Metabolic Bone Diseases — MCQs
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Which of the following is true about reflex sympathetic dystrophy?
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?
Most common cause of kyphotic deformity ?
Osteonecrosis is seen in all except
After chronic use of steroids severe pain in right hip with immobility is due to
Which of the following is not typically associated with osteogenesis imperfecta?
Metabolic Bone Diseases Indian Medical PG Practice Questions and MCQs
Question 131: Which of the following is true about reflex sympathetic dystrophy?
- A. Increased skin temp
- B. Osteoporosis (Correct Answer)
- C. Vasoconstriction
- D. Common in athletes
Explanation: ***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.
Question 132: 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?
- A. Lumbar muscle strain
- B. Vertebral compression fracture (Correct Answer)
- C. Herniated disc
- D. Spinal stenosis
Explanation: ***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.
Question 133: Most common cause of kyphotic deformity ?
- A. Trauma
- B. Osteoporosis (Correct Answer)
- C. Ankylosing spondylitis
- D. Rickets
Explanation: ***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.
Question 134: Osteonecrosis is seen in all except
- A. Fracture neck femur
- B. Paget's disease (Correct Answer)
- C. Perthe's disease
- D. Sickle cell anemia
Explanation: ***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.
Question 135: After chronic use of steroids severe pain in right hip with immobility is due to
- A. Avascular necrosis (Correct Answer)
- B. Perthes disease
- C. Hip dislocation
- D. Osteoarthritis
Explanation: ***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.
Question 136: Which of the following is not typically associated with osteogenesis imperfecta?
- A. Blue sclera
- B. Lax ligament
- C. Bilateral Hip dislocation (Correct Answer)
- D. Osteoporosis
Explanation: ***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.
Practice by Chapter
Osteoporosis
Practice Questions
Osteomalacia and Rickets
Practice Questions
Paget's Disease of Bone
Practice Questions
Hyperparathyroidism
Practice Questions
Renal Osteodystrophy
Practice Questions
Fluorosis
Practice Questions
Osteogenesis Imperfecta
Practice Questions
Bone Mineral Density Assessment
Practice Questions
Pharmacological Management of Metabolic Bone Diseases
Practice Questions
Surgical Considerations in Metabolic Bone Diseases
Practice Questions
Fragility Fractures
Practice Questions
Prevention Strategies
Practice Questions
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