This is the first in a series of monthly quizzes to get both C.O and volunteer drs thinking. This is based on a real life patient I treated.
Feel free to post your comments.
Answers in 2 weeks.
73 year old patient with a long term history of osteoporosis and spinal stenosis presents with worsening pelvis pain and difficulty walking. She has no history of trauma.
Paracetamol and codeine for pain
Alendronic acid and calcium and vitamin D for osteoporosis
O/E she is tender on palpation of her pelvis and walk with an antalgic gait (painful walk).
I refer her for an X-ray
What does the X ray show?
Blood tests are vitamin D 76 (>50 normal), Ca 2.8 (2.2-2.6) and PTH 13.4 (1.6-7.2)
What is her diagnosis?
Is this primary or secondary?
What is the commonest cause and how do you treat it?
What are the complications of this treatment?
If this treatment isn’t available how can you manage the patient?