rheumatology and orthopaedics

Question 1

what hormone is in excess in hyperparathyroidism

Answer 1

PTH

Question 2

5 effects of excess PTH in hyperparathyroidism

Answer 2

increased Ca2+ reabsorption, increased PO4 excretion in urine, hypercalcaemia, hypophosphatemia, skeletal changes of osteitis fibrosa cystica (absorption of bone, and replace it with fibrous tissue, forming brown cysts)

Question 3

what 4 organs are directly or indirectly affected by PTH (hence control Ca2+ metabolism)

Answer 3

parathyroid glands (produce PTH), bones (release Ca2+), kidneys (increase Ca2+ reabsorption and PO4- excretion), proximal small intestine (increase Ca2+ absorption); no negative feedback

Question 4

2 primary causes of hyperparathyroidism

Answer 4

parathyroid adenoma (85-90%), chief cell hyperplasia

Question 5

2 secondary causes of hyperparathyroidism

Answer 5

chronic renal deficiency, vitamin D deficiency

Question 6

4 symptoms of hyperparathyroidism

Answer 6

stones (Ca oxalate renal stones), bones (osteitis fibrosa cystica, bone resorption - late developed and normally diagnosed beforehand), abdominal groans (acute pancreatitis) and psychic moans (psychosis and depression)

Question 7

early skeletal changes associated with hyperparathyroidism

Answer 7

periosteal bone erosions (centre of trabceulae reabsorbed, forming tunnel)

Question 8

hyperparathyroidism brown cell tumour

Answer 8

giant cells, with reactive bone forming next to them

Question 9

feature of osteitis fibrosa cystica affecting tibia on x-ray

Answer 9

holes in bones throughout (brown cell tumours)

Question 10

where does bone resorption occur in hyperparathyroidism

Answer 10

subperiosteal, subchondral, intracrotical, brown tumours

Question 11

how does reabsorption of bone appear on x-ray

Answer 11

very dark