Calcium part 2

Question 1

Biochemistry in osteoporosis?

Answer 1

NORMAL

Question 2

What bones are measured on a dexa scan?

Answer 2

Hip, spine and wrist

Question 3

How is osteoporosis diagnosed?

Answer 3

DEXA scan

Question 4

What is a T score?

Answer 4

Normal healthy young person

Question 5

What is a Z score?

Answer 5

Compared to age-matched person

Question 6

How is osteopenia defined?

Answer 6

T score of -1 to -2.5

Question 7

What drugs can cause osteoporosis?

Answer 7

Prednisolone

Question 8

What can cause rapid bone loss?

Answer 8

Sedentary, alcohol use, smoking, low BMI/poor nutrition, hyperprolactinaemia, thyrotoxicosis, Cushing’s disease, steroids, prolonged intercurrent illness

Question 9

Treatment to prevent osteoporosis?

Answer 9

Vitamin D, bisphosphonate

Question 10

What is the problem with oral bisphosphonates?

Answer 10

Irritate the stomach, must be taken on an empty stomach with plenty of water. If taken alongside calcium, will just be excreted out.

Question 11

How often is zelendronate given?

Answer 11

Yearly

Question 12

What is teriparatide?

Answer 12

PTH analogue/derivative

Question 13

SERMS - example raloxifen - how does it affect bone?

Answer 13

Improves bone density, agonist on bone
Similar to tamoxifen

Question 14

Normal calcium level?

Answer 14

2.2-2.6

Question 15

Osteomalacia?

Answer 15

Same amount of bone but bone is not calcified (content is wrong)

Question 16

Osteomalacia is caused by what?

Answer 16

Lack of vitamin D

Question 17

Osteoporosis is caused by what?

Answer 17

Increasing age and sedentary lifestyle

Question 18

Symptoms of high calcium?

Answer 18

Polydipsia/polyuria
Constipation
Neuro symptoms

Question 19

In high calcium, what should the PTH be?

Answer 19

Suppressed

Question 20

What is high calcium with suppressed PTH indicative of?

Answer 20

Malignancy

Question 21

Most common cause of hypercalcaemia in hospital?

Answer 21

Metastatic cancer invading bone

Question 22

What else could cause high calcium with suppressed PTH?

Answer 22

Sarcoidosis, vitamin D excess, thyrotoxicosis, milk alkali syndrome

Question 23

High calcium with normal PTH?

Answer 23

Primary hyperparathyroidism

Question 24

Commonest cause of hypercalcaemia in the community?

Answer 24

Primary hyperaparathyroidism

Question 25

Parathryroid hyperplasia is associated with what?

Answer 25

MEN 1, 2A?

Question 26

Which bone is affected first in primary hyperparathyroidism?

Answer 26

Wrist

Question 27

Primary hyperparathyroidism signs?

Answer 27

Bones, stones, moans and groans PTH bone disease, renal calculi, constipation, pancreatitis, confusion

Question 28

Parathryroid adenoma is normally singular or multiple?

Answer 28

Singular

Question 29

What is familial benign hypercalcaemia?

Answer 29

High PTH and calcium Body can't see this Leave them alone! Caused by a gene mutation

Question 30

How does malignancy cause hypercalcaemia?

Answer 30

1. Humoural hypercalcaemia of malignancy (PTHrp) 2. Bone metastasis (Local bone osteolysis) 3.Haematological malignancy (cytokines)

Question 31

What is PTHrp?

Answer 31

Shouldn't be expressed in adults. Can be expressed by cancer cells.

Question 32

What cancers can secrete PTHrp?

Answer 32

Small cell lung cancer

Question 33

How does sarcoidosis cause hypercalcaemia?

Answer 33

Non-renal production of 1 alpha hydroxylase

Question 34

How does thryotoxicosis cause hypercalcaemia?

Answer 34

Causes bone resorption

Question 35

How does hypoadrenalism cause hypercalcaemia?

Answer 35

Affects renal calcium transport

Question 36

Which drugs can cause hypercalcaemia?

Answer 36

Thiazide diurectics (wee out less calcium)

Question 37

How is hypercalcaemia treated?

Answer 37

0.9% saline !!!! (4L daily if they don't have heart failure)

Question 38

How to treat hypercalcaemia known to be caused by malignancy?

Answer 38

Bisphosphonates

Question 39

When shouldn't you give bisphosphonates?

Answer 39

If high calcium is caused by hyperparathyroidism

Question 40

Signs of low calcium?

Answer 40

Tetany Chvtoken's sign - tap the facial nerve Trousseau's sign - Carpal spasm when BP cuff is put on Can also cause hyperreflexia, convulsions and stridor

Question 41

Treatment for hypocalcaemia?

Answer 41

IV calcium

Question 42

How to check if low calcium is a true hypocalcaemia?

Answer 42

check albumin and get adjusted calcium level Then - what's the PTH?

Question 43

Causes of hypocalcaemia?

Answer 43

Chronic kidney disease, post-parathyroidectomy, vitamin D deficiency, PTH resistance, DiGeorge syndrome, hypoparathyroidism

Question 44

Thyroid operation can cause what?

Answer 44

Can cut out parathryoid, need to take calcitrol for life

Question 45

What is paget's disease

Answer 45

Thought to be a virus that causes increased bone turnover Elevated ALP on biochemistry

Question 46

Treatment's for paget's disease?

Answer 46

Bisphosphonates for pain

Question 47

Signs of Paget's disease?

Answer 47

Focal pain, warmth, deformity, fracture, SC compression, malignancy, cardiac failure

Question 48

What is renal osteodystrophy?

Answer 48

Secondary hyperaparathyroidism + retention of aluminium from dialysis fluid