Bones

Question 1

Hormones and locations?

Answer 1

PTH in parathyroid hormones and calcitonin in parafollicular cells. Calciitriol in skin + UV light.

Vit D by 25-hydroxylase in liver and 1alpha-hydroxlase in kidneys to activated form

Question 2

Causes and features of primary HyperPTH?

Answer 2

Parathyroid adenoma or hyperplasia

Increased calcium and decreased phosphate

Question 3

Secondary hyperPTH causes and features?

Answer 3

Called osteomalacia.

Vitamin D deficiency
CKD
Liver disease

Decreased calcium and phosphate (if Vit d deficient). Increased phosphate (if CKD)

Question 4

Tertiary hyperPTH causes and features?

Answer 4

CKD (causes autonomous PTH secretion)

Increased calcium and increased phosphate

Question 5

Causes of high caclium?

Answer 5

High PTH: primary and tertiary hyperPTH

Low PTH:
1) Malignancy (bone mets, Haem e.g multiple myeoma, paraneoplastic e.g. lung SqCC

2) Sarcoidosis
3) Thiazide diuretics

Pancreatitis

Question 6

Causes of low Calcium?

Answer 6

Secondary hyperPTH

Surgical complication
Auto-immune hypoparathyoridism

Question 7

Signs for low calcium?

Answer 7

Trousseas and Chvosteks

Question 8

Primary hyperPTH RFs and signs/symptoms?

Answer 8

MEN-1/2, hypertension

Often asymptomatic
hypercalcaemia features

Question 9

Hypercalcaemia features?

Answer 9

Stones, bones, thronoes, abdo moans and psych groans

Question 10

Men-1 conditions?

Answer 10

Pituitary tumours + pancreatic tumours + PTH gland hyperplasia

Question 11

Men2 conditions?

Answer 11

Phaeochromocytomas + medullary thyroid cancer + PTH gland hyperplasia

Question 12

Seconcary HyperPTH signs and symptoms?

Answer 12

fractures/bone pain, proximal myopathy, fatigue, hypocalcaemia
CATs go numb.

Rickets : Bowed Legs
Knock knees

Question 13

Proximal myopathy endocrine causes?

Answer 13

COT
Cushings
Osteomalacia
throtoxicosis

Question 14

Causes of Secondary HyperPTH?

Answer 14

Vitamin D deficiency (poor diet, sunlight and malabsorption)
CKD
Liver Disease

Question 15

ALP differences?

Answer 15

Same in primary hyperPTH and raised in secondary/osteomalacia

Question 16

Primary HyperPTH Xray features?

Answer 16

Subperiosteal bone resorption (radial)
Acro-osetolysis
pepper pot skull

Question 17

Secondary hyperPTH xray features?

Answer 17

Rachitic Rosary (nodularity at costochondral junctions)
Loosers pseudofractures

Question 18

Primary HyperPTH management?

Answer 18

Acute hypercalcaemia : IV fluids and bisphosphonates
Surgical: 1st line = total parathyroidectomy

If surgery unsuitable = cinacalcet (calcimimetic)

Question 19

Risk of parathyroidectomy?

Answer 19

Damage to recurrent laryngeal nerve and speaking

Question 20

osteomalacia management?

Answer 20

Acute hypocalcaemia: IV calcium infusion (calcium glucoronate )

medical = calcium and vit D (ergocalciferol Inactive)

If due to CKD: calcium, alfacalidol (active) and treat CKD

Question 21

What else is calcium gluconate used to treat>

Answer 21

Hyperkalaemia

Question 22

What is Pagets disease and phases?

Answer 22

Disorder of bone remodelling

1) Lytic phase (hyperactive osteoclasts)
2) mixed phase (compensation from osteoblasts)
3) Sclerotic phase (hyperactive osteoblasts = woven bone, not lamellar)

Question 23

RFs for Pagets?

Answer 23

Elderly and RHx

Question 24

Symptoms and signs of Pagets?

Answer 24

Symptoms: often asymptomatic, fragility fractures, bone pain (skull, pelvis, femur), nerve compression (hearing loss and sciatica)

Signs = bone enlargment and bossing, warm skin over the painful area (metabolic)

Question 25

Investigations for Pagets?

Answer 25

Normal calcium, phosphate, PTH. High ALP ``` Look at serum CTX (resorption) and Serum P1NP (formation markers) Bone Scan (tec99) ```

Question 26

Causes of osetoporosis?

Answer 26

Primary = post-menopausal and elderly Secondary - Drugs ( steroids, thyroxine, alcohol), Endo (cushings, HyperPTH, Hyperthyroid), GI = coeliac and IBD

Question 27

Signs and symptoms of osteoporosis?

Answer 27

Often asymptomatic Fragility fractures Back pain

Question 28

Common osteoporotic fractres?

Answer 28

HIP - NOF Wrist - Colles fracures Lumbar - wedge fractures Shoulder - NOH

Question 29

Osteoporosis Bloods and Imaging?

Answer 29

Calcium, phosphate, PTH and ALP all normal USe DEXA T score < -2.5

Question 30

Signs of hypocalcaemia?

Answer 30

``` CATs go numb Convulsions Arrhythmias Tetany Parasthesia in hands,feet, mouth ```