Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3: Block 1: MSK system > Metabolic bone disease > Flashcards

Metabolic bone disease Flashcards

1
Q

Bone consists of (3)

A

Osteoblasts
Osteoclasts
Bone remodelling
cycles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What cell controls turnover

A

osteoblasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do we get VIT D

A

sunshine and diet

UV radiation - skin - chemical reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Chemical reactions of VIT D

A

7DHC

25 OH vit D (stored in lier fat and muscle)

kidney 1,25 Oh2 vit D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is calcium absorbed

A

gut under influence of vit d

maintaining extracellluar fluid calcium in a tight level for body functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Paget’s disease of bone

  • what does this cause and lead to?
A

Localised disorder of bone turnover

Increased bone resorption followed by increased bone formation

Leads to disorganised bone: bigger, less compact, more vascular and more susceptible to deformity and fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

does Paget’s disease have a genetic component?

believe there is a?

A

YES- strong
15-30% are familial

environmental trigger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the major viral trigger for Paget’s

A

Possibility of chronic viral infection within Osteoclast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

paget’s - symptoms (4)

A

always over 40, often over 60 in presentation

  • deep seated bone pain all the time, often at night
  • bone deformity

excessive heat over the Pagetic bone
- or by neurological complications such as nerve deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Common bones for Paget’s disease

A

long bone,

femur , tibia, fibia and humerus
pelvis , skull , forearm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Diagnostic tests for Paget’s

A

X-ray

isotope bone scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Features of tests that may show Paget’s disease (5) (more rarely)

A

Isolated elevation of serum alkaline phosphatase-is the commonest presentation in the 21st centuary - liver test

  • Bone pain and local heat
  • Bone deformity or fracture
  • Hearing loss
  • Rarely the development of osteosarcoma in affected bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Treatment of Paget’s Disease - what should you not treat on alone?

what therapy would yo use? - how is it given? is it repeated?

A

raised alkaline phosphatase

Intravenous Bisphosphonate therapy-One off zoledronic acid infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Paget’s is often a cause of ?

effectively managed by?

A

isolated elevation of serum alkaline phosphatase.

intravenous Bisphosphonates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What causes ricket’s in a growing child?

A

Severe nutritional vitamin D or Calcium deficiency causes insufficient mineralisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What Is caused in the adult after severe insufficient mineralisation

A

Osteomalacia in the adult when the epiphyseal lines are closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is impaired in low Vit D states

A

Muscle function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what does vit D - STIMULATE

A

absorption of calcium and phosphate from the gut and calcium and phosphate then become available for bone mineralisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Features of a child with rickets

A
  • Abnormal bony shape
  • stunted growth
  • large skull - frontal bossing
  • rib shape - rickety rosary
  • protruded abdomen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

how is rickets treated in children

A

vitamin D and calcium supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Osteomalacia in adult common in?
symptoms? (3)
- seen more common in?

A

elderly - house bound

bone pain, muscle weakness, increased falls risk

asian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where can you see micro fractures in osteomalacia?

A

pelvis, ribs and long bones - looser bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

treatment of osteomalacia

A

calcium and vit d supplements

24
Q

What is Osteogenesis Imperfecta - what is it characterised by?

A

Genetic disorder of connective tissue characterised by fragile bones from mild trauma and even acts of daily life

25
Q

How many types of genetic Osteogenesis Imperfecta

A

28

26
Q

Osteogenesis Imperfecta - type 1 , type 11, type 111, type 4
- describe them and the features
what types are they?

A

1: milder form-when child starts to walk and can present in adults

Type 11: lethal by age 1

Type 111: progressive
deforming with severe bone dysplasia and poor growth

Type 4 : similar to type 1 but more severe

collagen defects

27
Q

Osteogenesis Imperfecta-other features (7)

A

Growth deficiency

Defective tooth formation (dentigenesis imperfecta) - baby teeth

Hearing loss

Blue sclera

Scoliosis / Barrel Chest

Ligamentous laxity

Easy bruising

28
Q

management of OI

surgical
medical
social
genetic

A

surgical - to treat fractures

Medical - to prevent fracture intravenous Bisphosphonates

Social-educational and social adaptions

Genetic - genetic counselling for parents and next generation

29
Q

osteoporosis characterised by

- what does this lead to ?

A

low bone mass and micro architectural deterioration of bone tissue,

  • leading to enhanced bone fragility and a consequent increase in fracture risk
30
Q

DXA bone scanning for osteoporosis ? menopause ?

A
31
Q

The relevance of of osteoporosis is?

risk of fracture is related to?

A

risk of fracture

Age; BMD; Falls; and Bone Turnover

32
Q

what tool used in osteoporosis

A

FRAX - risk fracture assessment tool

Q fracture - aged 30-85, men and women

33
Q

Osteoporosis scanner when Q or FRAX is greater than??

what interferes with scan result?

A

10% - Prodigy Scanner
DEXTER
- L1-L4 in spine
- DXA scan of spine

  • aorta calcification
  • degeneration
34
Q

What else is scanned with DXA for osteoporosis

A

HIP scan - t scores and z scores are generated for the bone density

lateral DXA scan

total body often scanned in children and those who are underweight

35
Q

significant risk of osteoporosis fracture numbers?

A

a >10% risk of osteoporotic fracture over 10 years) the individual should be referred for a DXA scan ( Dual energy X-ray Absorptiometry)

36
Q

who should be referred for a DXA scan regardless of their Fracture risk percentage?

A

All who are on oral steroids or suffer a low trauma fracture

37
Q

How common is Osteoporosis?

A

I in 2 women over 50

I in 5 men over 50

38
Q

If you suffer 1 vertebral fracture you are?

A

are 5 times more likely to have another and twice as likely to have hip fracture than if you had no vertebral fractures.

39
Q

Endocrine causes of osteoporosis (6)

A

Thyrotoxicosis

Hyper and Hypoparathyroidim

Cushings

Hyperprolactinaemia

Hypopituitarism

Low sex hormone levels

in pregnancy and breast feeding bone can be lost

40
Q

Rheumatic causes of osteoporosis (3)

A

Rheumatoid arthritis

Ankylosing Spondylitis

Polymyalgia Rheumatica

41
Q

Gastroenterological causes of osteoporosis? (3)

ones in the liver and malabsorption

A

Inflammatory diseases: UC and crohns

Liver diseases: PBC, CAH, Alcoholic cirrhosis, Viral cirrhosis (Hep C)

Malabsorption: Cystic Fibrosis, chronic pancreatitis, coeliac disease, whipples disease, short gut syndromes and ischaemic bowel

42
Q

Medications which cause osteoporosis (6)

A

Steroids

PPI

Enzyme inducting antiepileptic medications

Aromatase inhibitors

GnRH inhibitors

Warfarin

43
Q

Peak bone mass age around- when does accelerated loss occur?

A

30 years old

  • menopause
44
Q

How to we prevent osteoporotic fractures?

A

Minimise risk factors - non smokers, alcohol intake

  • Ensure good calcium and Vitamin D status

Falls prevention strategies

Medications

45
Q

Medications that help prevent fractures

what are the side effects? (3)

A

Hormone replacement therapy

Increased risks of blood clots

Increased risk of breast cancer with extended use into late 50s/early 60s

Increased risk of Heart disease and stroke if used after large gap from menopause

46
Q

What are SERMS

A

Selective oEstrogen Receptor Modulator-Raloxifene

47
Q

Raloxifene reduces risk of ?

A

vertebral fractures

48
Q

Negative Effects of SERMS? (3)

A

Hot flushes if taken close to menopause

Increased clotting risks

Lack of protection at hip site

  • help reduce the risk of breast cancer
49
Q

Bisphosphonates are?

features required to use this mediation?

A

Oral Bisphosphonates generally the first line of treatment

Adequate Renal function required
Adequate Calcium and Vitamin D status 
Good Dental Health and Hygiene advised
Notify dentist on Bisphosphonates
Encourage regular check ups / well fitting dentures
50
Q

EGFR for Bisphosphonates

A

oral - less than 30

IV - less than 45

51
Q

Side effects of Bisphosphonates?

A
  • Oesophagitis
  • Iritis/uveitis
  • heartburn

Not safe when eGFR<30 mls/min

ONJ - osteonecrosis of jaw

Atypical femoral shaft fractures

52
Q

What is Denosumab

what does it reduce?
how is it given?

A

Monoclonal antibody against RANKL

Reduces osteoclastic bone resorption

Subcutaneous injection every 6 months - reduces bone break down but closer to recovery

53
Q

Denosumab is after in patients with?

A

significant renal impairment then bisphosphonates

54
Q

Denosumab blocks????

A

Osteoclast Formation, Function, and Survival Inhibited

55
Q

Side effects of Denosumab?

reserve it for?

A

Allergy/rash
Symptomatic hypocalcaemia if given when vitamin D deplete
ONJ
Atypical femoral shaft fractures - rebound fracture

  • older individuals
56
Q

only licensed anabolic therapy for bone?

how is it given?

A

TERIPARATIDE: Intermittent Human Parathyroid Hormone

single daily injection

57
Q

Side effects of Teriparatide? (3)

A

minor

  • Injection site irritation
  • Rarely hypercalcaemia
  • Allergy

not suitable for children

Year 3: Block 1: MSK system (22 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions