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LOCO2 > LOCO Revision5 > Flashcards

LOCO Revision5 Flashcards

1
Q

Which would commonly present with a fracture from a low force injury?

RA
OA
OP
Gout

A

OP

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2
Q

Osteoporosis patients are likely to present with

lordosis
kyphosis
scoliosis

A

kyphosis: called

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3
Q

Osteonecrosis is associated with the treatment of

RA
OA
OP
Gout

A

OP

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4
Q

Recombinant PTH used to treat OP is called? [1]

A

Teriparatide

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5
Q

Name drug A used to treat osteoporosis [1]

A

Denosumab

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6
Q

Name drug A used to treat osteoporosis [1]

A

Teriparatide

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7
Q

alkaline phosphatase (ALP) is produced by which cell type? [1]

A

Osteoblast

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8
Q

Which disease is shown in this CT [1]

Describe the pattern shown in the skull [1]

A

Pagets disease; cotton wool skull

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9
Q

Osteoporosis

What is T and Z score on a DEXA scan? [2]

Which is more commonly used? [1]

A

T-score = number of standard deviations from the mean young (30 yr) same gender and ethnicity. More commonly used

Z-score = number of standard deviations from same age, gender and ethnicity. Used for younger populations

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10
Q

Which 3 locations do you measure a T score from in the body? [3]

Why do you measure these areas? [1]

A

Neck of femur, lumbar vert or distal radius

Have high areaa trabecular bone here [1]

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11
Q

What T score is a clinical cut off that suggests osteoporosis? [1]

What T score is a clinical cut off that suggests osteopenia?

A

Osteoporosis: T-score lower than -2.5. [1]

Osteopenia: T-score between –1.0 and –2.5 standard deviations below normal.

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12
Q

How would a patient present with osteoporosis? [1]

A

Have a fracture due to low force injury

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13
Q

Name two bones that are more likely to suffer from osteoporosis [2]

A

Vertebral bodies
Femoral neck

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14
Q

Describe pathophysiology of osteoporosis [3]

A
  • Bone formation is normal
  • Just relative increase in bone resorption not matched by formation
  • Trabecular bone more at risk

Trabecular bone almost dissapeared on R (L is normal)

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15
Q

Describe the clinical presentation of osteoporosis [3]

A
  • Fracture is the only cause of symptoms in osteoporosis
  • Sudden onset of severe pain in the spine, often radiating to the front
  • Thoracic vertebral fractures may lead to kyphosis - ‘widows stoop’
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16
Q

What is first line treatment for osteoporosis? [1]
Describe MoA [3]

A

Bisphosphonates:

  • inhibits osteoclast activity
  • promotes osteoclast apoptosis
  • Decreases RANKL expression (so osteoblasts don’t turn into osteoclasts [?])
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17
Q

Describe complications of bisphosphonates

A

Kills off osteoclasts: don’t remove old bone: thickened bone

Get giant osteoclasts: poisoned osteoclasts

Osteonecrosis occurs

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18
Q

Osteoporosis treatment

Describe the MoA of Teriparatide [2]

A

Teriparatide is a recombinant PTH:

  • PTH upregulates RANKL - signals osteoblast to differentiate when have low Ca2+: work indirectly on osteoclasts to boost bone making potential
  • Intermittent exposure to PTH activates osteoblasts more than osteoclasts
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19
Q

Osteoporosis treatment

Describe the MoA of Denosumab [2]

A

PTH normally inhibits OPG.

Denosumab is a an osteoprotegrin artificial antibody & acts as a monoclonal antibody to RANK:

Denosumab: human monoclonal antibody that inhibits RANKL and helps regulate turnover in healthy bone. Denosumab binds with high specificity and affinity to the cytokine RANKL, inhibiting its action; as a result, osteoclast recruitment, maturation and action are inhibited, and bone resorption slows

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20
Q

Descibe pathophysiology of Pagets disease [2]

Describe the three phases of Pagets disease [3]

A

(Theory) osteoclasts: may be infected with a virus that alters them AND genetics

Phases:
1. increased rate of bone resorption:
* large number of giant osteoclasts

2. Compensatory phase / proliferative:
* increased bone formation & accelerated depostion in disorganised manner

3. Burnt out phase: sclerotic:
* Hyper-vascular bone marrow; Bone hypercellularity may diminish leaving dense “Pagetic bone”

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21
Q

How do serum results for Ca, PO4, ALP, PTH and 1,25(OH)D2 present for osteoporosis? [1]

A

Normal

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22
Q

How do serum results for Ca, PO4, ALP, PTH and 1,25(OH)D2 present for osteomalacia? [1]

