Week 3 Flashcards
Recognise common pathologies occurring at the following sites: spinal cord, nerve root, plexus, peripheral nerves (motor and sensory), neuromuscular junction, muscle
peripheral neuropathy affects longest nerves of the body, hands and feet sock distribution.
can get abnormal spontaneous excessive function.
charcot marie tooth- peripheral neuropathy- combines motor, sensory and autonomic- leads to joint deformities as present from birth.
GBS- nerves + nerve routes affected- peripheral and then proximal.
anterior horn cell disorders
motor neuron disease
myasthenia gravis affects what
neuromuscular junction
should have no sensory disturbance
affects eyelids and ocular muscles.
hallmark: fatiguability- progressively weaker with ongoing use.
myopathy is what
disorder of the muscles- proximal weakness - limb girdle.
e.g muscular distrophy.
induced by steroid use.
Recognise the signs and symptoms of hyper- and hypo-calcaemia
Hyper-dec concentration, confusion, fatigue, stupor, coma.
QT interval shortens- slow HR and HTN.
bone pains, osteopenia osteoperosis, musle weakness.
gut- feeling sick, vomit, peptic ulcer, pancreatitis
Ca directly toxic to renal tubules.
STONES BONES PSYCHIC MOANS.
hypocalcaemia- muscle cramps, distal parasthesia, bronchospasm, colic, tetany, confusion hallucinations and seziures. chvosteks sign.
List the common causes of of hyper- and hypo-calcaemia and explain in overview how they cause abnormal calcium levels
hypercalcaemia
divided into high PTH and low PTH causes
high- hyperparathyroidism (rare cancer)
low PTH- Cancer (rare- hypervitaminosisD, granulomatous disease) acromegaly/ thyrotoxicosis
anything in the picture is for hypocalcaemia
Outline the investigative pathways for common causes of hypercalcaemia (hyperparathyroidism, hypercalcaemia of malignancy) and interpret basic blood tests in relation to calcium levels
Cxr- central opacities- bilateral hilar lymphadenopathy.
inc PTH- uss of neck
dec PTH- bone scan.
Outline the treatment options for hypercalcemia including immediate and longer-term management
saline rehydration 3-6L
frusemide
pamirdronate infusion 15-90mg
calcitonin 400iu IM Qds
pred 40mg
dialysis- if its higher than 4.
Outline the treatment of hypocalcaemia
treat underlying cause
(discontinue offending drugs
oral supplimentation up to 2g a day.
vit D supplimentation.
severe- 10ml 10% IV calcium gluconate diluted in saline 200ml. over 10 mins.
Understand what is meant by primary, secondary and tertiary hyperparathyroidism
primary- overgrowth of a single gland ca level high pth level high.
2’ - calcium level is low- high pth- all 4 glands become hyperplastic.
3’ - had a condition that causes 2’ and has been cured (renal failure treated with transplant) - forget how to control themselves and become self governing (4 gland hyperplasia)
Describe the process of calcium and phosphate homeostasis in relation to its endocrinological control and the roles of bone, parathyroid glands and kidney
pth- stims osteoblasts to prod rank ligand- more ca released.
inc ca reabsorbtion in DCT
vit D- synth in liver then kidneys. it is a fat- hits type 2 nuclear receptor(RNA). synergises with PTH on bone. inhibits PTH synth. increased Ca2+ absorption in the gut. regulates itself. causes mature osteoblasts –> osteocyte.
Describe the process of bone remodelling and its endocrinological control
osteoclast- myeloid lineage, similar to macrophages. prod acid to dissolve, prod enzymes. Creates a sealed zone to make it tidy.
blasts- create new bone. become quiecant cells or osteocites.
mineralisation, quiecance, reabsorbtion, formation.
Describe the pathogenesis of osteoporosis and relate to risk factors for the development of osteoporosis
1/2 women will break a bone, 1 in 5 men due to osteoperosis.
reduced bone mass and strength
Outline the common clinical presentation and diagnosis of osteoporosis
DEXA scan measures quantity not quality.measures bone mineral density. (hip, Lspine)
does not tell about quality of bone.
osteoporosis is T score of -2.5 on dexa. (not entirely diagnostic, also need other tests)
need to do FRAX assessment online (evaluates risk factors also)
low t score not always due to osteoporosis. or could have high score due to osteophites.
silent disease, often present with fracture.
Outline the treatments for osteoporosis and their mechanisms of action
antireabsorbative drugs - bisphosphinates, rank lignad inhibitors (denosmab)
anabolic drugs -act on osteoblasts- parathyroid hormone-34
romosozumab - sclerosin antibody.
