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Musculoskeletal Physiopathology > Lab: Metabolic & Endocrine Pathology > Flashcards

Lab: Metabolic & Endocrine Pathology Flashcards

1
Q

What is the normal serum calcium level range?

A

8.6-10.6 mg/dl

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2
Q

What is the normal serum phosphate level range?

A

1.5-4.5 mg/dl

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3
Q

What does DEXA measure?

A

Bone density

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4
Q

What is the DEXA T-score for osteopenia?

A

-1.0 to -2.5

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5
Q

What is the DEXA T-score for osteoporosis?

A

Below -2.5

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6
Q

In short, what is rickets?

A

Impaired bone mineralization

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7
Q

What are the expected lab findings for rickets?

Calcium:
Phosphate:
PTH:
Alkaline phosphatase:

A

Calcium: decreased
Phosphate: decreased
PTH: increased
Alkaline phosphatase: increased

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8
Q

Osteomalacia is an adult ___ deficiency

A

Vitamin D

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9
Q

What is the typical cause of hypervitaminosis D?

A

Over supplementation

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10
Q

What are the lab findings for Vitamin D toxicity (hypervitaminosis D)?

Calcium:
PTH:

A

Calcium: increased (in blood and urine)
PTH: decreased

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11
Q

A patient has a serum calcium level of 7.4 mg/dl.
Would PTH production be elevated or decreased?
What term describes this serum calcium value?

A

PTH would be elevated (hyperparathyroidism) due to hypocalcemia

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12
Q

Which Vitamin D metabolite is necessary to facilitate calcium absorption in the gut?

A

Calbindin

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13
Q

Which Vitamin D metabolite interacts with PTH on bone to increase serum calcium levels?

A

Calcitriol

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14
Q

Calcitriol, a Vitamin D metabolite, works with ___ to ___ serum calcium levels

A

works with PTH to increase serum calcium levels

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15
Q

In response to increased PTH levels, what functions does the kidney perform to increase serum calcium levels?

A
  • Increase calcitriol
  • Conserve calcium
  • Excrete phosphate
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16
Q

What hormonal secretion helps decrease serum calcium levels by sequestering calcium in the mitochondria of the cells?

A

Calcitonin (from parathyroid)

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17
Q

What clinical term describes the blood results of a patient with a phosphate value of 10.3 mg/dl?

A

Hyperphosphatemia

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18
Q

This bone was sectioned with a butter knife
What metabolic pathology is present?

A

Osteomalacia

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19
Q

What do the white areas in this bone indicate?

A

Increased osteoid (organic, unmineralized tissue)

osteomalacia

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20
Q

There is reduction in normal ___ bone in this specimen

A

trabecular

osteomalacia

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21
Q

How does the organic vs inorganic bone composition of this femur compare with a normal adult specimen?

A

Increased organic to inorganic ratio

osteomalacia

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22
Q

stress strain

How does the replacement of trabecular bone with osteoid alter the biomechanical properties of bone?

A

Bones soften and weaken making them more likely to bend and break

osteomalacia
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23
Q

This is the proximal metaphysis and diaphysis of the humerus
What is the dense white substance that has accumulated in the marrow cavity at the purple arrow?

A

Osteoid

osteomalacia

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24
Q

This is the proximal metaphysis and diaphysis of the humerus
Would the bending of this specimen’s diaphysis generally be reversible without surgical intervention?

A

No

osteomalacia

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25
Q

Which metabolic pathology created these changes in bone?

A

Rickets

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26
Q

At what age did these changes occur?

A

Young age

rickets

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27
Q

Where does calcitriol come from?
How does it affect plasma calcium and PTH?

A

Calcitriol comes form the kidney
Calcium increases, PTH decreases

28
Q

What is the function of calbindin?

A

Binds calcium in the gut, increases calcium absorption

29
Q

What are the expected lab results for this patient?

Calcium:
Phosphate:

A

Calcium: decreased
Phosphate: decreased

rickets

30
Q

How would serum levels of phosphate and calcium contribute to this bowing?

A

Less calcium and phosphate means the bone is more organic, thus more elastic and more plastic, leading to deformity

rickets

31
Q

What is the presentation of this knee?

A

Normal skeletally immature knee

32
Q

What is unusual about the metaphyses seen here?

A

Paintbrush metaphyses; widened

rickets

33
Q

What sort of fracture has occurred in the right fibula?

A

Oblique diaphyseal and transverse distal diaphyseal fractures: complete, noncomminuted, insufficiency (stress) pathological fractures

rickets

34
Q

How are these joints affected by their pathology?

A

Not dislocated, but subluxated/misaligned

rickets

35
Q

How has the composition of this individual’s bones changed in response to stress?

A

More bone laid down according to weight bearing (Wolff’s law)

rickets

36
Q

Based on this radiograph, what is your suspected diagnosis?

A

Rickets

37
Q

What disease pathogenesis (cellular events) would explain the bones in this radiograph?

A

Decreased cartilage formation, decreased osteoid mineralization, and increased organic to inorganic ratio leads to soft and weak bones increasing risk of fracture

rickets

38
Q

What are the expected lab results for this patient?

ESR:
Vitamin D:
Calcium:
PTH:
Phosphate:

A

ESR: elevated (inflammation associated)
Vitamin D: deficient
Calcium: decreased (needs vitamin D)
PTH: increased (trying to increase calcium resorption in kidneys)
Phosphate: decreased (PTH decreases phosphate resorption)

39
Q

What are the potential etiologies of this condition?

