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Orthopaedics > Biochemistry > Flashcards

Biochemistry Flashcards

1
Q

What is a quantitative bone defect?

A

When there is sufficient bone quality, but not enough is present.

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2
Q

What is a qualitative bone defect?

A

When there is sufficient bone quantity, but it is not of the required quality.

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3
Q

What is osteoporosis?

A

A quantitative bone defect characterised by decreased density, and increased porosity.

Defined as being >2.5 standard deviations BELOW the young adult peak.

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4
Q

What is a consequence of osteoporosis?

A

Increased fracture risk.

May occur with minimal trauma.

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5
Q

What is osteopenia?

A

A bone mass density between 1-2.5 standard deviations BELOW the young adult peak.

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6
Q

Can bone density loss be normal?

A

Yes, it is lost physiologically with age.

Most noticeable in women following menopause (as no effects of oestrogen remains within the system).

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7
Q

How is osteoporosis diagnosed?

A

DEXA scan

Remember to compare BMD to that of a young adult of the same race and gender.

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8
Q

Can osteoporosis be cured?

A

No, the aim of treatment is to prevent progression, and minimise risk of fracture.

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9
Q

How can risk of fracture be reduced in those with osteoporosis?

A

Healthy diet
Good exposure to sunlight
Vitamin D supplements
Calcium supplements
Bisphosphonates

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10
Q

What is a potential side-effect of both HRT and raloxifene?

A

DVT

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11
Q

Aside from bisphosphonates, what may be used to treat osteoporosis?

A

Desunomab
Strontium
Zoledronic acid
HRT
Raloxifene

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12
Q

By which mechanism do bisphosphonates help in osteoporosis?

A

Reduces osteoclastic function.

This is the first-line form of treatment.

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13
Q

By which mechanism does desunomab help in osteoporosis?

A

Reduces osteoclast activity.

A form of monoclonal antibody.

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14
Q

What form of drug is zoledronic acid?

A

Bisphosphonate - this type is given once yearly.

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15
Q

What is osteomalacia?

A

A qualitative defect which results from abnormal bone softening.

The result of deficiencies in bone mineralisation.

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16
Q

What is osteomalacia called in children?

A

Rickett’s

17
Q

What is thought to be responsible for osteomalacia/Rickett’s development?

A

Insufficient absorption of calcium, or a deficiency of vitamin D.

18
Q

How does osteomalacia/Rickett’s present?

A

Bone pain
Soft bone deformities
Features of hypocalcaemia

19
Q

What are features of hypocalcaemia?

A

Bone pain
Renal stones
Abdominal groans
Psychiatric moans

20
Q

How does osteomalacia/Rickett’s impact blood tests?

A

Low calcium
Low phosphates
High ALP

21
Q

How is osteomalacia/Rickett’s treated?

A

Vitamin D supps
Calcium supps
Phosphate supps

22
Q

What is hyperparathyroidism?

A

Overactivity of the parathyroid glands.

Will lead to high PTH levels, high calcium, and normal/low phosphate levels.

23
Q

What may cause primary hyperparathyroidism?

A

Benign adenoma
Hyperplasia
Malignancy

24
Q

What may be responsible for secondary hyperparathyroidism?

A

A physiological overproduction of PTH
Vitamin D deficiency
Chronic kidney disease

25
Q

How are very high calcium levels treated?

A

IV fluids
Bisphosphonates
Calcitonin

26
Q

What is renal dystrophy?

A

Bone changes observed in those with chronic kidney disease.

27
Q

How does chronic kidney disease affect bone?

A

There will be reduced phosphate excretion and inactivation of vitamin D, resulting in secondary hyperparathyroidism.

This produces osteomalacia, sclerosis of bone, and the calcification of soft tissues.

28
Q

What is Paget’s disease?

A

A chronic bone disorder that produces thickened, mis-shapen, brittle bones.

It is the result of increased bone turnover.

29
Q

Where does Paget’s disease commonly affect?

A

Pelvis
Skull
Femur
Tibia
Ear ossicles

30
Q

How does Paget’s disease affect blood results?

A

Normal calcium
Normal phosphates
Raised ALP

31
Q

How should Paget’s disease be treated?

A

Give bisphosphonates

Manage any pathological fractures with IM nails/plating. Some may need joint replacement.

32
Q

What diagnosis is indicated by a normal calcium, normal phosphate, normal ALP and normal PTH levels?

A

Osteoporosis
Osteopetrosis

33
Q

Low calcium, low phosphate, raised ALP, and raised PTH levels are indicative of which diagnosis?

A

Primary hyperparathyroidism

34
Q

Reduced calcium, normal phosphate, normal PTH, and raised PTH levels are indicative of which diagnosis?

A

Chronic Kidney Disease
Secondary Hyperparathyroidism

35
Q

Normal calcium, normal phosphate, raised ALP, and normal PTH levels are indicative of what?

A

Paget’s disease

36
Q
A

Orthopaedics (13 decks)

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