MSK/Bone/Rheum

Question 1

Main Risk factors of OP in those >50years
Where you would consider doing FRAX/Qfracture —> ?BMD scan

Answer 1

FHx of OP, FHx of hip fracture, smoker, diabetes, IBD, HyperT, T1DM, COPD, CKD, Hx of anything that makes you fall
Alcohol, smoking
SSRI PPI

Question 2

Main risk factors <50 for OP

Answer 2

Steroids >3months, perimenapausal, previous fragility fracture

Question 3

What t score for osteroporsis

Answer 3

<-2.5
<-2.5 to -1 is osteopenia

T score is mean BMD for 30yr old women

Question 4

What are the Qrisk guidelines for starting Tx

Answer 4

Oral bisphospahtes if >1%
Consider IV zolerdante (3monthly for 3 years) if >10%

Question 5

Teriparatide SC injection is consider in what OP

Answer 5

Steroid related or men

Question 6

What are some other examples of bone protections in OP
What supplements

Answer 6

HRT in perimenoapsual
Raloxifene
Denosumbab

Vit d (400-800) + calcium (not if <700)

Question 7

Who should we consider screen for OP with dexa/Qfra
- age + 3 risk factors

Answer 7

All women >65 + men >75
Fragility fracture
High dose steroids >3months
Post menopausal with risk factors

Question 8

Management of osteopenia

Answer 8

Consider zolerondic acid at 65yrs with hip changes

Re scan at 3 years
BMD is very specific but not very sensitive
Bone loss starts at 30years

Question 9

Oral bisphosphates advice

Answer 9

Check teeth prior (ON jaw risk)
PPI doesn’t help dyspepsia - empty stomach, stand up, no meds within 30mins
Rare risk of subtrocnetntic fracture
R/v at 5 years

Question 10

The most common cause of hypercalacaemia (>2.6)
- >3 looking for admission (mod)

Answer 10

Hx of malignancy
Hyperparathyroidism (usually mild - also low phosphate, and inappropriate Normal or high PTH)

Drugs - thiazides (also hyponataemia), lithium, vit d ++, vit A, combine ca + vit d preparations

Question 11

What is most common cause of hyperparathroidism

Answer 11

Soldiatory adenoma!

Question 12

Main reason of malignancy related hypercalcamia
Most common cancers

Tx

Answer 12

Secretion of PTH-related protein - paraneoplastic hypercalacamia
20% will be boney mets

Breast, lung, oesophageal, HNT, cervix

Oncology - bisphosphates can be consider

Question 13

Management of hypercalaemic in those that don’t need admission

Answer 13

Rpt in 1 week with PTH + bone profile
Assess VitD
?malignayc - FBC, LFTs, serum and urine electrophoresis, urine hence hones
TFTs - thyroidxotcisit some times

Question 14

What is the Biochem and causes of secondary hyperPTH

Answer 14

Low Ca, high PTH, high phosphate
- vit D def, chronic RF

Question 15

What may occur after thyroid surgery
And what are the bloods like
Treatment

Answer 15

Primary hypoparathroidism
Low PTH, low ca, high phosphate

Vit D + Calcium supplements (need to take 4hours apart from Levothyroid), calcium citrate if on PPI

Question 16

C5 + C6 Muscle weakness Reflex changes Sensory changes

Answer 16

Shoulder abduction and flexion, Elbow flexion
Biceps
Lateral arm

Elbow flexion, Wrist extensio
Biceps Supinator Lateral forearm, Thumb, Index finger

Question 17

what nerve root supples Finger abduction and adduction

Answer 17

T1

Question 18

causes of erythema nodosum

Answer 18

1/3 no cause can be found;
10–30% of cases in young adults follow streptococcal throat infection;

other causes include: tuberculois, sarcoid, inflammatory bowel disease, drugs (e.g. selective serotonin reuptake inhibitors, isotretinoin), rheumatological and autoimmune conditions, pregnancy/combined oral contraception and haematological malignancy (rare)