A
  • Indadequate dietary intake of Vitamin D or sun (acquired)
  • Vitamin D dependent rickets type I: defective hydroxylation of metabolites in liver or kidney (inherited)
  • Vitamin D dependent rickets type II: end organ insensitivity to vitamin D (inherited)

rickets

40
Q

What treatment would you recommend for a patient with an acquired deficiency and a radiograph similar to this?

A

Vitamin D supplementation

41
Q

A 1 year-old female presents with bleeding gums and bilateral swelling in the thighs. The patient’s guardian reports constant crying, and her temperature is recorded at 98.6 F (37 C). The child also shows bruises in multiple stages of healing. The parents report no traumatic incidents to explain the bruises. Blood work and radiographs are ordered.
What are the relevant signs and symptoms in this case?

A

Bleeding gums and easy bruising (vessel fragility)

scurvy

42
Q

A 1 year-old female presents with bleeding gums and bilateral swelling in the thighs. The patient’s guardian reports constant crying, and her temperature is recorded at 98.6 F (37 C). The child also shows bruises in multiple stages of healing. The parents report no traumatic incidents to explain the bruises. Blood work and radiographs are ordered.
What category of pathology (infection, fracture, collagen synthesis, etc.) matches the intial signs and symptoms we see for this patient?

A

Collagen synthesis and metabolic

scurvy

43
Q

Is the radiopaque outline around the cortex in the radiograph osteolytic or osteoblastic activity?
What could create the outline around the cortex?

A

Osteoblastic activity created by subperiosteal bleeding/hemorrhage

scurvy

44
Q

A 1 year-old female presents with bleeding gums and bilateral swelling in the thighs. The patient’s guardian reports constant crying, and her temperature is recorded at 98.6 F (37 C). The child also shows bruises in multiple stages of healing. The parents report no traumatic incidents to explain the bruises. Blood work and radiographs are ordered.
What diagnosis best fits this case?

A

Scurvy (hypovitaminosis C)

metabolic

45
Q

The formation of which tissue type affecting bone is altered during this pathology? How?

A

Collagen synthesis; vitamin C is important for hydroxylation of prolyl and lysyl residues in collagen (hydroxyproline and hydroxylysine)

scurvy

46
Q

What is causing the discoloration indicated by the blue arrows?
Is this obervation potentially reversible?

A

Repeated/chronic hemorrhage
Irreversible

scurvy

47
Q

What does DEXA measure?

A

Bone density

48
Q

What is the meaning of a DEXA T-score?

A

Comparison of bone density to that of a healthy young adult

49
Q

What is the meaning of a DEXA Z-score?

A

Comparison of bone density to that of other patients the same age

50
Q

What are the following DEXA scores according to World Health Organization?

Normal:
Osteopenia:
Osteoporosis:

A

Normal: +1 to -1
Osteopenia: -1 to -2.5
Osteoporosis: -2.5 or lower

51
Q

A 53 year-old female patient of yours has asthma and has been using steroids to control her condition for decades. She was also prescribed a blood thinner following a recent heart attack and the placement of a stent in the right carotid artery. Based on her age and medications, her primary care provider suggested she receive a DEXA scan. On her next visit, she brings the results to show you.
What risk factors does this patient have that could impact bone density?

A
  • Age
  • Steroids
  • Blood thinners
  • Association with cardiovascular history
52
Q

When does peak bone mass occur?

A

Ages 25-30

53
Q

What are some factors that may negatively impact peak bone mass?

A
  • Physical activity (lack thereof)
  • Diseases
  • Fractures
  • Medications
  • Hormones
54
Q

What would you recommend for an osteopenic/osteoporotic patient?

A
  • Weight bearing and strength training exercise
  • Calcium and vitamin D supplementation
  • Alterations to chiropractic treatment plan
55
Q

Your 53 year-old patient (with osteoporosis) fell and caught herself on an outstretched hand. She presented to the emergency room with pain in the left wrist.
How would you describe this racture?

A

Osteoporotic/pathologic fracture; Colles fracture

56
Q

What is the term for a common distal radius fracture, often acquired after falling on an outstretched hand?

A

Colles fracture

57
Q

Which is more common in cases of rickets, genu varum or genu valgum?

A

Genu varum (bowlegged)

58
Q

A 2 year-old child presents with hypotonia (decreased muscle tone) and delayed growth. The child is unable to stand and there is bowing in the legs (genu varum) and arms bilaterally. You also note that the patient presents with frontal bossing, rachitic rosary, and pectus carinatum. The patient’s blood work reveals serum calcium levels at the low end of normal. Blood work also indicated that the patient is hypophosphatemic but has high serum levels of Vitamin D.
What is the likely diagnosis for this patient?

A

Rickets

Vitamin D being stored trying to increase calcium

59
Q

Besides genu varum, what are some other bony presentations found in children with rickets?

A
  • Pectus carinatum (Pigeon breast)
  • Frontal bossing
  • Rachitic rosary
60
Q

This enlargment of the costochondral joints of the ribs is seen in which pathology?

A

Rickets

61
Q

In which pathology do we see pectus carinatum in children?

A

Rickets

62
Q

In which pathology do we see pediatric frontal bossing that grows via intramembranous ossification?

A

Rickets

63
Q

What produces genu varum in cases of rickets?

A

Lack of control over endplate growth

64
Q

What are the expected PTH levels in the case of rickets?

A

Increased

65
Q

A patient’s presentation indicates rickets, but their blood work revealed high Vitamin D levels in the blood
What could explain this?

A

Body is trying to retain/store vitamin D because of hypocalcemia

Musculoskeletal Physiopathology (32 decks)

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