Explain each result

A

Low Ca
Low PO4
ALP high
PTH high
Vit D low

  • Main cause of osteomalacia: low vitamin d
  • Low PO4 and Ca due to phosphate being excreted in order to keep any calcium possible via renal regulation).
  • ALP high because produced in osteoblasts
  • PTH high due to low Ca2+
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23
Q

How do serum results for Ca, PO4, ALP, PTH and 1,25(OH)D2 present for Pagets disease? [5]

Explain your answer [1]

A

Ca: normal
PO4: normal
ALP: raised
PTH normal
Vit D: normal

ALP raised due to characterised by high burn turnover

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24
Q

How do serum results for Ca, PO4, ALP, PTH and 1,25(OH)D2 present for renal failure [5]

Explain your answer [1]

A

failure leads to vitamin D deficiency, as 1,25(OH)2 D3 is made in the kidney.

This results in high PO4, low calcium and normal/high alkaline phosphatase

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25
Q

Name a rare complication of Paget’s disease that occurs in 1% of cases [1]

A

Osteosarcoma

26
Q

What would lab results of a patient with osteomalacia show:

  • Ca2+ levels [1]
  • PO4- levels [1]
  • ALP levels [1]
  • Vitamin D levels [1]
A
  • Reduced serum calcium and phosphorous
  • High alkaline phosphatase (as this is a product of osteoblasts, so there is increase compensatory osteoblastic activity)
  • Low vitamin D levels
27
Q

Describe the pathophysiology of osteomalacia [2]

A

Osteomalacia is a condition that is the result of insufficient calcium and phosphate to mineralise new bone osteoid.

This results in bones becoming softer and more liable to bend or fracture

. It is usually result of vitamin D deficiency either in diet or production, and has different clinical presentation in adults and kids:

28
Q

How would you diagnose osteomalacia from a bone biopsy? [1]

A

Normal bone:
- approx. 20% unmineralized bone osteoid

Osteomalacia:
- wide seams of unmineralized osteoid. In severe cases, up to 100% of the bone is covered by unmineralised osteoid.

29
Q

Which drug would allow you to determine the level of bone mineralisation [1]

A

Tetracycline chelates: less labelling would be seen

30
Q

What phase of Pagets Disease is depicted? [1]

Explain your answer [1]

A

Burnt-out sclerotic phase of Paget disease (Phase 3):

Woven bone appears as bony shelves divided by cement lines into irregular regions.

31
Q

What are the arrows pointng to in this slide from a Pagets disease patient? [1]

A

Cement lines

32
Q

Which pathology is depicted in this X-ray

Osteoporosis
Osteomalacia
Pagets Disease
Osteoarthiritis
Osteosarcoma

A

Which pathology is depicted in this X-ray

Osteoporosis
Osteomalacia
Pagets Disease
Osteoarthiritis
Osteosarcoma

33
Q

How would you confirm Osteosarcoma from a biopsy? [1

A

Giant cells confirm the diagnosis of an osteosarcoma arising out of Paget’s disease.

34
Q

Osteosarcoma arises as a complication from:

Osteoporosis
Osteomalacia
Pagets Disease
Osteoarthiritis

A

Osteosarcoma arises as a complication from:

Osteoporosis
Osteomalacia
Pagets Disease
Osteoarthiritis

35
Q

How do you treat Pagets disease? [5]

A
  • Bisphosphonates work directly on osteoclasts to slow bone resorption. Can be given orally for 2-6 months, or IV single infusion-3 infusions. Bisphosphonates can almost cure Paget’s disease if you catch it early, and stop the osteoclast hyperactivity, as this will prevent sclerotic bone from forming.
  • Calcium and vitamin D supplements
  • Pain management
  • Surgery
  • Calcitonin used to be used more often, but now less than bisphosphonates
36
Q

What is sclerostosis caused by? [1]

How do patients with sclerotosis present? [2] Explain your answer [1]

A

Absence, abnormal or reduced produced of sclerostin

Sclerostin produced by healthy osteocytes and inhibtis osteoblasts to prevent XS bone formation

Condition results in resistance to fractures and XS height

37
Q

Which nerve is at risk here? [1]

A

median

38
Q

Ptx has normal serum calcium, phosphate, ALP & PTH. Which condition are they most likely to have?

