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MedEd > Bones > Flashcards

Bones Flashcards

1
Q

Hormones and locations?

A

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

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2
Q

Causes and features of primary HyperPTH?

A

Parathyroid adenoma or hyperplasia

Increased calcium and decreased phosphate

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3
Q

Secondary hyperPTH causes and features?

A

Called osteomalacia.

Vitamin D deficiency
CKD
Liver disease

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

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4
Q

Tertiary hyperPTH causes and features?

A

CKD (causes autonomous PTH secretion)

Increased calcium and increased phosphate

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5
Q

Causes of high caclium?

A

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

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6
Q

Causes of low Calcium?

A

Secondary hyperPTH

Surgical complication
Auto-immune hypoparathyoridism

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7
Q

Signs for low calcium?

A

Trousseas and Chvosteks

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8
Q

Primary hyperPTH RFs and signs/symptoms?

A

MEN-1/2, hypertension

Often asymptomatic
hypercalcaemia features

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9
Q

Hypercalcaemia features?

A

Stones, bones, thronoes, abdo moans and psych groans

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10
Q

Men-1 conditions?

A

Pituitary tumours + pancreatic tumours + PTH gland hyperplasia

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11
Q

Men2 conditions?

A

Phaeochromocytomas + medullary thyroid cancer + PTH gland hyperplasia

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12
Q

Seconcary HyperPTH signs and symptoms?

A

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

Rickets : Bowed Legs
Knock knees

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13
Q

Proximal myopathy endocrine causes?

A

COT
Cushings
Osteomalacia
throtoxicosis

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14
Q

Causes of Secondary HyperPTH?

A

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

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15
Q

ALP differences?

A

Same in primary hyperPTH and raised in secondary/osteomalacia

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16
Q

Primary HyperPTH Xray features?

A

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

17
Q

Secondary hyperPTH xray features?

A 
Rachitic Rosary (nodularity at costochondral junctions)
Loosers pseudofractures
18
Q

Primary HyperPTH management?

A

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

If surgery unsuitable = cinacalcet (calcimimetic)

19
Q

Risk of parathyroidectomy?

A

Damage to recurrent laryngeal nerve and speaking

20
Q

osteomalacia management?

A

Acute hypocalcaemia: IV calcium infusion (calcium glucoronate )

medical = calcium and vit D (ergocalciferol Inactive)

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

21
Q

What else is calcium gluconate used to treat>

A

Hyperkalaemia

22
Q

What is Pagets disease and phases?

A

Disorder of bone remodelling

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

23
Q

RFs for Pagets?

A

Elderly and RHx

24
Q

Symptoms and signs of Pagets?

A

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)

25
Q

Investigations for Pagets?

A

Normal calcium, phosphate, PTH.

High ALP

Look at serum CTX (resorption) and Serum P1NP (formation markers)
Bone Scan (tec99)
26
Q

Causes of osetoporosis?

A

Primary = post-menopausal and elderly

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

27
Q

Signs and symptoms of osteoporosis?

A

Often asymptomatic
Fragility fractures
Back pain

28
Q

Common osteoporotic fractres?

A

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

29
Q

Osteoporosis Bloods and Imaging?

A

Calcium, phosphate, PTH and ALP all normal

USe DEXA T score < -2.5

30
Q

Signs of hypocalcaemia?

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

MedEd (32 decks)

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