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endocrine > bone > Flashcards

bone Flashcards

1
Q

effect of corticosteroids on bone

A

direct

  • reduction of osteoblast activity + lifespan
  • suppression of replication of osteoblast precursors
  • reduction in calcium absorption

indirect
- inhibition of gonadal + adrenal steroid production

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2
Q

which type of collagen is affected in osteogenesis imperfecta?

A

type 1

genetic mutation that affect maturation + organisation of type 1 collagen

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3
Q

osteogenesis imperfecta

A

brittle bones brone to fractures - due to mutations affecting matuaration + organisation of type 1 collagen

8 types depending on mutation - vary in severity, mild may present in adult
most autosomal dominant

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4
Q

osteogenesis imperfecta presentation

A

recurrent + inappropriate fractures
blue/grey sclera (whites of eyes)

dental problems
deafness
short stature
triangle face
hypermobility
bone deformities - bowed legs, scoliosis
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5
Q

diagnosis of osteogenesis imperfecta

A

clinical
genetic testing can be done but not routine

xrays for fractures

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6
Q

management of osteogenesis imperfecta

A

no cure - fix + prevent further fractures

bisphosphonates - increase bone density
vit D supplementation

MDT - physio, occ, paeds, social workers

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7
Q

which bones are most affected in paget’s disease?

A

axial skeleton

pelxis
lumbar spine
skull
long bones

may be single site (monostotic) or multiple (polyostotic)

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8
Q

Paget’s disease

A

disorder of excessive bone turnover - overactivity of osteoblasts + osteoclats

uncoordinated, leads to patchy areas of sclerosis + lysis

increased risk of pathological fractures

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9
Q

Paget’s presentation

A

older patients
bone pain
bone deformity + fractures

hearing loss - bones of ear affected

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10
Q

Paget’s appearance on x-ray

A

bone enlargement + deformity - patchy
osteoporosis crcumscripta = well defined osteolytic lesions that appear less dense

cotton wool appearance of skull - patchy sclerosis + lysis
V-shaped defects in long bones

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11
Q

biochemistry in paget’s

A

raised alkaline phophatase - other LFTs normal

normal calcium
normal phosphate

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12
Q

Pagets investigations

A

X-ray - patchy, less dense bones

biochemistry - raised alkaline phosphatase

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13
Q

management of Paget’s

A

bisphosphonates

NSAIDs for pain
calcium + vit D - esp when on bisphosphonates

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14
Q

Paget’s complications

A

osteogenic sarcoma (osteosarcoma)

spinal stenosis + spinal cord compression

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15
Q

osteogenic sarcoma (osteosarcoma)

A

key complication of Paget’s

poor prognosis
increased focal pain, bone swelling, pathological fractures

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16
Q

what type of receptor is the calcium sensing receptor in the parathyroids?

A

G-protein couple receptor

plays an essential role in regulation of extracellular calcium homeostasis

17
Q

osteoclasts

A

multinucleated cells responsible for bone resorption

derived from haematopoietic progenitors

18
Q

osteoblasts

A

mononuclear cells derived from mesenchymal cells in the bone marrow stroma

–> responsible for bone formation

19
Q

osteocytes

A

primary cell of mature bone + most common bone cell type

derived from osteoblasts
thought to sense mechanical strain on skeleton

20
Q

common osteoporotic fracture sites

A

neck of femur
vetebral body
distal radius
humeral neck

21
Q

osteoporosis investigations

A

DEXA scan

normal serum calcium + phosphate

22
Q

indications for DEXA scan

A

> 50 yrs
< 50yrs with risk factors

FRAX / Qfracture >10%risk of fracture over 10yrs

23
Q

osteoporosis treatment

A

lifestyle - diet, sun exposure

calcium + vit D supplements

24
Q

what type of cells produce parathyroid hormone?

A

chief cells

produces parathyroid hormone in response to hypocalcaemia

25
Q

how does parathyroid act to raise blood calcium?

A

increases osteoclast activity (reabsorbing calcium from bones0

increasing calcium absorption from the gut

increasing calcium absorption from kidneys

increasing vit D activity (increases calcium absorption from intestine)

26
Q

symptoms of hyperparathyroidism

A

(hypercalcaemia)

renal stones
painful bones
abdominal groans - constipation, N+V
psychiatric moans - fatigue, depression, psychosis

27
Q

primary hyperparathyroidism

A

uncontrolled parathyroid hormone produced directly by tumour of the parathyroid glands - leads to hypercalcaemia

treatment = surgically removing tumour

28
Q

secondary hyperparathyroidism

A

where insufficient vit D or chronic renal failure leafs to low absorption of calcium from intestines, kidneys and bones

–> causes hypOcalcaemia

treatment = correcting vit D deficiency / renal transplant

29
Q

tertiary hyperparathyroidism

A

when secondary continues for a long period of time causing hyperplasia of the glands

–> causes hypercalcaemia

treatment = surgically removing part of parathyroid tissue to return parathyroid hormone to appropriate level

endocrine (15 decks)

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