Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

MB2: Endocrinology > Bone and calcium endocrinology > Flashcards

Bone and calcium endocrinology Flashcards

1
Q

describe bone microarchitecture in middle age

A

decreased trabecular thickness in non-load bearing horizontal trabeculae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

describe bone microarchitecture in older age

A

decreased number of connections between vertical trabecular and so decrease in strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

factors affecting bone mass

A 
age 
sex hormones 
diet 
exercise 
weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

factors affecting bone loss

A 
sex hormone deficiency 
age 
weight 
genetics 
diet 
immobility 
disease 
aromatase inhibitor/glucocorticoids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

describe bone mass over lifetime in men

A

increases up to age of 30, higher tha that of women then plateau and slow decline linerarly after 50

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe bone mass over lifetime in women

A

increases up to age of 30, less than that of men, sudden drop at menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

common osteoporotic fracture sites

A

distal radius
vertebral body
neck of humerus
neck of femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the fracture domino effect

A

one fracture leads to another and leading to progressive disability and lost independence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

modifiable risk factors ofr fragility fracture

A 
diet 
BMD 
alcohol
smoking 
weight 
pharmacological risk factors 
physical activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

non-modifiable factors for fragility fracture

A 
age 
ethnicity 
gender 
FHx
pre-existing fracture 
co-existant disease 
menopause <45
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

who to assess for fragility fractures?

A

<50 with strong risk factors like exogenous steroids or early menopause
>50 with risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

who to refer for risk of fragility fracture

A

anyone with 10 year risk assessment >10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

normal DEXA scan?

A

within 1SD of young adult ref range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

osteopaenia on DEXA?

A

1-2.5SD of normal ref range young adult

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

osteoporosis on DEXA?

A

> 2.5SD of normal young adult ref range

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

severe osteoporosis on DEXA?

A

> 2.5SD of normal young adult ref range and a fragility fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

causes of secondary osteoporosis

A

steroid use
IBD, malabsorption, coeliac diseas, chronic liver disease, chronic pancreatitis
cushings, hyperthyroidism, hyperparathyroidism
CKD
CF, COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

lifestyle management of osteoporosis

A 
high intensity strength training 
low impact weight bearing exercises 
avoid excess alcohol 
avoid smoking 
fall prevention 
calcium in supplement or diet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when should calcium and vitamin D supplements not be taken

A

within 2 hours of oral bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

name and mechanism of action of 2 bisphosphonates

A

alendronate, risedronate

uptake by osteoclasts leading to cell death to inhibit bone resorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

indication for bisphosphonates and cautions/side effects

A

osteonecrosis of the jaw, oesophageal malignancy, atypical fractures
T score >2.5SD or >1.5SD in steroid treatment >3m or pre existing fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

mechanism of action of denosumab and cautions

A

binds to RANKL and prevents activation of RANK receptor so inhibits osteoclastic activity
hypocalcaemia, eczema, cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

mechanism of action of teriparatide

A

recombinant PTH so stimulates bone growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

indication for teriparatide

A

recommended over bisphosphonate in postmenopausal women with 2 moderate/1 severe or low trauma vertebral fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
mechanism of action of romosozumab
binds to and inhibit sclerosin, substance formed be osteoclasts, to inhibit bone resorption
26
indication/contraindication for romosozumab
postmenopausal women with severe osteoporosis who are at imminent risk of fragility fracture contraindicated in previous cerebrovascular accident and MI
27
what is osteogenesis imperfecta associated with
dentinogenesis imperfecta | blue sclerae
28
management of osteogenesis imperfecta
fracture fixation, surgery for deformity and bisphosphonates
29
inheritance of osteogenesis imperfecta?
mostly autosomal dominant
30
what is pagets disease, where does it affect and who is it more common in
abnormal osteoclastic activity followed by abnormal osteoblastic activity long bones, skull, lumbar spine, pelvis usually people >40
31
presentation of pagets disease
deafness bone pain deformity compression neuropathy
32
diagnosis of pagets disease
raised alk phos x ray isotope bone scan
33
management of pagets disease
bisphosphonates and analgesia
34
complication of pagets disease
osteosarcoma
35
describe the basic uptake and metabolism of vitamin D
vitamin D from sun and diet undergoes reaction with 25-hydroxylase in liver and 1-OHase in kidney - PTH stimulated and increases calcium and phosphate absorption
36
how does PTH work on the body to increase serum calcium
stimulates 1-OHase to increase active vitD and increase Ca and PO4 causes calcium resorption from bone
37
what is the action of calcitonin
lowers osteoclast resorption and so lowers Ca and PO4
38
what is the calcium sensing receptor and where is it founds
found in PTH gland and stimulation acts as -ve feedback on parathyroid hormone secretion
39
acute symptoms of hypercalcaemia
``` Bones Stones Thrones Groans Psychiatric overtones ```
40
chronic features of hypercalcaemia
``` myopathy fracture oesteopenia depression hypertension pancreatitis DU renal calculi FHH ```
41
causes of hypercalcaemia
``` primary hyperparathyroidism malignancy vitamin D, thiazide diuretics sarcoidosis, TB thyrotoxicosis, pagets disease tertiary hyperparathyroidism ```
42
Low PTH with raised ALP is suggestive of
bone pathology | mets, sarcoid, thyrotoxicosis
43
Low PTH with low ALP is suggestive of
bone pathology vitamin D toxicity myeloma
44
high PTH with high urine calcium excretion is suggestive of
primary/tertiary hyperparathyroidism
45
high PTH with low urinary calcium excretion
FHH
46
investigation of metastatic hypercalcaemia
PTHrp calcium and alk phos XR, CT, MRI, PET isotope bone scan
47
initial management of hypercalcaemia
0.9% saline 4-6L in 24 hours consider loop diuretics single dose bisphosphonates steroids for sarcoid
48
definitive management of hyperparathyroidism
surgery | cinacalcet for tertiary hyperparathyroidism or parathyroid carcinoma
49
indication for parathyroidectomy
``` bone disease gastric ulcers renal stones osteoporosis serum Ca >2.85mmol/L under 50 eGFR<60mL/min ```
50
genetic causes of hyperparathyroidism
MEN1/2 - parathyroid adenoma with hypercalcaemia at a young age familial isolated hyperparathyroidism
51
what is FHH
familial hypercalcuric hypercalcaemia dysfunctional calcium sensing receptor so elevated PTH, elevated serum Ca but low urine Ca autosomal dominant and usually benign
52
diagnosis of FHH
mild hypercalcaemia reduced urine Ca excretion marginally elevated PTH genetic screen
53
features of hypocalcemia
``` paraesthesia in fingers, toes, perioral fatigue muscle weakness, cramps, tetany bronchospasm /laryngospasm fits chovsteks sign trousseau sign prolonged QT on ECG ```
54
acute management of hypocalcaemia
emergency IV calcium gluconate 10ml 10% over 10 mins infuse 10ml 10% in 100ml infusate at 50ml/h
55
chronic management of hypocalcaemia
calcium supplements | vitamin D
56
causes of hypocalcaemia
``` digeorge syndromew malignancy, radiotherapy, surgery autoimmune hypomagnesaemia idiopathic ```
57
describe why hypomagnesaemia causes hypocalcaemia
calcium release from cells is dependent on magnesium so in deficiency intracellular Ca is high
58
causes of hypomagnesaemia
``` PPI GI illness pancreatitis alcohol thiazide diuretics ```
59
what is pseudohypoparathyroidism and features
GNAS1 low calcium but high PTH due to resistance causes bone abnormality, obesity, s/c calcification, learning disability, bradydactyly of 4th metacarpal
60
causes of osteomalacia/rickets
gastric surgery, coeliac disease, liver disease, pancreatic failure chronic renal failure/disease lack of sunlight anticonvulsant drugs
61
clinical features of osteomalacia/rickets
``` low calcium prox myopathy dental defects bone tenderness rib/limb deformity ```
62
management of osteomalacia/rickets
vitamin D3 - loading dose over 12 weeks calcitriol combined Ca and vitamin D alfacalcidol

MB2: Endocrinology (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions