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Medicine Year 2 > Week 218 - Fractured Hip > Flashcards

Week 218 - Fractured Hip Flashcards

1
Q

Loss of which line on an x-ray might indicated a fractured neck of femur?

A

Shenton’s line

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2
Q

What contours does Shenton’s line trace?

A

The inferior border of the superior pelvic ramus and the medial border of the proximal femur

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3
Q

What is the term used for the surgical procedure used to replace an individual’s femoral head without replacing the acetabulum?

A

A hemiarthroplasty

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4
Q

What two surgical procedures are preferred in extracapsular NOF fractures

A

Dynamic Hip Screw

Cannulated Screw - provides more rotational stability

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5
Q

What two surgical procedures are generally preferred in intracapsular NOF fractures and why?

A

Hemiarthroplasty
Total Hip Replacement
As intracapsular NOF fractures carry greater risk of disruption to the blood supply to the femoral head and neck carrying a risk of AVN - may risk in young

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6
Q

How do you classify a NOF fracture as intra or extracapsular?

A

By the intertrochanteric line which runs between the greater and lesser trochanter - including or distal to this line is considered extracaspular

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7
Q

From which arteries does main blood supply to the hip joint come?

A

The lateral and medial femoral circumflex arteries

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8
Q

List 3 lifestyle factors that help improve bone health

A

Exercise (weight-bearing); healthy diet particularly with high calcium and Vit D; exposure to sun - Vit D

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9
Q

List 2 major lifestyle factors which reduce bone health and remodelling capabilities

A

Smoking

Alcohol

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10
Q

What two hormones have a protective effect on bone

A

Oestrogen (largely) and testosterone

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11
Q

Explain briefly the role of PTH on calcium in the body

A

PTH (parathyroid hormone) encourages calcium resorption and so increased blood plasma calcium levels and can, in large quantities, reduce bone strength

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12
Q

Describe the key steps in the Vitamin D production pathway.

A

UV light contacts skin converting cholesterol into Vit D3 > Liver hydroxylates Vit D3 to 25-hydroxyvitamin D(Calcidiol) > Kidneys further hydroxylate Calcidiol to 1, 25 dihydroxyvitamin D (Calcitriol - most potent form of Vit D!)

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13
Q

What affect does PTH have on serum calcium levels in the body and how?

A

PTH (parathyroid hormone) increases serum calcium in the body by 2 direct actions and 2 indirect actions. Direct - 1) increases osteoclastic activity in the bones 2) increases renal resorption of calcium
Indirect - 1) GI resorption of calcium 2) increases 1, 25 dihydroxy Vit D

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14
Q

What are the 4 main predisposing factors to osteoporosis?

A

Age; Female gender; Genetics (FHx); Oestrogen deficiency

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15
Q

name 5 further risk factors for osteoporosis (there are MANY)

A

Alcohol; smoking; poor diet (eating disorders); inactivity and low BMI

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16
Q

What effect does Vit have on calcium in the body?

A

Vit D helps calcium to be absorbed from the small intestine

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17
Q

Which hormone acts in opposition to PTH and what does it do?

A

Calcitonin - it increases bone calcium levels “tones the bone” by increasing osteoblastic activity and reducing osteoclastic activity

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18
Q

What is Trousseu’s sign?

A

Flexion of wrist and thumb with extension of fingers. it is an indication of hypocalaemia along with tremor/spasm due to increased nerve and muscle cell excitability but with reduced neurotransmitter release at synapses

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19
Q

Name some drugs/treatments which are risk factors for osteoporosis

A

Glucocorticoids (corticosteroids); Lithium; Chemotherapy; SSRIs; anticonvulsants; GnRH agonists; Methotrexate; Prolonged heparin use; Aromatase inhibitors

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20
Q

What does an Aromatase inhibitor do and what is it used in the treatment of predominantly?

A

Breast and ovarian cancer - reduces the production of oestrogen

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21
Q

What is a DEXA scan used for and what does it stand for?

A

Measures bone mineral density (g/cm2)

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22
Q

On a DEXA scan a ‘T’ score of between -1 SD (standard deviation) and -2.5 from the healthy ‘normal’ suggests a diagnosis of what in an individual?

A

Osteopenia

23
Q

For a patient to be considered osteoporotic by their DEXA result what should the result show?

A

A ‘T’ score of -2.5 SD (or below) below the normal

24
Q

What tool can be used to estimate an individual’s likelihood of suffering with a fragility fracture / osteoporosis?

A

A FRAX tool - you type in answers regarding known risk factors and it generates a 10-year probability score for that individual suffering a ‘low energy trauma’ fracture to their hip, wrist, vertebrae or shoulder

25
Q

How do bisphosphonates work in the treatement of osteoporosis?

A

They decrease / inhibit osteoclastic activity thereby slowing the rate of bone breakdown

26
Q

How does Strontium Ranelate act to help maintain bone strength?

