NBME 20 Activity level before the fracture (NBME Answers)

Retired NBME 20 Answers

nbme20/Block 2/Question#10 (reveal difficulty score)
A 70-year-old woman is transferred to a ...
Activity level before the fracture 🔍 / 📺 / 🌳 / 📖
tags: msk elderly

+8 upvote downvote
submitted by ∗monoloco(155)

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This is indirectly asking about peak bone density. That whole thing about weight-bearing exercises, eating right, yada yada, before and during that down-slope phase of life for bone density. All about reducing that 1% per year age-related bone density loss as best as we can. Level of activity is precisely like weight-bearing exercise. (Consider: no activity, bed-ridden -- say goodbye to your bones; highly active, runs every other day -- good amount of weight-bearing / stress to induce remodeling and maintain integrity of the bones.)

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sympathetikey Yeah, I was thinking about that while taking the exam. Just got thrown off because I don't see how that matters, now that they've fractured the femur. How do prior increases in bone density allow for better chances of bone healing? +19

rsp I think that bone density is important here, but think about all of the other things that go in to recovering from a fracture at that age too. How strong are the muscle that will stabilize you while going through the motions of physical therapy? How conditioned are you? +4

j123 I'd put money on a fat baby who doesn't exercise to heal faster than my 95 yo grandpa who rides his stationary bike 2 hrs per day... lol +1

stresssweat In that same train of thought, another modifiable risk factor for fracture would be levels of calcium and vitamin D intake throughout childhood. I crossed these out because they were essentially the same thing so obviously neither could be right, but aside from that - what would be the actual reason those were wrong? +

+3 upvote downvote
submitted by ∗sherry(35)

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This is the second best choice I was gonna take during the exam. I thought Age was better since FA indicated decreased estrogen and old age are the reasons for bone resorption. Can somebody explain to me why Age could not possibly be the answer?

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kard I solve it like this: So age is 70 (already, nothing we can do to change it), is asking about a predictor of success in the Rehab process (So basically, what this patient did in matter of activity, life style, etc. to have a Good rehab process). So From all the answers the, Activity level is the most likely choice because of the, increase in Bone density(Specially Weigh bearing) and OsteoBlastic activity. +6

misterdoctor69 But bu that logic: just like you can't do anything about age, you also can't do anything about activity level BEFORE the fracture right...? +4

+3 upvote downvote
submitted by coconut(7)

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NCBI Resource : "Successful interventions concern patients able to walk with or without help before the fracture. Pre-fracture motor and not cognitive level is the most important predictive factor for motor recovery."

https://www.ncbi.nlm.nih.gov/pubmed/17682794

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-1 upvote downvote
submitted by ∗stepwarrior(29)

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I don't think you're going to find any evidence for this one. It's just the test-writers' opinion

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