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Clinical Pathology > Bone and Biochemistry > Flashcards

Bone and Biochemistry Flashcards

1
Q

Summary of Bone Pathology

A

Bone composition/cells
Investigations of Bone disease

Bone Diseases:

  • Osteoporosis
  • HPT
  • Paget’s, -Osteomalacia/Rickets
  • Mets

Ca/Mg/Pi homeostasis

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2
Q

State 4 functions of bone.

A

Structural support
Protection
Produce blood cells
Store minerals (esp Ca)

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3
Q

Bones are HIGHLY VASCULAR & are constantly remodelling. Describe the 4 structural components of bone.

A

Outer: Cortical bone
Inner: Trabecular bone
Cells: (3)
ECM: Ca + minerals = hydroxypatitie

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4
Q

Which bone cell produces hormones to comm with other bone cells & produces osteoid?

A

Osteoblast

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5
Q

Markers for osteoblast activity and therefore bone formation?

A

P1NP

ALP

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6
Q

Which bone cell regulated ECM turonver & has mechanosensory properties?

A

Osteocytes

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7
Q

Osteoclasts breakdown bone and have a ruffled border. What regulates them?

A

PTH
Clacitonin
IL-6

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8
Q

As we age our bone becomes less dense. Who are most suseptibly to a quicker decrease in bone density and therefore osteoporosis?

A

Early menopause women

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9
Q

State 4 commonly used investigations in bone disease.

A

X-ray (gross)
DEXA (density)
Bone markers
Biopsy

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10
Q

Name the bone formation and bone resorption markers.

A

Bone formation: P1NP,
ALP (also in HPT, growth spurt, preg, fractures, Paget’s

Bone resorption: CTX, NTX (increases in periods of high bone turnover)

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11
Q

DEXA uses radiation through which bones to assess density?

A

Lumbar spine

Hip

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12
Q

A T-score in DEXA of

A

OSTEOPOROSIS

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13
Q

A normal T-score in DEXA is over what value?

A

> -1

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14
Q

Osteoporosis has numerous risk factors. List 5 main ones.

A 
Female
Early menopause
Smoking
Alcohol
Long-term steroids
Vit D def
UC
RA
UC
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15
Q

2” causes of osteoporosis involve conditions from which systems?

A 
Endocrine
GI
Haematological
Respiratory
RA
CKD
Drugs
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16
Q

Osteoporosis presents as increase biconvavity in T vertebral bodies, vertebral fractures and a hunched back. T/F?

A

T

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17
Q

Common complication of osteoporisis is…?

A

Fragility fractures

FRAX tool

18
Q

Bone mets can be lytic or osteoblastic. Presentation?

A

Signs of hypercalcaemia
Pain
Pathological fractures
Numbness/paralysis, diff urinating (sc mets*)

19
Q

1” HPT is often seen in Females, >45yrs. What are the 4 possible causes?

A

Adenoma
Parathyroid carcinoma (rare)
Glandular hyperplasia
Ectopic adenoma

20
Q

1” HPT is often ASYMPTOMATIC. What are other possible presentations?

A

Symptoms of hypercalcaemia

Renal: stones, CKD

Bone: Osteoporosis

Proximal muscle wasting

21
Q

Investigations for 1” HPT?

A

Imagine: Tc99 Sestambi

Biochemistry (high PTH, high ca, low Pi, High ALP)

22
Q

Treatment for 1” HPT?

A

Calcimimetics

Surgery

23
Q

2” HPT is caused by what?

A

Vit D def
CKD (kidneys activate Vit D)

(High PTH, Low Ca)

24
Q

Which type of HPT is present in prolonged 2” HPT (usually CKD)?

A

3” HPT

25
Q

Which type of HPT is present in prolonged 2” HPT (usually CKD)?

A

3” HPT

26
Q

The presentation of hypercalcamaemia is described using what mneumonic?

A

BONES, STONES, GROANS & MOANS

27
Q

Mild symptoms of hypercalcaemia?

A 
Polyuria/Polydispia
Anorexia
Nausea
Constipation
Mood changes
28
Q

Severe symptoms of hypercalcaemia?

A 
Abdo pain
Vomiting/dehydration
Pancreatitis
Arrthymias
Coma
29
Q

State the most common non-PTH and PTH mediated causes of hypercalcaemia.

A

Non-PTH - malignancy
(Sarcoidosis, hyperthyroid, acromegaly)

PTH - 1” HPT

30
Q

Vit D def, hypoparathyroidism, Hypoproteinaemia, Reduced dietary intake and EDTA contamination can all cause what?

A

Hypocalcaemia

31
Q

Ca is needed for what functions?

A 
Muscle contraction
Neuronal excitability
Blood clotting
Enzyme activity
Bone ECM
32
Q

[Ca] is regulated by the Kidneys/Gut/Bone. What 2 molecules also feature in Ca metabolism?

A

PTH

Vit D

33
Q

Does Acidosis lead to hypercalcaemia or hypocalcaemia?

A

Hypercalcaemia

H+ displaces Ca

34
Q

Mg is an intracellular ion that is essential in metabolism of what other ions?

A

Ca - Releases PTH

K+ - reabsorption in kidneys

ALWAYS CONSIDER HYPOKALAEMIA/HYPOCALCAEMIA with Mg def

35
Q

Mg is used for what in the body..?

A 
Neuromuscular excitation
Cofactor ATP
Enzyme activity
Aids PTH release
Aids K+ reabsorption
36
Q

Name 3 causes of hypomagnesia.

common in hospitals

A

Renal
Drugs: Gentamicin, chemo, Diuretics
GI: Malnutrition/Malabsorption, IV nutrition, diarrhoea

37
Q

Hypomagnesia can cause muscle weakness, decrease CV contractility, ataxia, hyperreflexia etc.. T/F?

A

T

38
Q

Phosphate is an intracellular ion involved in intracellular signalling. What are some of its functions?

A 
ATP component
Cellular metabolism
DNA backbone
Bone ECM
Cell membrane
39
Q

What hormone controls [Pi]?

A

PTH

Promotes excretion

40
Q

Pi def can lead to muscle weakness, general cellular dysfunction. Severe def can lead to what?

A

RESPIRATORY FAILURE

41
Q

Causes of Pi def?

A

HPT
Reduced dietary intake
Excess loss: renal, GI, Diabetes (diuresis)
Refeeding syndrome

Clinical Pathology (13 decks)

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