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NBME 22 Answers

nbme22/Block 1/Question#20

A 49-year-old man comes to the physician because of ...

Avascular necrosis

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 +3  upvote downvote
submitted by dr.xx(47),

MRI is highly sensitive, specific, and accurate in the detection of AVN.

T1-weighted images: AVN most often presents with a crescentic, ring-like or well defined band of low signal within the superior portion of the subchondral femoral head bone marrow. This band is thought to represent the reactive interface between the necrotic and reparative zones, and typically extends to the subchondral plate.

http://radsource.us/avn-of-the-hip/





 +1  upvote downvote
submitted by paloma(2),

According to UW, alcohol abuse is a risk factor for avascular necrosis. The most common site is the femoral head, which presents with pain that is exarcebated by weight bearing without inflammatory signs on physical examination.





I thought it was septic arthritis bc pain with weight bearing + mri, but 2 months with septic arthritis come on, it was an easy question and I missed it.

warbyparker1  Evolution time is key +  




 -1  upvote downvote
submitted by aerrow3(-1),

What are we supposed to be seeing on the MRI? Or do you just base it off the patient being an alcoholic with hip problems? I would’ve assumed avascular necrosis would’ve shown something on the X-ray but the x-ray showed no abnormalities so idk if the MRI is showing something?

skinnynomore  alcoholic in the hx should point you towards avascular necrosis when there is an “atraumatic” complaint +  
batrays  http://radsource.us/avn-of-the-hip/ +  




 -1  upvote downvote
submitted by seagull(432),

maybe someone can explain why this is avascular necrosis and not sepsis. It doesn't mention fever or absence of fever. The MRI has a small amount of hypodensity but to get avascular necrosis seems odd/

someduck3  Pg 455 of F.A. mentions that alcoholism can be a cause of avascular necrosis. +4  
meningitis  I think the small dark area on the left head of femur and the darkened neck are the avascular sites. Neck: http://img.medscapestatic.com/pi/meds/ckb/15/19515tn.jpg Head: (obvious lesion on the RT femur, but similar discrete lesion on the left as seen on the practice NBME) http://radsource.us/wp-content/uploads/2005/11/1a.jpg +1  
yotsubato  He wouldnt be playing golf if he had septic arthritis. Avascular necrosis is a more chronic condition that has a slow onset. +2  




 -1  upvote downvote
submitted by meningitis(159),

I think the small dark area on the left head of femur and the darkened neck are the avascular sites.

Neck: http://img.medscapestatic.com/pi/meds/ckb/15/19515tn.jpg

Head: (obvious lesion on the RT femur, but similar discrete lesion on the left as seen on the practice NBME) http://radsource.us/wp-content/uploads/2005/11/1a.jpg





(A) Risk factors for developing avascular necrosis include:

1) Trauma = Injuries, such as hip dislocation or fracture, can damage nearby blood vessels and reduce blood flow to bones.

2) Steroid use= Use of high-dose corticosteroids, such as prednisone, is a common cause of avascular necrosis. The reason is unknown, but one hypothesis is that corticosteroids can increase lipid levels in your blood, reducing blood flow.

3) Excessive alcohol use = Consuming several alcoholic drinks a day for several years also can cause fatty deposits to form in your blood vessels.

4) Bisphosphonate use = Long-term use of medications to increase bone density might contribute to developing osteonecrosis of the jaw. This rare complication has occurred in some people treated with high doses of these medications for cancers, such as multiple myeloma and metastatic breast cancer.

5) Certain medical treatments = Radiation therapy for cancer can weaken bone. Organ transplantation, especially kidney transplant, also is associated with avascular necrosis.

(B) Medical conditions associated with avascular necrosis include:

Pancreatitis Diabetes Gaucher's disease HIV/AIDS Systemic lupus erythematosus Sickle cell anemia





Causes

1) Avascular necrosis occurs when blood flow to a bone is interrupted or reduced. Reduced blood supply can be caused by:

2) Joint or bone trauma. An injury, such as a dislocated joint, might damage nearby blood vessels. Cancer treatments involving radiation also can weaken bone and harm blood vessels.

3) Fatty deposits in blood vessels. The fat (lipids) can block small blood vessels, reducing the blood flow that feeds bones.

4) Certain diseases. Medical conditions, such as sickle cell anemia and Gaucher's disease, also can cause diminished blood flow to bone.

For about 25 percent of people with avascular necrosis, the cause of interrupted blood flow is unknown.





 -3  upvote downvote
submitted by sirminalot(-48),

[special]





 -5  upvote downvote
submitted by sirminalot(-48),

[special]