A 49-year-old blue-eyed blonde woman was brought to the emergency room with a history of having come down heavily on the right leg while stepping off a curb. The paramedics reported that she had vomited once during the trip. The patient stated that she had had a dull ache in the right thigh for the past few weeks and had noticed a “boil” there. She had made an appointment to see her primary care physician for this and for recent onset of hot flushes (also called hot flashes). The emergency physician noted that she was in moderate distress. Her blood pressure was 90/60 mm Hg, pulse was 98/min regular and thready, her respirations were 22/min, and her temperature was 37.5C (99.5F). She had no cyanosis, but had pallor of the mucosa. Cardiovascular examination was unremarkable except for a sinus tachycardia and a capillary circulation longer than 2 seconds. Exami - nation of the respiratory system revealed normal breath sounds bilaterally. Her right thigh was swollen, and she had lateral rotation and shortening of the leg. The right groin was tender to palpation, and movement of the leg induced severe pain. There was a raised papular lesion over anterior midthigh, surrounded by inflammation. The pelvis and the left leg were normal. Which of the following choices is the most likely reason for her problem? (A) Chronic osteomyelitis (B) Osteoporosis (C) Stress fracture (D) Osteogenesis imperfecta (E) Metastatic bone disease
Posted on: Mon, 08 Jul 2013 10:24:46 +0000
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