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Skel A > Hyper Parathyroidism - HPT > Flashcards

Hyper Parathyroidism - HPT Flashcards

1
Q

Hyper parathyroidism is a result of

A

increased blood level of parathyroid hormone

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2
Q

Explain Primary HPT

  • what causes it
  • Is it a major cause of hypercalcimia
A

Involves the gland itself
Stimulated to secrete more parathyroid hormone
Most commonly a benign adenoma, carcinoma, hyperplasia, ectopic tumors, hyper CA and hypophosphatemia

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3
Q

Explain Secondary HPT

A 
Abnormal stimulation of the glands by sustained HYPOCALCEMIA predominantly from renal disease 
- loss of Ca++ and decrease in Vit. D
- low normal hypocalcemia and hyperphosphatemia
Can be caused by:
-Chronic renal disease
- malabsorption
- serum calcium is low or low normal 
- Phosphorous is elevated
- associated with renal osteodystrophy
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4
Q

What occurs in renal osteodystrophy

A

Elected phosphorous can lead to soft tissue calficiation - which can even lead to bone osteosclerosis

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5
Q

Explain Tertiary HPT

A

Long standing secondary HPT with chronic renal failure or malabsorption
Parathyroid function may become autonomous - can relate to ectopic tissues
paraneoplastic syndrome
May have hypercalcemia
Only been around for 20 years

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6
Q

What is the function of parathyroid hormone

A

Increase in osteoclastic and osteocytic stimulation
- Ca++, phosphorus and osteoid are all broken down
Osteoblastic inhibition
Renal conversion of calcium an dinhbition of phosphate resorption
Renal stimulation of 1-alpha-hydroxylase, causing increased formation of 1, 25 Vit D
Indirect efect on GI absorption

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7
Q

Once Ca++ serum goes down the parathyroid starts to stimulate parathyroid hormone - tells the osteoclasts and osteocytes to get to work and work harder - the renal will start to dump ca++ because kindle can not conserve ca+ - excessive parathyroid stimulation will ultimately have us

A

loose bone density

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8
Q

Calcitonin is secreted by

A

the human thyroid - c cells or parafolicular cells

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9
Q

Calcitonin is regulated by

A

serum calcium level

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10
Q

Calcitonin inhbits

A

bone resorption by osteoclastic function and may lead to hypocalcemia and hypophosphatemia
Inhibits GI calcium absorption
Stimulates osteoblastic activity
Inhibits renal tubular cells reabsorption of calcium

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11
Q

Why is calcitonin important in humans?

A

is the normal regulation of normal calcium homeostasis

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12
Q

Histopathic changes in HPT include…

What are common disease names related?

A

osteoclastic and osteocytic bone resorption with fibrous tissue replacement
Osteitis fibrosa cystica
Recklinghausen’s disease of bone

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13
Q

Major bone changes in HPT include

A

Osteopenia
accented trabecular pattern
loss of cortical definition
Brown tumors

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14
Q

What bone change is unique to HPT? Explain it

A

Brown tumors: Subperiosteal bone resorption

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15
Q

What is the male and female ratio for HPT? What age range?

A

Female 3: 1 males - 30 - 50 years old

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16
Q

Symptoms of HPT usually related to what three structures?

A

Bone, renal, GI

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17
Q

Symptoms/signs of HPT include

A

weakness (hypercalcemia), lethargy, polydipsia, pyuria, renal calculi (kidney stones), bone tenderness
Sub-periosteal bone resorption

18
Q

Where in the body is it common to see Tertiary HPT

A

In the hands

Middle phalanges radial aspect (thumb) 2nd - 4th digits pathognomonic

19
Q

Where does inter cortical bone resorption occur?

A

within haversian canals, linear striations/porous looking

20
Q

Where does endosteal bone resorption occur?

A

Typically hand and with other findings

21
Q

Where does subchondral bone resorption occur?

A

Common in SI, SC, AD, symphysis pubis and disco vertebral junctions - can mimic inflammatory joint disease
ex) SI joint sacrolilits

22
Q

Tertiary HPT are against

A

Joints - they get up under the articulation

23
Q

DRA stands for

A

Dialysis related athropathy

24
Q

DRSA means

A

Dialysis related spondyloarthropathy

25
Q

What does the trabecular bone resorption look like in tertiary HPT?

A

Diffuse in skeleton, very prominent in cranium - cause very granular appearance to diploid space - salt and pepper skull

26
Q

Sub-ligamentous bone resorption at enthuses can occur in terry HPT this can happen at the sites of:

A

Trochanters, ischial and humeral tuberosity, elbow, calcaneus, inferior distal end of clavicle

27
Q

Explain Brown tumor/osteoclastoma

A

Localized cyst-like bone resorption containing fibrous tissue, giant cells and hemorrhage “brown” color is histopahtoligc * tumor like disorder

28
Q

Acro osteolysis

A

Distal tuft resorption, seen with many other conditions - all RA, psoriatic arthritis, scleroderma, burn/frostbie victims, gout

29
Q

Densities might find HPT T/F

A

True

30
Q

Chondrocalcinosis

A

Calcification of articular cartilage - maybe hydroxyapatite or CPPD (calcium pyrophosphate dehydrate)

31
Q

Rugger-Jerse Spine may be related to ______. And is found in which type of HPT

A

Hyperphosphatemia

Secondary

32
Q

Osteosclerosis and periostitis is most commonly founding what HPT and rarely in what HPT?

A

Commonly found in secondary

Rarely found in primary

33
Q

Chondrocalcinosis and brown tumors are most commonly found in what HPT and rarely in what HPT?

A

More commonly founding primary

Rarely found in secondary

34
Q

Combination of secondary HPT + osteomalacia + soft tissue and vascular calcification is termed

A

Renal osteodystrophy/uremic osteopathy

35
Q

PHP

  • Etiology
  • define
  • characteristics
  • X-ray findings
A

Genetic disorder
Related to end organ resistance to parathyroid hormone with normal Ph production
Characteristics: short stature, obesity, round face, brachydactyl,
Xray: similar to hypoparathyroidism, hypocalcemia and hyperphosphatemia
*have it but do not respond to it

36
Q

PPHP

  • etiology
  • what makes it different from PHP
A

genetic
Similar to PHP
has normal Ca++ and phosphorous

37
Q

Hypoparathyroidism

A

Defieicniy of PTH most commonly from excision or trauma to the PTG during thyroidectomicies - seen in

38
Q

Signs of hypoparathyroidism?

A 
Bone osteosclerosis
thickening of the cranial vault bones
calcification of the basal ganglia
rarely choroid plexus and cerebellum 
Rare spine changes:
pain, stiffness with calcification of ALL and posterior spinal ligaments - resembling DISH
39
Q

Etiology of Hypoparathyroidism

A

Acquired

40
Q

Neoplasm in children is most likely

A

Leukemia

41
Q

Neoplasm in adults is most likely

A

Non-Hodgkins

42
Q

T/F neoplasm is often seen with anemia

A

True

Skel A (5 decks)

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