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drfax
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10/02/06 - 10:13 AM       #1

A 48 yr old woman injured her right wrist in a fall down a flight of stairs. On physical examination, she has marked pain on palpitation of the wrist and does not want to move the hand. A radiograph of the right hand and arm shows marked osteopenia and a fracture of the radial head. Which of the following underlying diseases is most likely to contribute to the risk of fracture in this patient ?
A. coronary atherosclerosis
B. pulmonary emphysema
C. primary biliary cirrhosis
D. chronic lymphocytic leukemia
E. atrophic gastritis


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sandra
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10/02/06 - 10:52 AM       #2

c

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drfax
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10/02/06 - 11:28 AM       #3

Why did u pick C sandra



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sandra
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10/02/06 - 11:51 AM       #4

cozprimary biliary cirrhosis is assosiated with osteoporosis. the mechanism is unclear. thats what i have read. if any one knows the mechanism, pls explain

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young_doc
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10/02/06 - 12:15 PM       #5

Well according to one research:

"CONCLUSIONSOsteoporosis is not a specific complication of PBC."

http://gut.bmjjournals.com/cgi/content/abstract/49/2/282

!!!

Maybe it is the answer who know's! I can't find a connection with any of the answers...

Anyone know for sure?


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Leopard
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10/02/06 - 02:01 PM       #6

The mechanism of osteoporosis in PBC is clear

PBC-------------> biliary obstruction -------------> No bile in the intestine -----------> No fat absorption -------------> vit D deficiency ---------------> Hypocalcemia -------------> secondary Hyperparathyroidism ----------> osteoporosis

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young_doc
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10/02/06 - 02:29 PM       #7

Complete obstruction of the bile ducts is a possibility, yes.

But then so is Osteolytic processes seen in CLL (due either to tumor production of PTH-like peptides, or Osteoclast activators like IL-1/TNF-a).

So how could we rule out CLL?

Even if we go by odds, PBC is listed as a rare disease by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH)....meaning that it affects less than 200,000 americans. (or 0.0008% of americans). CLL is much more common!

And if we go by symptoms, well both of them should have other associated symptoms that are not mentioned in the Q, so can't really go by symptoms. (i.e. PBC with complete obstruction of the bile ducts will present with Jaundice before it ever presents with hypocalcemia, let alone osteopenia)

This is an interesting question! Thank god i'm done with the Step already..haha

=)


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mytime
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10/02/06 - 02:42 PM       #8

i think it's D. especially since she's a woman.


sandra
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10/02/06 - 03:36 PM       #9

its unlikely to be CLL. CLL is more common in pts over 60

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Leopard
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10/02/06 - 03:40 PM       #10

sandra wrote:
its unlikely to be CLL. CLL is more common in pts over 60



Most probably you are talking with reference to standard textbooks like Harrison etc.But our "forum" believes in "FA".

Best of luck


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sandra
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10/02/06 - 04:18 PM       #11

harrisonsmiling face
who reads harrison for mle. atleaSt not me.
what does FA say? in kaplan and goljan its mentioned that CLL is more common in people over 60

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drfax
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10/03/06 - 08:50 AM       #12

The answer is C.
explanation by leopard is ture.


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Leopard
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10/03/06 - 12:44 PM       #13

Thanks drfax

I have a question

Does FA concept go for CLL ??

Just curious

Best of luck


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drfax
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10/03/06 - 09:35 PM       #14

Leopard, I don't like books like FA really (to be just HY phrases) and I don't do it for pathology especially might be for pharma. or microbiology .. as a source of oreintation.
my bible is Robbins pathologic basis of disease 7th. edition, and it doesn't have anything about reduced fat absorption in patients with CLL/SLL
GL


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