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Geriatrics > Bones > Flashcards

Bones Flashcards

1
Q

What happens to bone mass and bone mineralisation in osteoporosis?

A

Bone mass decreases

Bone mineralisation stays the same

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2
Q

What is osteoporosis characterised by?

A

Low trauma fragility fractures

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3
Q

Family history is important for what kind of fracture?

A

Hip fracture

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4
Q

Risk factors for osteoporosis?

A 
Woman
Menopause
Early menopause
Low calcium diet especially teenage years
Lack of mobility 
FH of hip fracture
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5
Q

2 causes of primary osteoporosis?

A

Post-menopausal lack of oestrogen

Lack of mobility

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6
Q

Pneumonic RACISM for secondary causes of osteoporosis?

A 
Rheumatoid arthritis
Alcohol
Corticosteroids
Immobility
Smoking
Multiple myeloma
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7
Q

% of fractures in women over the age of 45 that are caused by osteoporosis?

A

70%

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8
Q

4 most common sites for fractures?

A

Proximal humerus
Proximal femur
Colle’s fracture
Vertebral fracture

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9
Q

What types of things can result from multiple vertebral fractures?

A 
Chronic back pain
Reflux oesphagitis
Kyphosis
Loss of height
Abdominal distension
Neck pain
Depression
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10
Q

What is the 1 year mortality after a hip fracture?

A

25%

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11
Q

In osteoporosis how will a bone profile be affected?

A

Calcium normal
Phosphate normal
ALP normal

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12
Q

How are vertebral fractures identified on xray

A

with more than a 20% loss in vertebral height

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13
Q

What percentage loss in height of the vertebrae is classified as a crush fracture?

A

50%

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14
Q

Very advanced vertebral fractures are known as what?

A

Vertebra plana

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15
Q

What scan do you perform to assess osteoporosis?

A

DEXA scan

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16
Q

What is a T score on a DEXA scan and what does it symbolise?

A

T score is a measure of the bone mineral density as standard deviations relative to the peak bone mass

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17
Q

What is the T score of normal bone density?

A

1

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18
Q

What is the t score of osteopenia?

A

-1 to -1.5

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19
Q

What is the T score of osteoporosis?

A

-2.5 or more

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20
Q

What is the difference between osteoporosis and established osteoporosis?

A

They will both have a T score below -2.5 but the established osteoporosis will also have fractures

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21
Q

How can you prevent osteoporosis?

A

1g of Calcium per day in diet

Weight baring exercises in adolescence

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22
Q

3 supplements given to elderly patients with a fracture?

A

1g Calcium
800 IU of Vitamin D3
Oral bisphosphonates

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23
Q

What do you have to tell a patient about taking bisphosphonates and the side effect?

A

Need to be taken fasting

Side effect of reflux oesophagitis if not taking standing with a glass of water

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24
Q

Name 2 commonly used bisphosphonates

A

Alendronic acid

Risedronate

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25
Q

What is the only drug that actually increases the bone mass density?

A

Teriparatide

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26
Q

How is Teriparatide administerd?

A

daily SC injection for 18 months

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27
Q

What is osteomalacia?

A

Failure of the matrix to calcify leading to low bone mineralisation

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28
Q

What causes osteomalacia?

A

Vitamin D deficiency

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29
Q

Compare bone mineralisation and bone density in both osteoporosis and osteomalacia?

A

Bone mineralisation is normal in osteoporosis but abnormal in osteomalacia
Bone density is normal in osteomalacia but abnormal in osteoporosis

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30
Q

What is the active form of Vitamin D

A

1,25 - dihydroxycholecalciferol

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31
Q

What is the childhood form of osteomalacia?

A

Rickets

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32
Q

What causes Vitamin D deficiency in elderly?

A 
Lack of sunlight
Immobility 
Isolation
Dietary deficiency due to gastrectomy 
Chronic renal failure
Drugs - barbituates
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33
Q

Classical symptoms of osteomalacia?

A

Bone pain

Weakness of proximal muscles - waddling gait

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34
Q

What 4 investigations would you perform in suspected osteomalacia?

A 
Bone profile
U&E
X-rays
Bone biopsy
LFT - albumin
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35
Q

What would a bone profile and urinalysis find in osteomalacia?

A 
Calcium slightly low
Phosphate is slightly low
ALP slightly raised
Urinary calcium is low
CKD sees raised phosphate on urinalysis
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36
Q

3 things you would find on an xray of osteomalacia?

A

Looser zones
Transverse lucencies
Pseudofractures at point of stress
(diagnostic when present)

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37
Q

Diagnostic investigation into osteomalacia?

A

Bone biopsy

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38
Q

What do you treat osteomalacia with?

A

Vitamin D

Calcium supplements

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39
Q

What calcium supplement do you treat osteomalacia with?

A

Ergocalciferol

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40
Q

If there is poor compliance to ergocalciferol what is used instead?

A

IM calciferol 600k IU

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41
Q

How many units of vitamin D is in ergocalciferol?

A

10000-20000 IU

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42
Q

Prophylaxis of osteomalacia what 2 things are given?

A

Vit D3 800 IU OD

Calcium 1g

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43
Q

What is Paget’s Disease? 7 bones most likely effected in Pagets?

A 
localised and patchy with new born being soft and spongy, prone to deformity and fractures
Pelvis
Lumbar spine
Humerus
Femur
Tibia
Clavicle 
Skull
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44
Q

4 key features seen in the bone of someone with Paget’s disease?

A

Increase in multinucleated osteoclasts
Increase in osteoblasts
Increased fibrosis
Bone matrix becomes disorganised

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45
Q

What 2 investigations would you do for someone with suspected Paget’s disease? What abnormalities would you see on both?

A

Bone profile - normal phosphate and calcium but abnormally high ALP
X-ray - Cortical thickening and thickened trabecular pattern

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46
Q

Pagets disease is the only disease that does what to the bone?

A

Causes bony expansion

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47
Q

What is used as treatment for Pagets disease?

A

bisphosphonates - Oral risedronate 30mg OD for 2 months or IV zoledronic acid 5mg one dose

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48
Q

What are the main 2 ways in which effectiveness of Pagets disease treatment is assessed?

A

Level of ALP

Level of bone pain

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49
Q

What scan is performed to assess Paget’s disease?

A

bone scintigraphy
Assesses level of technetium uptake
Technetium isotope bone scintigraphy

50
Q

6 most common sites for a pathological fracture to occur?

A 
Thoracic vertebrae
Lumbar vertebrae
Skull
Femur
Ribs
Pelvis
51
Q

7 big cancers that are known to spread to the bone?

A

3 pairs - lungs, breast, kidney
2 midline glands - thyroid, prostate
2 Ms - myeloma, melanoma

52
Q

What 4 investigations can be done for a pathological fracture?

A

X-ray
Bone profile
MRI
Techetium isotope scintography

53
Q

What is raised in a bone profile of a pathological fracture?

A

Calcium and ALP

54
Q

How are metastases seen on an x-ray?

A

Sclerotic, lytic mixed lesions

55
Q

3 treatments of bone metastases?

A

Bisphosphonates
Radiotherapy
Orthopaedic surgery

56
Q

What is polymyalgia rheumatica and what are 4 locations where it usually occurs?

A

Pain or stiffness caused by blood vessel inflammation that usually occurs in the shoulders, neck, upper arms and hips

57
Q

3 main features of temporal arteritis? what is the concern if it is left untreated?

A

Headache
temple tenderness
jaw claudication

58
Q

4 risk factors for polymyalgia rheumatica?

A

Viral or bacterial infection
Genetics
over 65
female twice as likely

59
Q

Presenting complaints in polymyalgia rheumatica?

A

vague symptoms of weight loss, pain, mild fever

Stiffness in neck, arms and shoulders

60
Q

What 3 things will blood tests show in polymyalgia rheumatica?

A

Abnormal LFTs
Mild anaemia
Raised ESR and CRP

61
Q

What is the full steroid treatment course in polymyalgia rheumatica?

A

40mg Prednisolone for 1 week then a reducing dose over 12-18 months

62
Q

What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in osteoporosis?

A

Dont change

63
Q

What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Osteomalacia?

A 
Calcium decreases
Phosphate decreases
ALP increases
Urea stays the same
Urine Ca decreases
64
Q

What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Renal bone disease?

A 
Calcium decreases 
Phosphate increases
ALP increases
Urea increass
Urine Ca decreases
65
Q

What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Paget’s Disease?