A

It affects both osteoclastic and osteoblastic activity to reduce bone resporption (osteoclasts) and increase bone formation (osteoblasts) - only indicated if bisphosphonates are unsuitable

27
Q

In osteoporotic treatment what does SERMs stand for and how does the drug work?

A

Selective Oestrogen Receptor Modulators - acts similarly to oestrogen which has a protective effect on bone through increasing bone density

28
Q

What monoclonal antibody is used in the treatment of osteoporosis?

A

Denosumab

29
Q

How does Denosumab act to treat osteoporosis?

A

By acting on the RANK ligand preventing osteocytes turning into osteoclasts thereby promoting osteoblasts

30
Q

If hyperparathyroidism can cause osteoporosis how does human recombinant parathyroid hormone treatment help prevent / manage osteoporosis?

A

Fluctuant levels of parathyroid hormone (as is issued with parathyroid hormone treatment) has an anabolic effect on bone where continuous high levels of parathyroid hormone has a catabolic effect

31
Q

When osteoporosis exists in men with hypogonadism what treatment might be appropriate?

A

Testosterone therapy

32
Q

What is the difference between osteomalacia and rickets?

A

osteomalacia is simply the term used for ‘Rickets’ in adults - both are the result of a lack of Vitamin D and therefore weaker bones

33
Q

What is the definition of osteoporosis?

A

Reduced bone mass (normal mineralisation! - despite the fact a DEXA scan measures bone mineral density!)

34
Q

Name two drugs with increase bone formation

A

Teriparatide (recombinant parathyroid hormone)

Strontium ranelate

35
Q

Name two drugs with decrease bone resorption

A

Denosumab (RANK ligand inhibitor)

Bisphosphonates

36
Q

How should Bisphosphonates be taken and why?

A

At least half an hour before any food and with a full glass of tap water - bisphosphonates will bind to any calcium it comes into contact with

37
Q

name 3 bisphosphonates

A

any 3 of the following:

  • Alendronic Acid (alendronate)
  • Risedronate
  • Zolendronic Acid
  • Ibandronate
38
Q

Why should patients on bisphosphonates pay special attention to their gums?

A

A rare side effect is bone necrosis of the jaw

39
Q

How is Denosumab administered?

A

Subcut injection 6 monthly

40
Q

What 5 things does Vit D do in the body?

A

1) maintains calcium homeostasis
2) maintains bone health
3) increases Ca++ absorption in the gut
4) increases phosphate absorption in the gut
5) osteoclast maturation / function

41
Q

What is Paget’s disease?

A

Disordered bone metabolism - overactive osteoclasts followed by overactive osteoblasts resulting in a woven mosaic effect in the bone - weaker than normal

42
Q

What are the direct and indirect symptoms of Paget’s disease?

A

Direct - constant boring bone pain particularly on weight-bearing - pathological fracture - sacromatous change (rare)
Indirect - high cardiac output - compression effects

43
Q

List the more common sites affected by Paget’s

A

Spine; Pelvis; Skill; Femur

44
Q

What compression injuries should you look out for?

A

Cranial nerve (palsies); Deafness; basilar invagination (potentially leading to brainstem compression and death); Cauda Equina (paraplegia); sciatica

45
Q

How can you diagnose Paget’s disease?

A

X-ray; Blood Tests; Isotope Bone Scan (increased uptake); Urinary Hydroxyproline (increased)

46
Q

What would the following results be (high, low, normal) in a blood test for a Pt with Paget’s - Alkaline Phosphatase;
Calcium; PTH; Vit D; phosphate ?

A

Alkaline Phosphatase - High

Calcium, PTH, Vit D, phosphate ALL normal

47
Q

How should you treat someone with Paget’s Disease?

A

ONLY if SYMPTOMATIC treat with bisphosphonates (Risedronate or Zolendronate)

48
Q

In a blood test if serum calcium is normal, phosphate is low and Alkaline Phosphatase is high what is the likely diagnosis with regard to bone disease?

A

Osteomalacia

49
Q

In a blood test if serum calcium is normal, phosphate is normal and Alkaline Phosphatase is very high what is the likely diagnosis with regard to bone disease?

A

Paget’s Diease

50
Q

In a blood test if serum calcium is high, phosphate is low and Alkaline Phosphatase is normal what is the likely diagnosis with regard to bone disease?

A

Primary hyperparathyroidism

51
Q

In a blood test if serum calcium is high, phosphate is high and Alkaline Phosphatase is high what is the likely diagnosis with regard to bone disease?

A

Bone metastases

52
Q

What affect do corticosteroids have on bone cells?

A

inhibit osteoblast activity and enhance osteoclastic activity therefore increasing bone resorption

53
Q

What does calcitonin do?

A

Inhibits osteoclastic activity

Medicine Year 2 (28 decks)

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