** [1]. **Deep tendon reflexes** are part of a general neurological exam [2] but are not included in the GCS. *Motor response* - This is one of the three components of the **GCS** [1], assessing the patient's ability to move in response to commands or pain. - It evaluates responses ranging from obeying commands to no motor response. *Eye opening* - This is a key component of the **GCS** [1], assessing the patient's level of consciousness based on their spontaneous or stimulated eye opening. - Scores range from spontaneous eye opening to no eye opening. *Verbal response* - This is one of the three components of the **GCS** [1], evaluating the patient's ability to communicate verbally. - It assesses responses from oriented conversation to no verbal response.
Question 9: The drug that causes fall in elderly patients with postural hypotension is:-
- A. Acarbose
- B. Prazosin (Correct Answer)
- C. Nor-adrenaline
- D. Metformin
Explanation: ***Prazosin*** - **Alpha-1 adrenergic blocker** used to treat hypertension and benign prostatic hyperplasia (BPH) - Commonly causes **orthostatic hypotension (postural hypotension)** as a side effect by blocking alpha-1 receptors on vascular smooth muscle, preventing compensatory vasoconstriction upon standing - Leads to **dizziness, lightheadedness, and falls**, especially in elderly patients who have reduced baroreceptor sensitivity - **First-dose phenomenon** is particularly notable, with marked hypotension after the initial dose *Acarbose* - Alpha-glucosidase inhibitor used to treat type 2 diabetes by reducing carbohydrate absorption in the intestine - Primary side effects are **gastrointestinal** (flatulence, diarrhea, abdominal discomfort) - Does not affect blood pressure or cause postural hypotension *Nor-adrenaline (Norepinephrine)* - **Vasopressor** and sympathomimetic agent that causes vasoconstriction through alpha-adrenergic receptor stimulation - **Increases blood pressure** and is used to treat severe hypotension in critical care settings - Would not cause falls due to postural hypotension; rather, it counteracts hypotension *Metformin* - **Biguanide** oral hypoglycemic agent for type 2 diabetes that primarily decreases hepatic glucose production and increases insulin sensitivity - Main side effects include gastrointestinal disturbances and rare lactic acidosis - Not associated with postural hypotension or increased risk of falls
Question 10: A 70-year-old man presents with a hip fracture after a fall. What type of fracture is most common in this scenario?
- A. Intertrochanteric fracture
- B. Femoral head fracture
- C. Subtrochanteric fracture
- D. Femoral neck fracture (Correct Answer)
Explanation: ***Femoral neck fracture*** - **Femoral neck fractures** are exceedingly common in elderly patients, particularly women, after low-energy trauma such as a fall. - This fracture type is due to the **osteoporotic weakening** of the bone in this region, which bears significant weight. *Intertrochanteric fracture* - **Intertrochanteric fractures** occur between the greater and lesser trochanters and are also common in the elderly, but they tend to be extracapsular and have a better vascular supply. - While common, they typically involve higher energy trauma or significant twisting forces compared to the low-energy falls associated with femoral neck fractures in the elderly. *Subtrochanteric fracture* - **Subtrochanteric fractures** are located below the lesser trochanter. While they can occur in older patients, they are less common than femoral neck or intertrochanteric fractures after a simple fall. - These fractures often result from **high-energy trauma** in younger individuals or can be associated with certain medications like bisphosphonates. *Femoral head fracture* - **Femoral head fractures** are rare and typically occur in younger patients from high-energy mechanisms, such as a **dashboard injury** in a car accident, often associated with a hip dislocation. - The patient's presentation of an elderly person with a fall makes a femoral head fracture highly unlikely as the primary injury.
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