4.5 Flashcards
is estrogen high or low in someone with atrophic vaginitis
low
why is cervix friable in atrophic vaginitis
hypoestrogenic state
why is someone with atrophic vaginitis at increased risk of infections
decreased lactobacilli –> increased pH
therapy for atrophic vaginitis
intravaginal estrogen products
can lichen sclerosis be spread through sexual contact
yes
what is a precursor to osteoporosis
osteopenia
what pathologic fractures are most common in osteoporosis
vertebral fractures
best diagnostic test for osteoporosis
DEXA scan
osteoporosis T score
T score -2.5 or less
Initial lifestyle modifications for osteoporosis
Vitamin D + calcium supplementation
how much vitamin D is advised
800 mg
how much calcium is advised
1500 mg
first line MEDICAL management and prevention of osteoporosis
bisphosphonates
Osteopenia T score
-1 to -2.5
USPSTF advice for screening men for osteoporosis
insufficient evidence to screen men
best tool for diagnosis of osteoporosis
DEXA
USPSTF recommendations for DEXA scan
women 65 and older
younger women at risk
-a personal history of fractures
-low body weight
-smoking
-glucocorticoids
-and early menopause
classification used based on vertebral height lost
Genant classification
fractures above what level are suggestive of a malignancy
T4
types of compression fractures
wedge
crush
burst
what is the most common type of compression fracture
wedge
menorrhagia
heavy menstrual bleeding that lasts longer than 7 days
women who take estrogen alone and risk of breast cancer
lower risk of breast cancer
women who take estrogen + progesterone and risk of breast cancer
higher risk of breast cancer
two types of breast implants
saline
silicone
which breast implant is safer
silicone
when do patients with breast implants need an MRI
5 years later
and then every 2-3 years
do breast implants affect a woman’s ability to breastfeed
no
ALP tends to be higher in
bone disease
if ALP + GGT are high this indicates
hepatobiliary issue
BAP
bone alkaline phosphatase
measures metabolic status of osteoblasts
should BAP be used for screening of osteoporosis
NO – can be used to monitor meds
what is necessary for activation of vitamin D
magnesium
functional cells in parathyroid
chief cells
blood supply to parathyroid
same as for thyroid
inferior thyroid arteries
congenital parathyroid aplasia
DiGeorge syndrome - a type of hypoparathyroidism
vitamin D levels at what level indicate risk for osteomalacia
< 12
preferred vitamin D supplementation
D3 (cholecalciferol)
after starting vitamin D supplementation, when should you recheck serum levels
3 months
cancer associated with proliferation of a single clone of immunoglobulin-producing plasma cells leading to increased production of ineffective monoclonal antibodies
multiple myeloma
what are the main ineffective monoclonal antibodies in multiple myeloma
IgG (60%) and IgA (20%)
most common primary bone malignancy in adults
multiple myeloma
risk factors for multiple myeloma
older adults (median age 65)
african americans
men
bones BREAK in multiple myeloma
Bone pain
Recurrent infections
Elevated calcium
Anemia
Kidney injury
most common symptom of multiple myeloma
bone pain; vertebral involvement most common
bone pain in multiple myeloma is due to what type of lesions
osteolytic lesions
what will you see on CBC for multiple myeloma
Rouleaux formation “stack of coins”
calcium levels in multiple myeloma
hypercalcemia!!!!
serum protein electrophoresis for multiple myeloma
monoclonal spike protein - IgG most common
urine protein electrophoresis in multiple myeloma
Bence-Jones proteins composed of kappa or lambda light chains
what causes kidney injury in multiple myeloma
light chain antibody deposition in kidneys
radiographs for multiple myeloma
“punched out” lytic lesions
definitive diagnosis of multiple myeloma
bone marrow aspiration –> plasmacytosis (clonal plasma cells) >/= 10%
most effective therapy in multiple myeloma
autologous stem cell transplant
low bone turnover + decreased bone mineralization and/or cartilage at the epiphyseal plates
vitamin D deficiency
decreased bone (osteoid) mineralization)
osteomalacia
decreased cartilage at the epiphyseal plates
Rickets
if we have demineralization of the bone osteoid, what do we see in our bones
soft bones
malabsorption from what diseases can cause vitamin D deficiency
chronic liver or kidney disease
gastric bypass
celiac
most common form of vitamin D deficiency in kids
Rickets
most common form of vitamin D deficiency in adults
osteomalacia
clinical manifestations of vitamin D deficiency
diffuse bone pain and tenderness
proximal muscular weakness
hip pain
bowing of long bones –> antalgic/waddling gait
hypocalcemia
what clinical symptoms are associated with hypocalcemia
muscle spasms
cramps
positive Chvostek’s sign
tingling, numbness
Diagnosis of vitamin D deficiency
decreased calcium, phosphate, and 25-hydroxyvitamin D levels
Increased alkaline phosphatase
increased parathyroid hormones
what will you see on radiographs for vitamin D deficiency
looser lines (zones) – transverse pseudo-fracture lines
often bilateral and symmetrical
management for vitamin D deficiency
vitamin D supplementation
when do we commonly see vitamin D deficiency in Rickets in kids
between 3 most - 3 years when growth needs are high and decreased sun exposure
common causes of rickets
calcipenic - calcium or vitamin D deficiency
phosphopenic - due to renal phosphate wasting
initial clinical manifestations of rickets
bowing of forearm bone, knee, costochondral junction
other clinical manifestations in rickets
delayed fontanel closure
craniotabes (soft skull bones)
genu varum (bowing of the femur and tibia)
growth delays
delayed dentition
parietal and frontal bossing
Diagnosis for rickets
decreased calcium
decreased phosphate
decreased 25-hydroxyvitamin D
what will you see on radiographs for rickets
costochondral junction enlargement
long bones have a “fuzzy” cortex
widening of epiphyseal plate