Metabolic Bone Diseases Practice Questions

Q: Which of the following is true about reflex sympathetic dystrophy?

Osteoporosis. ***Osteoporosis*** - **Osteoporosis** is a characteristic feature of reflex sympathetic dystrophy (RSD), also known as **complex regional pain syndrome (CRPS)** type 1, often visible on imaging as patchy bone demineralization in the affected limb. - This bone loss is thought to be due to increased osteoclast activity and altered local blood flow and nerve supply in the affected region. *Increased skin temp* - While initial stages of RSD can involve **increased skin temperature** due to vasodilation, later stages often show **decreased skin temperature** and cyanosis. - The temperature changes are often asymmetric and can fluctuate, but a constant increase is not universally true or defining. *Vasoconstriction* - RSD can present with both **vasodilation** in the acute phase and **vasoconstriction** in the chronic phase, leading to diverse vascular symptoms. - Therefore, stating only vasoconstriction as a universal truth for RSD isn't accurate, as the condition involves a dysregulation of blood vessel control. *Common in athletes* - RSD is not specifically more common in athletes; it can affect anyone after **trauma (e.g., fracture, surgery)**, nerve injury, or even without an identifiable cause. - While athletes can experience trauma leading to RSD, no specific predisposition exists in this population compared to others experiencing similar injuries.

Q: A 70-year-old woman with a history of osteoporosis presents with sudden severe back pain after lifting a heavy object. What is the most likely diagnosis?

Vertebral compression fracture. ***Vertebral compression fracture*** - The patient's age (70 years), history of **osteoporosis**, and sudden severe back pain after lifting a heavy object are classic signs of a **vertebral compression fracture**. - **Osteoporosis** significantly weakens bones, making them susceptible to fracture from minor trauma or even routine activities. *Lumbar muscle strain* - While lifting can cause **muscle strain**, the combination of **osteoporosis** and severe sudden pain points more strongly to a skeletal injury. - Muscle strains typically cause localized pain that might be exacerbated by movement but usually doesn't present as sudden, severe pain following a 'heavy object' lift in an osteoporotic patient. *Herniated disc* - A **herniated disc** typically presents with radiating pain down the leg (**sciatica**), numbness, or weakness, which are not mentioned in this scenario. - Although heavy lifting can precipitate a herniated disc, the patient's age and osteoporosis history make a compression fracture more likely. *Spinal stenosis* - **Spinal stenosis** usually causes pain that radiates down the legs and worsens with walking (**neurogenic claudication**), improving with sitting or leaning forward. - It's a chronic condition and does not typically present as sudden, severe back pain triggered by a single lifting event.

Q: Most common cause of kyphotic deformity ?

Osteoporosis. ***Osteoporosis*** - **Osteoporosis** leads to vertebral compression fractures, particularly in the thoracic spine, which causes a gradual collapse of the vertebral bodies and an increase in the kyphotic curve. - This condition is very common, especially in **postmenopausal women** and the elderly, making it the most frequent cause of kyphotic deformity. *Trauma* - While significant **spinal trauma** can lead to kyphotic deformities, it is generally less common than the gradual kyphosis resulting from osteoporosis. - Traumatic kyphosis usually results from severe injuries leading to **vertebral body collapse** or neurological deficits. *Ankylosing spondylitis* - **Ankylosing spondylitis** can cause severe kyphosis, often referred to as a "bamboo spine," due to chronic inflammation and fusion of the vertebrae. - However, it is a less prevalent condition compared to **osteoporosis-related kyphosis**. *Rickets* - **Rickets**, a childhood bone disorder caused by **vitamin D deficiency**, can lead to bone deformities including kyphosis due to softened bones. - While a cause in children, its prevalence is lower than osteoporosis globally as a cause of kyphosis and it primarily affects a different age group.