Paget’s disease
Chronic kidney disease
Primary hyperparathyroidism
Osteoporosis
Osteomalacia

A

Osteoporosis

39
Q

Damage occurs from twisting injuries:

Posterior cruciate ligament injury
Menisical injury
Medial collateral ligament injury
Lateral collateral ligament injury

A

Menisical injury

40
Q

A female immigrant from the Indian subcontinent presents with ‘bone pain’, muscle weakness and anorexia. Bloods show a decreased calcium and phosphate level is a stereotypical history of ? [1]

A

Osteomalacia

41
Q

A patient is found to have the following results: low serum calcium, low serum phosphate, raised ALP and raised PTH. Which condition are these findings most consistent with?

Paget’s disease
Chronic kidney disease
Primary hyperparathyroidism
Osteoporosis
Osteomalacia

A

Osteomalacia

42
Q

Which of the following commonly affects the DIP and PIP joints?

Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
Rheumatoid arthritis

A

Osteoathritis

43
Q

Which of the following commonly affects the MCP and PIP joints?

Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
Rheumatoid arthritis

A

Rheumatoid arthritis

44
Q

X-ray findings include osteophytes forming at joint margins

Paget’s disease
Osteoathritis
Osteoporosis
Osteomalacia
Rheumatoid arthritis

A

Osteoathritis

45
Q

Which of the following antibodies is most associated with RA?

P-ANCA
Anti-dsDNA
Anti-Ro
Anti ACPA
Anti La

A

Anti ACPA

46
Q
A

SLE

47
Q
A

SLE

48
Q

An elderly man is investigated for ‘bone pains’. He is known to be deaf. Bloods show a raised ALP and a skull x-ray shows a thickened vault is a stereotypical history of? [1]

A

Paget’s disease

49
Q
A

Colchicine - inhibits microtubule polymerization by binding to tubulin, interfering with mitosis. Also inhibits neutrophil motility and activity

50
Q

STI –> arthritis, urethritis, conjunctivitis in a question is most likely to indicate ? [1]

A

Reactive arthritis

51
Q

State three categories of inflammatory joint disease [3]

A
  1. Infection: septic arthiritis or generalised arthralgia
  2. crystal arthropathy: gout and pseudogout
  3. Autoimmune disorders: RA, spondarthritis, connective tissue disease
52
Q

Many joints / polyarthralgia would be suggestive of what type of disease? [1]

Single joint / monarthralgia would be suggestive of what type of disease? [1]

A

polyarthralgia: autoimmune disorders

monarthralgia: inflammatory disorder

53
Q

Draw a flow chart for diagnosis of joint pain

A
54
Q

Describe the features of RA [3]

A

Symmetrical

Hands and feet in 80% of cases

Early morning stiffness

Valgus deformity

Bakers cyst: synovial fluid at popliteal area

55
Q

What is this sign of RA [1]

A

Bakers cyst: synovial fluid at popliteal area

56
Q

State three eye complications of RA [3]

Why is the eye commonly a problem? [1]

A

RA effects type 2 collagen; get lots of type 2 collagen in they eye

Keratoconjunctivitis sicca

Scleritis & episcleritis

Scleromalacia perforans: intraocular contents prolaspes out of the sclera

57
Q

Describe three neuromuscular complications of RA [3]

A

Muscle wasting
Carpal tunnel syndrome
Atlanto-axial subluxation: odointal peg impinges on the spinal cord

58
Q

What causes cervical myelopathy in RA patients? [1]

What are signs of cervical myelopathy? [5]

A

Compression of the spinal cord and brain stem is typically caused by atlantoaxial instability (AAI) or atlantoaxial subluxation (AAS)

spasticity (sustained muscle contractions)
hyperreflexia
pathologic reflexes
digit/hand clumsiness
gait disturbance

59
Q

State a cardiac [1] and bone [1] complication of RA

A

ischaemic heart disease

osteoporosis

60
Q

State three connective tissue diseases

A

Systemic lupus erythematosus:

Scleroderma / Systemic sclerosis: progressive atrophy of soft tissue

Dermatomyositis: high level of creatine kinase; muscle weakness - get lots of rashes. proximal weakness

61
Q

Describe pathophysiology of Systemic lupus erythematosus

A

Characterised by anti nuclear antibodies (antibodies to proteins within the persons own nucleus): causes immune system to target these proteins and generates inflammatory response / loss of tolerance

Inflammation leads to the symptoms

62
Q

Describe the symptoms of SLE

A

90% of patients have arthritis:
* symmetrical small joint polyarticular arthiritis (most common)
* jaccoud arthropathy (rare)
* avascular necrosis

Fatigue
Weight loss
arthralgia
myalgia
fever
butterfly rash: gets worse with sunlight
shortness of breath
hair loss

LOCO2 (58 decks)

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