Splintered

Musculoskeletal System


{"ops":[{"insert":"Diagnosis and reasoning"},{"insert":"\n","attributes":{"header":1}},{"insert":"This young woman has presented with a fracture of the left femur, following only minor trauma. X-rays of the affected limb showed a puzzling finding: increased bone density (i.e., osteosclerosis).\n\nThe key causes of osteosclerosis can be recalled via the \u00273 M\u0027s PROOF\u0027 mnemonic:\n"},{"insert":"M","attributes":{"bold":true}},{"insert":": malignancy (metastases, lymphoma, and leukemia)"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"M","attributes":{"bold":true}},{"insert":": myelofibrosis"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"M","attributes":{"bold":true}},{"insert":": mastocytosis"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"S","attributes":{"bold":true}},{"insert":": sickle cell disease"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"P","attributes":{"bold":true}},{"insert":": Paget\u2019s disease and pycnodysostosis"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"R","attributes":{"bold":true}},{"insert":": renal osteodystrophy"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"O","attributes":{"bold":true}},{"insert":": osteopetrosis"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"O","attributes":{"bold":true}},{"insert":": other (sclerotic dysplasias, hyperthyroidism, and hypoparathyroidism)"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"F","attributes":{"bold":true}},{"insert":": skeletal fluorosis"},{"insert":"\n","attributes":{"list":"bullet"}},{"insert":"An analysis of her history provides some clues. First of all, her mother has a history of fractures. This may imply a genetic etiology\u2014e.g., osteopetrosis, pycnodysostosis, or sclerotic dysplasias. The latter two conditions can be excluded though, as they are associated with characteristic dysmorphisms. Paget\u2019s disease is almost unheard of at her age, while metastatic malignancies are also clinically less likely. Fluorosis is also unlikely, as most cases occur in the developing world, following occupational exposure to fluoride fumes or dust or consumption of groundwater contaminated with fluoride.\n\nA series of investigations should follow, including a complete blood count with peripheral smears; ESR; liver and renal profiles; serum thy"}]}

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