Q: Osteonecrosis is seen in all except

Paget's disease. ***Paget's disease*** - **Paget's disease of bone (osteitis deformans)** is a localized disorder of bone remodeling, characterized by excessive and disorganized bone formation, leading to enlarged, softened, and misshapen bones, but not directly causing osteonecrosis. - While complications like **pathological fractures** and **osteosarcoma** can occur, primary osteonecrosis is not a typical feature of Paget's disease itself. *Fracture neck femur* - **Fractures of the femoral neck** can disrupt the blood supply to the femoral head, particularly the medial circumflex femoral artery, leading to **avascular necrosis** (osteonecrosis) of the femoral head. - This is a well-known and common complication, especially in displaced fractures. *Sickle cell anemia* - **Sickle cell anemia** causes sickling of red blood cells, leading to **vaso-occlusion** and impaired blood flow to bones, resulting in **bone infarcts** (osteonecrosis). - This can affect various bones, including the femoral head, humeral head, and vertebrae. *Perthe's disease* - **Perthe's disease** (Legg-Calvé-Perthes disease) is a childhood condition characterized by **idiopathic osteonecrosis** of the femoral head. - It involves the collapse and subsequent re-ossification of the femoral epiphysis due to an interruption of its blood supply.

Q: After chronic use of steroids severe pain in right hip with immobility is due to

Avascular necrosis. ***Avascular necrosis*** - Chronic **steroid use** is a major risk factor for avascular necrosis (AVN), particularly affecting the **femoral head** of the hip. - Reduced blood supply leads to bone death, resulting in severe pain and impaired mobility. *Perthes disease* - This is a condition of idiopathic **avascular necrosis of the femoral head** occurring in **children**, primarily between ages 4-10. - It is not associated with steroid use and typically presents in a different age group. *Hip dislocation* - Hip dislocation presents with **acute, severe pain** and an inability to bear weight or move the hip, often due to significant trauma. - While it causes immobility, it is an **acute traumatic event** rather than a chronic consequence of steroid use. *Osteoarthritis* - Osteoarthritis is a degenerative joint disease characterized by **cartilage breakdown** and joint pain that typically **worsens with activity** and improves with rest. - While chronic hip pain can be due to osteoarthritis, its direct link to steroid use for severe pain and immobility as described is less prominent than AVN.

Q: Which of the following is not typically associated with osteogenesis imperfecta?

Bilateral Hip dislocation. ***Bilateral Hip dislocation*** - While hip dislocations can occur in severe cases due to bone fragility, **bilateral hip dislocation** is not a characteristic or typical primary association with osteogenesis imperfecta. - The underlying issue is primarily **bone fragility** leading to fractures, not inherent joint instability or malformation causing bilateral dislocation. *Blue sclera* - **Blue sclera** is a classic sign of osteogenesis imperfecta, caused by the thinness of the sclera allowing the underlying choroid vessels to show through. - This is due to a defect in **Type I collagen** synthesis, which affects not only bones but also other connective tissues including the sclera. *Lax ligament* - **Lax ligaments** are common in osteogenesis imperfecta due to the generalized **connective tissue defect**, particularly involving Type I collagen. - This can contribute to joint instability, *hypermobility*, and an increased risk of sprains. *Osteoporosis* - **Osteoporosis** with reduced bone mineral density is a hallmark feature of osteogenesis imperfecta, leading to **fragile bones** and recurrent fractures. - The genetic defect in **Type I collagen** impairs bone matrix formation, resulting in weak and brittle bones.

Question 1

Which of the following is true about reflex sympathetic dystrophy?

Accepted Answer

Osteoporosis

Answer

Increased skin temp

Answer

Vasoconstriction

Answer

Common in athletes

Question 2

A 70-year-old woman with a history of osteoporosis presents with sudden severe back pain after lifting a heavy object. What is the most likely diagnosis?

Accepted Answer

Vertebral compression fracture

Answer

Lumbar muscle strain

Answer

Herniated disc

Answer

Spinal stenosis

Question 3

Most common cause of kyphotic deformity ?

Accepted Answer

Osteoporosis

Answer

Trauma

Answer

Ankylosing spondylitis

Answer

Rickets

Question 4

Osteonecrosis is seen in all except

Accepted Answer

Paget's disease

Answer

Fracture neck femur

Answer

Perthe's disease

Answer

Sickle cell anemia

Question 5

After chronic use of steroids severe pain in right hip with immobility is due to

Accepted Answer

Avascular necrosis

Answer

Perthes disease

Answer

Hip dislocation

Answer

Osteoarthritis

Question 6

Which of the following is not typically associated with osteogenesis imperfecta?

Accepted Answer

Bilateral Hip dislocation

Answer

Blue sclera

Answer

Lax ligament

Answer

Osteoporosis

Metabolic Bone Diseases — MCQs

Metabolic Bone Diseases — MCQs

On this page

Practice by Chapter

Want unlimited practice?