MSK/Bone/Rheum Flashcards
Main Risk factors of OP in those >50years
Where you would consider doing FRAX/Qfracture —> ?BMD scan
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
Main risk factors <50 for OP
Steroids >3months, perimenapausal, previous fragility fracture
What t score for osteroporsis
<-2.5
<-2.5 to -1 is osteopenia
T score is mean BMD for 30yr old women
What are the Qrisk guidelines for starting Tx
Oral bisphospahtes if >1%
Consider IV zolerdante (3monthly for 3 years) if >10%
Teriparatide SC injection is consider in what OP
Steroid related or men
What are some other examples of bone protections in OP
What supplements
HRT in perimenoapsual
Raloxifene
Denosumbab
Vit d (400-800) + calcium (not if <700)
Who should we consider screen for OP with dexa/Qfra
- age + 3 risk factors
All women >65 + men >75
Fragility fracture
High dose steroids >3months
Post menopausal with risk factors
Management of osteopenia
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
Oral bisphosphates advice
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
The most common cause of hypercalacaemia (>2.6)
- >3 looking for admission (mod)
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
What is most common cause of hyperparathroidism
Soldiatory adenoma!
Main reason of malignancy related hypercalcamia
Most common cancers
Tx
Secretion of PTH-related protein - paraneoplastic hypercalacamia
20% will be boney mets
Breast, lung, oesophageal, HNT, cervix
Oncology - bisphosphates can be consider
Management of hypercalaemic in those that don’t need admission
Rpt in 1 week with PTH + bone profile
Assess VitD
?malignayc - FBC, LFTs, serum and urine electrophoresis, urine hence hones
TFTs - thyroidxotcisit some times
What is the Biochem and causes of secondary hyperPTH
Low Ca, high PTH, high phosphate
- vit D def, chronic RF
What may occur after thyroid surgery
And what are the bloods like
Treatment
Primary hypoparathroidism
Low PTH, low ca, high phosphate
Vit D + Calcium supplements (need to take 4hours apart from Levothyroid), calcium citrate if on PPI
C5 + C6 Muscle weakness Reflex changes Sensory changes
Shoulder abduction and flexion, Elbow flexion
Biceps
Lateral arm
Elbow flexion, Wrist extensio
Biceps Supinator Lateral forearm, Thumb, Index finger
what nerve root supples Finger abduction and adduction
T1
causes of erythema nodosum
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)
