Temporal Arteritis Flashcards
What is GCA?
Inflammatory disease of blood vessels of the head, mainly the branches of the ECA
Which part of the vessels is most commonly affected in GCA?
Tunica Medium
What simple blood test can be used for diagnosis of GCA?
ESR
Which test can be used to confirm the diagnosis of GCA?
Temporal artery biopsy
Why can patients develop blindness when they have GCA?
Ophthalmic artery involvement
What is the treatment of GCA?
Steroids
Oral prednisolone started immediately
IV methylpred is evolving visual loss or history of amaurosis fugax
What pathological changes occur in osteoporosis?
Histologically normal bone that is decreased in quantity
Postmenopausal osteoporosis is caused by increased osteoclast activity affecting mainly bones that have increased surface area. The trabecular plates become perforated, thinned and lose their interconnections leading to progressive micro fractures and eventually vertebral collapse
What is osteoporosis and what is its pathogenesis?
Metabolic bone disease characterised by:
- Low bone mass
- micro architectural deterioration of bone tissue
- increase bone fragility
- loss of bone matrix
Three main mechanisms
- Inadequate peak bone mass
- excessive bone resorption
- inadequate formation of new bone during bone turnover
How do corticosteroids cause osteoporosis?
Direct inhibition of osteoblast formation
Direct stimulation of bone resorption
Inhibition of GIT calcium absorption
Stimulation of renal calcium losses
Inhibition of sex steroids
What are the causes of osteoporosis?
Primary
- idiopathic
- postmenopausal
- senile
Secondary
- Endocrine
– Addison’s
– T1DM
– Thyroid disease
– Hyperparathyroidism
– pituitary tumours
- GI
– hepatic insufficiency
– malabsorption
– Malnutiriton
– Vit C and D deficiencies
- Drugs
– alcohol
– anticoags
– chemotherapy
– corticosteroids
- Miscellaneous
– anaemia
– immobilisation
– osteogenesis imperfecta
– pulmonary disease
Other than osteoporosis can you name some other causes of pathological fractures?
Skeletal mets
Paget’s disease
Multiple Myeloma
Rickets
Osteomalacia
Osteogenesis imperfecta
Radiotherapy
What is multiple myeloma?
A plasma cell neoplasm commonly associated with lytic bone lesions, hypercalcaemia, renal failure and acquire immune abnormalities
Produces large amounts of IgG or IgA
Most commonly primary bone tumour in elderly
How is MM diagnosed?
Punched out lytic skull lesions on xray
M spike on protein electrophoresis
Ig Light chains in urine (bence jones protein)
CRAB
- Hypercalcaemia
- Renal insufficiency
- Anaemia
- Bone lesions
What is Bence Jones Protein?
Monoclonal globulin protein or immunoglobulin light chain found in the urine
Proteins are produced by neoplastic plasma cells
Present in 2/3 of MM cases
What is the concern if a patient who is steroid dependent requires surgery
Addisonian crisis