A 
Calcium is the same
Phosphate is the same
ALP increases loads
Urea is the same
Urine Ca increases
66
Q

What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Hyperparathyroidism?

A 
Calcium increases
Phosphate decreases
ALP increases
Urea is normal
Urine Ca increases
67
Q

What is osteoarthritis?

A

Disintegration of articular cartilage usually accompanied by osteophyte formation

68
Q

What are some predisposing factors to the development of osteoarthritis?

A 
Previous damage
Avascular necrosis of the joint
Disease of the joint - rheumatoid, gout
Hypermobility
Endocrine diseases - acromegaly, diabetes, hyperparathyroidism
Obesity
Occupation
Hereditory
69
Q

Which joints are most effected in osteoarthritis?

A

Knees
Hips
Sometimes elbows and shoulders
Women = DIP joints

70
Q

How is the pain characterised in osteoarthritis?

A

Worse late in evenings after use
Morning stiffness less than an hour
Can impair mobility

71
Q

What can be felt on examination of joints with osteoarthritis?

A

Crepitus

Bony swelling - herbedens (DIJ) and bouchards (PIJ)

72
Q

4 signs of osteoarthritis on xray?

A

Sclerotic changes
Subchondral cysts
Loss of joint space
Osteophytes

73
Q

What can be put into joints of osteoarthritis to reduce pain?

A

Intra-articular injection of steroids such as methylprednisolone

74
Q

Surgical treatment of osteoarthritis?

A

Arthroplasty

75
Q

What form of Rheumatoid arthritis is most likely to lead to old, frail individuals with fragile skin and peripheral neuropathy/vasculitis?

A

Seropositive RA

76
Q

What medication can be used in RA if there is evidence of active disease?

A

DMARDs

77
Q

What is the predominant pathophysiology thought to be developing in RA?

A

Autoimmune response that effects the synovial membranes and causes joint destruction

78
Q

Is inflammation present in OA/RA?

A

Only in RA really

79
Q

What generalised symptoms may be present in RA that arent present in OA?

A

Feelings of fatigue, weakness, anaemia

80
Q

What can be found in the blood that is specific to rheumatoid arthritis?

A

Rheumatoid factor

81
Q

What is the antibody present in the blood of those with RA?

A

Anti-CCP

82
Q

4 blood tests in RA?

A

CRP
ESR
Anti-CCP
Rheumatoid factor

83
Q

How does drug metabolism change over time?

A

decreases as liver enzymes become less active

84
Q

How does drug excretion change as we age?

A

Glomerular filtration and renal plasma flow decrease

85
Q

What is the difference between a stroke and a TIA?

A

They are both disturbances of cerebral function due to a presumed vascular origin but TIA lasts less than 24 hours and stroke last longer

86
Q

Risk factors for atherosclerosis?

A 
High blood pressure
Smoking
Diabetes
elevated blood lipids
OCP
Obesity
87
Q

3 reasons why a CT scan used in stroke?

A

Confirm the diagnosis
Identify if there is any haemorrhage
Determine underlying pathology

88
Q

Benefits of an early CT scan vs a late CT scan on type of stroke identifiable?

A

Early - haemorrhagic

2-4 days - ischaemic

89
Q

Symptoms of a haemorrhagic stroke vs an ischaemic?

A

Haemorrhagic usually accompanied by headache and more sudden onset
Haemorrhagic nearly always a hypertensive patient whereas ischaemic isnt
Usually vomiting with haemorrhagic not often with ischaemic
Consciousness usually lost with haemorrhagic but not with ischaemic

90
Q

If a stroke presents with an isolated motor impairment, where is it likely to have occured?

A

In the internal capsule

91
Q

Which side of the brain is the speech centre in?

A

Usually the opposite to your dominant hand except half of left handed people where it is still on the left side

92
Q

Difference between aphasia and dysphasia?

A

Aphasia is when speech is absent and dysphasia is when speech is impaired

93
Q

2 types of dysphasia?

A

Expressive and receptive

94
Q

How should you talk to someone with receptive dysphasia?

A

Speak slower in smaller sentences

Stand in front of the patient so they can see facial movements

95
Q

what is the difference between dysarthria and dysphasia?

A

Dysarthria is a disorder of the muscles of articulation

96
Q

What is dysphonia?

A

disease of the vocal cords, larynx or respiratory system

97
Q

What is neglect?

