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MSK 1 > Pathology - osteoporosis and metabolic bone disease > Flashcards

Pathology - osteoporosis and metabolic bone disease Flashcards

1
Q

where is the greatest conc of calcium found in the body?

a. kidney
b. bone
c. gut
d. ciruclation

A

b. bone

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2
Q

what causes the conversion of cholesterol to vitamin D3 ?

a. enzymes
b. g proteins
c. UV
d. x rays

A

c.UV

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3
Q

vitamin D3 from sunlight and diet is converted to 25-hydroxy D3 by which enzyme in the liver

a. 23 hydroxylase
b. 24 hydroxylase
c. 25 hydroxylase

A

c.25 hydroxylase

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4
Q

what happens to FGF 23 at the kidney

a. switched off
b . switched on

A

a. switched off

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5
Q

what happens to PTH at the kidney

a. switched off
b . switched on

A

b. switched on

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6
Q

what is 25 hydroxy D3 converted to at the kidney?

a. vitamin D3 and D2
b. 1a - hydroxylase
c. calcitriol

A

c. calcitriol

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7
Q

what process happens at the kidney?

a. oxidation
b. reduction
c. 2 stage hydroxylation

A

c. 2 stage hydroxylation

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8
Q

increased calcium absorption at gut, increased bone calcification and what other effect is caused by increased vitamin D?

a. decreased kidney resorption
b. increased kidney resorption
c. increased liver resorption
d. decreased kidney absorption

A

b. increased kidney resorption

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9
Q

decreased plasma calcium causes which structure to release PTH?

a. thyroid
b. parathyroid
c. pituitary
d. kidney

A

b. parathyroids

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10
Q

where does PTH act?

a. gut and kidney
b. gut and bone
c. bone and kidney

A

c. bone and kidney

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11
Q

what does increased PTH do at the bone?

a. resportion
b. mineralisation
c. growth

A

a.resorption

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12
Q

what does increased calcitonin do at the bone?

a. resportion
b. mineralisation
c. growth

A

b. mineralisation

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13
Q

where is calcitonin produced?

a. kidney
b. liver
c. thyroid
d. parathyroids

A

c.thryroid

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14
Q

what affect does PTH have on the kidney?

a. calcium excretion
b. calcium absorption
c. calcium reabsorption

A

calcium reabsorption

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15
Q

where is 1. 25 DhccF released from?

a. kidney
b. thyroid
c. liver
d. gut

A

a. kidney

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16
Q

what activated the thyroid to release calcitonin?

a. decreased plasma calcium
b. increased plasma calcium
c. increased vitamin D
d. decreased vitamin D

A

b. INCREASED plasma calcium

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17
Q

what activates the kidney to release 1 25DhccF ?

a. increased plasma calcium
b. dietary intake of calcium
c. vitamin D from gut du to dietary intake of calcium

A

c. vitamin D from gut du to dietary intake of calcium

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18
Q

what affect does 1, 25 DhccF have on the kidney?

a. calcium absorption
b. calcium release
c. cacium reabsorption

A

c.cacium reabsorption

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19
Q

what affect does 1 25 DhccF have on the gut?

a. calcium excretion
b. calcium absorption
c. vitamin D release

A

b.calcium absorption

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20
Q

low bone mass and micro architectural detioriation of bone tissue with a consequent increase in susceptibility to fracture is characteristic of what condition?

a. osteomyitis
b. osteoperosis
c. osteosarcoma

A

b. osteoporosis

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21
Q

which of these is correct for osteoporosis ?

a. abnormal blood test, no symptoms
b. normal blood test, symptoms
c. abnormal blood test, symptoms
d. normal blood tests, no symptoms

A

d. normal blood tests, no symptoms

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22
Q

what is the biggest risk factor for osteoporosis?

a. post menopausal female
b. smoking
c. alcohol
d. genentics

A

a.post menopausal female

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23
Q

which drug increases risk of osteoporosis?

a. antibiotics
b. corticosteroids
c. NSAIDS
d. statins

A

b.corticosteroids

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24
Q

which type of arthritis is a risk factor for osteoporosis ?

a. rheumatoid
b. reactive
c. psoriatic

A

a.rheumatoud

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25
Q

true or false being underweight and genetids are risk factors for osteoporosis?

A

true

26
Q

what tool is sued to calculate osteoporosis risk?

aQRISK3
b FRAX
c VIP

A

b.FRAX

27
Q

age, sex, height, weight, previous fracture, current smoking, glucocorticoids, rheumatoid, secondary osteoporosis, alcohol 3/more units , femoral neck BHD snd which other factor are taken into account by FRAX?

a. parent fractured hip
c. excercise
d. hypertension

A

a. parent fractured hip

28
Q

investigation of osteoporosis involves: history, examination, blood cell count, thyroid function tests and which other test?

a. x ray
b. ultrasound
c. bone densitometry

A

c.bone densitometry

29
Q

what change should first be made to treat osteoporosis?

a. alcohol
b. excercise
c. smoking
d. protein

A

c.smoking

30
Q

what is the initial treatment method for osteoporosis ?

a. lifestyle
b. drugs
c. surgery

A

a.lifestyle

31
Q

what are the 3 fields of drugs used to treat osteoporosis?

a. antibiotics, corticosteroids, analgesics
b. anti resorptive, anabolic,other
c. pro resorptive, anabolic other

A

b. anti resorptive, anabolic,other

32
Q

patient prescribes an anabolic drug for osteoporosis. which one of these drugs is most likely to be prescribed ?

a. bisphosphonates
b. denosumab
c. teriparatide
d. oestrogen

A

c.teriparatide

33
Q

bisphosphonates and denosumab belong to what group of drugs?

