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Endo finals > Bone > Flashcards

Bone Flashcards

1
Q

Describe the parathyroid axis

A

Parathyroid glands produce PTH in response to a fall in calcium
PTH -> bones to release Ca by resorption and kidneys to increase Ca uptake, phos excretion + 1a hydroxylase activity
1a hydroxylase ^ Ca uptake in small bowel
Overall leads to increase in serum Ca

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2
Q

Describe the types of hyperparathyroidism and the biochemical changes assoc with each

A

Primary: parathyroid gland adenoma, hyperplasia, Ca
^ PTH, ^/- Ca, low P, - Vit D

Secondary: renal osteodystrophy (CKD)
^ PTH, low Ca, ^ P, low Vit D

Tertiary: chronic renal disease treated but autonomous activity
^ PTH, -/^ Ca, low P

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3
Q

Describe the presentation of hypercalcaemia

A

Renal stones, polyuria, polydipsia
Abdo pain, constipation
Psych: depression, psychosis

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4
Q

Describe the management of primary hyperparathyroidism (non-emergency)

A

Conservative:

  • Fluids
  • Avoid thiazides

Surgical:
-Parathyroidectomy

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5
Q

Describe the management of severe hypercalcaemia

A
  • Admission
  • Stop aggravating meds: thiazides, Ca, lithium
  • IV access
  • Aggressive rehydration: 1L 0.9% saline over 4 hours (may need 3-6 L/ 24 hours)
  • IV furosemide aids hydration
  • IV bisphosphonates
  • Calcitonin
  • > renal replacement therapy
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6
Q

What are the thresholds for hypercalcaemia? When should you treat?

A

Mild: 2.6-3.0
Mod: 3.0-3.4
Severe: >3.4

Treat if:

  • Symptomatic
  • Mod/severe
  • Admit as emergency if severe
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7
Q

Describe the causes of hypercalcaemia

A

Low PTH:

  • Cancer: any, mets, MM, squamous cell lung cancer
  • Sarcoidosis

High PTH:
-Primary or tertiary hyperparathyroidism

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8
Q

Describe the risk factors for osteoporosis

A
  • Advancing age
  • Low oestrogen states: postmenopausal F, FHA
  • High glucocorticoid states: exogenous, Cushing’s
  • Hyperthyroidism
  • RA
  • Family history
  • Low BMI
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9
Q

Describe the presentation of osteoporosis

A
  • Commonly detected after fracture eg. NOF, Colle’s, vertebral crush fracture
  • Bone pain
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10
Q

Describe the investigations for suspected osteoporosis

A
  • Bloods: bone profile (Ca, Vit D, ALP, phos, etc)
  • Xray (if fracture)
  • > DEXA scan
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11
Q

Describe the indications for DEXA scan

A
  • High risk
  • Low trauma # (abnormal)
  • Before long term steroids
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12
Q

Describe the interpretation of DEXA scan

A

Xray of lumbar spine + pelvis
Gives Z score and T score
T score: against young controls. Z: age-matched

Normal: T >-1
Osteopenia: T -2.5 to -1
Osteoporosis: T

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13
Q

Describe the treatments for osteoporosis

A

Based on FRAX score (10 year # risk)
Conservative:
-Calcium + vitamin D supplementation
-Exercise

Medical:

  • Bisphosphonates (alendronic acid, zolendronate)
  • Denosumab
  • Teriparatide
  • Raloxifene
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14
Q

Describe the side effects of bisphosphonates and instructions for administration

A

SEs: GI upset, ulceration, osteonecrosis of the jaw
Instructions:
-Take in the morning on an empty stomach
-Upright with glass of water, stay up for 30 mins

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15
Q

Describe the standard dosing regimen for bisphosphonates

A

Alendronic acid:

70 mg, PO, once weekly

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16
Q

Define osteomalacia

A

Abnormal mineralisation of bone due to lack of vitamin D and calcium

17
Q

Describe the signs and symptoms of osteomalacia

A
  • Bone pain
  • Abnormal fractures
  • Proximal myopathy
18
Q

Describe the causes of osteomalacia

A

Vitamin D deficiency:

  • Chronic renal and liver disease
  • Lack of sunlight- dark skin, indoors
  • Poor diet
  • Malabsorption: GI conditions
19
Q

Describe the classic investigation findings in osteomalacia

A
  • Bloods: low Ca, low Vit D, H/N PTH etc

- Xray: Looser’s zones (pseudofracture)

20
Q

Describe the management of osteomalacia

A

Depends on cause eg. CKD
Conservative:
-Calcium and vitamin D supplements (+/- activated)

21
Q

Describe the presentation of Paget’s disease

A
  • Bone pain + tenderness
  • Swelling and warmth
  • Fractures
  • Skull enlargement

Long-term:

  • Hearing loss
  • Radiculopathy
22
Q

What is the most important investigation in Paget’s disease?

A

Bone scan

23
Q

Describe the classic investigation findings in Paget’s disease

A
  • Bloods: very high ALP, normal biochem
  • Bone scan: hot spots
  • Xray: sclerosis, lytic lesions eg salt and pepper skull
24
Q

Describe the presentation of hypocalcaemia

A 
Convulsions
Arrhythmia
Tetany 
Stridor + spasms: carpopedal spasm, Chvostek's sign
Numbness
25
Q

Describe the causes of hypocalcaemia

A

CKD
Low Mg
Osteomalacia

Endo finals (6 decks)

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