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drspleen - 03-15-11 01:58

A 20 year old hispanic female is rushed to the emergency department status post motor vehicle accident. Per the paramedics, the patient was the driver, she was not wearing a seatbelt and the airbag failed to deploy. The patient reports hitting her head on the steering wheel but cannot recall other details of the accident. She is a well-dressed young woman with thin body habitus, visibly distressed and in pain. She is alert and oriented to person and place, but not time or situation. Her vitals on admission: temperature 37 C, respiratory rate 18 per minute, heart rate 95 beats per minute, blood pressure 98/65 mmHg, pulse ox 95%. Arterial blood gas: pCO2 38, pO2 100, HCO3 23, pH 7.38. Her BMI is 16 kg/meter2, she has a history of irregular periods, and her last menstrual period was 4 months ago. Urine toxicology and urine pregnancy screens are negative. She denies vomiting or laxative use. You note a deep laceration across her right forehead that extends to her left eyebrow. There is a large ecchymosis surrounding her left orbit which is exquisitely tender to palpation, likely indicating a left orbital blowout fracture given the mechanism of injury. She sustained multiple fractures in her left arm, which were confirmed by X-ray. The radiologist also noted several older healed fractures of her distal radius. What is the likely cause of these older fractures?

# A. Primary osteoporosis
# B. Hypogonadism
# C. Chronic metabolic acidosis
# D. Diet rich in calcium
# E. Low sodium diet