a. NSAIDs
b. anti resorptive
c. anabolic

A

b.anti resorptive

34
Q

what is the mode of action of bisphosphonates?

a. inhbit osteoblasts
b. inhibit osteocytes
c. inhibit osteoclasts

A

c.inhibit osteoclasts

35
Q

patient prescribes a bisphosphonate to be given orally which most likely?

a. alendronic acid
b. zoledronic acid
c. denosumab
d. teriparatide

A

alendrotnic acid

36
Q

patient prescribed alendrotnic acid bisphosphonate for osteoporosis how should this be administered?

a. oral weekly
b.Iv weekly
cIM daily
d. oral daily

A

a. oral weekly

37
Q

patient prescribed zoledronic acid bisphosphonate for osteoporosis how should this be administered?

a. oral weekly
b.Iv weekly
cIM daily
d. IV anually

A

d.IV annually

38
Q

what drug should be avoided in pregnancy, breastfeeding or renal impaurment?

a. bisphosphnates
b. denosumab
c. anabolics
d. anti resorptive

A

a. bisphosphonates

39
Q

patient on bisphosphonates experiencing heart burn and ulceration. which bisphosphonate causes these adverse effects?

a.zoledronic acid
b. alendronic acid
c.denosumab
dteriparatide

A

b. alendrotnic acid

40
Q

Patient on bisphosphonates experiences flu like illness which drug most likely responsible?

a. zoledronic acid
b. alendrotnic acid

A

a. zoledronic - IV

41
Q

all bisphosphonates can cause which group of adverse effects?

a. osteonecrossis of the jaw and atypical fractures
b. flu like illness
c. heartburn, ulceration

A

a.osteonecrossis of the jaw and atypical fractures

42
Q

how is denosumab administered?

a. IV annually
b. subcutaneous 6 monthly
c. orally weekly
d. subcutaneous injection daily for two years

A

b.subcutaneous 6 monthly

43
Q

a monoclonal antibody against receptor activator of nuclear factor kappa b ligand (regulator of osteoclast development and activity) is the mode of action of which drug?

a. denosumab
b. bisphosphonates
c. teriparatide

A

a.denosumab

44
Q

caution in renal impairment and avoidance in pregnancy are contraindications of which drug?

a. denosumab
b. bisphosphonates
c. teriparatide

A

a.denosumab

45
Q

osteonecrosis of the jaw, rapid bone loss when stopped, hypocalcaemia and which other effect is caused by denosumab?

a. renal impairment
b. heartburn and ulceration
c. infection

A

c.infection

46
Q

recombinant human parathyroid hormone which has anabolic skeletal effects describes which drug?

a. teriprartide
b. bisphosphonates
c. denosumab

A

a.teriparatide

47
Q

in which type of bone are the effects of teriparatide most marked?

a. spongy
b. cancellous
c. growth plates

A

b. cancellous

48
Q

which drug should be avoided in pregnancy, breast feeding, metabolic bone disease, severe renal impairment, previous radiotherapy and bone malignancy?

a. bisphosponates
b. denosumab
c. teripratide

A

c.teriparatide

49
Q

the adverse effects of teriparatide include: headache, nausea, dizziness and …

a. confusion
b. heartburn and ulceration
c. diarrohoea
d. postural hypotension

A

d.postural hypotension

50
Q

what is osteomalacia ?

a. defective mineralisation of bone matrix
b. disorder of bone remodelling
c. low bone mass

A

a.defective mineralisation of bone matrix

51
Q

when defective mineralisation occurs at the epiphyseal growth plate in children it is known as

a. osteoporosis
b. pages disease
c. rickets

A

c.rickets

52
Q

inadequate hydroxylation and a a lack of which vitamin causes osteomalacia?

a. A
b. C
d. D
e. k

A

d.D

53
Q

pain weakness and fractures are symptoms of which bone disorder?

a,osteomyitis

b. pagets
c. osteoporosis
d. osteomalacia

A

d. osteomalacia

54
Q

what is the main treatment for osteomalacia?

a. denosumab
b. bisphosphonates
c. teriparatide
d. vitamin D

A

d.Vitamin D

55
Q

patient has pagets disease. what best descries the nature of this disease?
a.defective mineralisation of bone matrix

b. disorder of bone remodelling
c. low bone mass

A

b.disorder of bone remodelling
due to increased osteoblast and osteoclast activity
new bone weak and prone to fracture and deformity

56
Q

raised alkaline phosphatase indicates which bone disorder?

a. osteomyitis
b. pagets
c. osteomalacia
d. ostepororis

A

b. pagets

57
Q

alkaline phosphatase and imaging are used to diagnose which condition?

a. osteomyitis
b. pagets
c. osteomalacia
d. ostepororis

A

b.pagets

58
Q

treatment for pagets?

a. denosumab
b. bisphosphonates
c. teriparatide
d. vitamin D

A

b.bisphosphonates

59
Q

what are the cardiac signs of pagets?

a. hypertrophy and high output failure
b. reduced heart size
c. hypertension

A

a.hypertrophy and high output failure

60
Q

what is the most common cause of hypercalcaemia ?

a. excessive PTH secretion
b. low PTH levels
c. excess vit D action

A

a.excessive PTH secretion

61
Q

what is the most common cause excess PTH secretion?

a. primary hyperparathyroidism
b. adenoma
c. hyperplasia

A

a.primary hyperparathyroidism

62
Q

which of these is not a cause of low PTH levels

a. myeloma
b. adenoma
c. PTH related protein secretion
d. production of osteoclastic factors by tumours
e. secondary deposits in bone

A

b.adenoma

MSK 1 (23 decks)

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