MKSAP: 55-year-old man with a wrist fracture and anemia

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is reevaluated during a follow-up examination for a wrist fracture and anemia. The patient is otherwise asymptomatic. He was treated in the emergency department 2 weeks ago after he slipped in his driveway and sustained a right wrist fracture; mild iron deficiency anemia was detected at that time. He had normal results of a routine screening colonoscopy 5 years ago. Since his emergency department evaluation, 3 stool samples have been negative for occult blood. He takes no medication. On physical examination, vital signs are normal; BMI is 19. Other than a cast on his right wrist, all other findings are normal. Hemoglobin level is 11.9 g/dL (119 g/L), and 25-hydroxyvitamin D level is 17 ng/mL (42 nmol/L). Results of a comprehensive metabolic profile and urinalysis are normal. A dual-energy x-ray absorptiometry (DEXA) scan shows T-scores of −1.6 in the lumbar spine, −2.2 in the femoral neck, and −1.9 in the total hip. Which of the following is the most appropriate next step in management? A: Begin alendronate B: Begin teriparatide C: Repeat DEXA scan in 1 year D: Screen for celiac disease Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: Tags: Conditions Endocrinology GI Source Type: blogs