A

When the patient becomes inattentive to the affected side

98
Q

What area of the brain is usually effected which causes the patient to present with neglect?

A

Non-dominant parietal lobe

99
Q

How can you see neglect present in body language? following an object? 2 tests?

A

Shift body away from stimulus, posture of head, eyes and body turned away
Difficulty following an object past the effected side
Alberts test or star cancellation test

100
Q

3 motor disorders that can develop in stroke?

A

Hemiplegia
Spasticity
Apraxia

101
Q

What is the usual presentation of spasticity in the upper and lower limbs following a stroke?

A

Flexion in the upper limbs and extension in the lower limbs

102
Q

Name 2 thrombolytic drugs that can be used in the treatment of acute ischaemic stroke? time limit

A

Alteplase
Streptokinase
4.5 hours

103
Q

3 phases of stroke care?

A

Acute phase - 1-2 weeks
rehabilitation phase - 2-12 weeks
Up to 2 years - to regain full function

104
Q

How long after someone has had a stroke do you then assess the severity and make a management plan?

A

2 weeks

105
Q

What aspects of the patient need to be examined post stroke?

A 
General medical and exercise tolerance
Speech impairment
Sensory impairment - sight, hearing, sensation
Muscle tone - spasticity, tone
Mental capacity 
Motivation
Swallowing
106
Q

What is the most common cause of death in stroke survivors?

A

IHD

107
Q

3 factors that are associated with poor prognosis of survival in stroke that indicate extensive damage to cerebral hemisphere or brain stem invovlement?

A

Impaired consiousness
Paralysis of conjugate deviation of the eye
Dense paralysis

108
Q

How does alteplase effect rates of mortality and morbidity in relation to ischaemic stroke?

A

decreases rate of morbidity but has little effect on mortality

109
Q

How do you manage and assess dysphagia in the early days post stroke?

A

Assess by SLT before feeding
Food through NG tube/PEG
Gag reflex does not indicate in tact swallow

110
Q

If a patient does not appear to improve 48 hours after stroke symptoms, what do you need think about as alternative diagnosis?

A 
Acute infection - respiratory, urinary tract
Subdural haematoma
Subarachnoid haemorrhage
Metabolic disorders - DKA
Cardiac impairment
Renal or hepatic failure
Hypothermia
Drugs
111
Q

3 aspects of the stroke rehabilitation?

A

Physical rehabilitation
Mental rehabilitation
Social rehabilitation

112
Q

What dose of aspirin in used in acute phase of stroke and in long term prophylactic prevention post stroke?

A

Acute phase = 150mg

Long term = 75mg OD

113
Q

Before prescribing aspirin what needs to be excluded?

A

Cerebral haemorrhage

114
Q

5 situations where long term anticoagulant therapy beneficial?

A 
AF
Completed ischaemic stroke
TIA
Valvular heart disease
Prosthetic heart valves
115
Q

List some complications of stroke?

A 
Depression
Epilepsy
Venous thrombosis
Painful stiff shoulder
Persistent pain
Fracture of long bones
Peripheral nerve palsies
Oedema of affected limb
Bullae
Contractures
Foot drop
116
Q

How does painful stiff shoulder develop after a stroke and what is its management?

A

Due to poor positioning and hemiplegia
Results in painful capsulitis
Treat with analgesia, heat packs and passive movements

117
Q

Main prevention and treatment of stroke related physical complications?

A

Individually designed orthoses
Foot rest when seated
Surgery

118
Q

What is the ABCD2 criteria for having another stroke at 7 days and 90 days?

A 
Age - over 65
Blood pressure - over 140/90
Clinical features - unilateral weakness
D - diabetic 
D - Duration over 60 mins or less than 60 mins
119
Q

What are the points allocated for each criteria in the ABCD2 criteria?

A 
Age over 65 is 1 point
Blood pressure is 1 point
Unilateral weakness is 2 points
dibetic is 1 points
duration over 60 mins is 2 points and under 60 mins is 1 point
120
Q

If someone scores 6 or 7 on the ABCD2 criteria what is the chance of them suffering another stroke in 7 days and 90 days?

A

12%

18%

121
Q

If someone scores 0-3 on the ABCD2 criteria what is the chance of them suffering another stroke in 7 days or 90 days?

A

1%

3%

Geriatrics (10 decks)

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