Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Geriatrics > Bones > Flashcards

Bones Flashcards

(121 cards)

Start Studying
1
Q

What happens to bone mass and bone mineralisation in osteoporosis?

A

Bone mass decreases

Bone mineralisation stays the same

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

What is osteoporosis characterised by?

A

Low trauma fragility fractures

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

Family history is important for what kind of fracture?

A

Hip fracture

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

Risk factors for osteoporosis?

A 
Woman
Menopause
Early menopause
Low calcium diet especially teenage years
Lack of mobility 
FH of hip fracture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 causes of primary osteoporosis?

A

Post-menopausal lack of oestrogen

Lack of mobility

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

Pneumonic RACISM for secondary causes of osteoporosis?

A 
Rheumatoid arthritis
Alcohol
Corticosteroids
Immobility
Smoking
Multiple myeloma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

% of fractures in women over the age of 45 that are caused by osteoporosis?

A

70%

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

4 most common sites for fractures?

A

Proximal humerus
Proximal femur
Colle’s fracture
Vertebral fracture

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

What types of things can result from multiple vertebral fractures?

A 
Chronic back pain
Reflux oesphagitis
Kyphosis
Loss of height
Abdominal distension
Neck pain
Depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the 1 year mortality after a hip fracture?

A

25%

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

In osteoporosis how will a bone profile be affected?

A

Calcium normal
Phosphate normal
ALP normal

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

How are vertebral fractures identified on xray

A

with more than a 20% loss in vertebral height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What percentage loss in height of the vertebrae is classified as a crush fracture?

A

50%

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

Very advanced vertebral fractures are known as what?

A

Vertebra plana

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

What scan do you perform to assess osteoporosis?

A

DEXA scan

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

What is a T score on a DEXA scan and what does it symbolise?

A

T score is a measure of the bone mineral density as standard deviations relative to the peak bone mass

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

What is the T score of normal bone density?

A

1

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

What is the t score of osteopenia?

A

-1 to -1.5

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

What is the T score of osteoporosis?

A

-2.5 or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the difference between osteoporosis and established osteoporosis?

A

They will both have a T score below -2.5 but the established osteoporosis will also have fractures

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

How can you prevent osteoporosis?

A

1g of Calcium per day in diet

Weight baring exercises in adolescence

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

3 supplements given to elderly patients with a fracture?

A

1g Calcium
800 IU of Vitamin D3
Oral bisphosphonates

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

What do you have to tell a patient about taking bisphosphonates and the side effect?

A

Need to be taken fasting

Side effect of reflux oesophagitis if not taking standing with a glass of water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name 2 commonly used bisphosphonates

A

Alendronic acid

Risedronate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the only drug that actually increases the bone mass density?
Teriparatide
26
How is Teriparatide administerd?
daily SC injection for 18 months
27
What is osteomalacia?
Failure of the matrix to calcify leading to low bone mineralisation
28
What causes osteomalacia?
Vitamin D deficiency
29
Compare bone mineralisation and bone density in both osteoporosis and osteomalacia?
Bone mineralisation is normal in osteoporosis but abnormal in osteomalacia Bone density is normal in osteomalacia but abnormal in osteoporosis
30
What is the active form of Vitamin D
1,25 - dihydroxycholecalciferol
31
What is the childhood form of osteomalacia?
Rickets
32
What causes Vitamin D deficiency in elderly?
``` Lack of sunlight Immobility Isolation Dietary deficiency due to gastrectomy Chronic renal failure Drugs - barbituates ```
33
Classical symptoms of osteomalacia?
Bone pain | Weakness of proximal muscles - waddling gait
34
What 4 investigations would you perform in suspected osteomalacia?
``` Bone profile U&E X-rays Bone biopsy LFT - albumin ```
35
What would a bone profile and urinalysis find in osteomalacia?
``` Calcium slightly low Phosphate is slightly low ALP slightly raised Urinary calcium is low CKD sees raised phosphate on urinalysis ```
36
3 things you would find on an xray of osteomalacia?
Looser zones Transverse lucencies Pseudofractures at point of stress (diagnostic when present)
37
Diagnostic investigation into osteomalacia?
Bone biopsy
38
What do you treat osteomalacia with?
Vitamin D | Calcium supplements
39
What calcium supplement do you treat osteomalacia with?
Ergocalciferol
40
If there is poor compliance to ergocalciferol what is used instead?
IM calciferol 600k IU
41
How many units of vitamin D is in ergocalciferol?
10000-20000 IU
42
Prophylaxis of osteomalacia what 2 things are given?
Vit D3 800 IU OD | Calcium 1g
43
What is Paget's Disease? 7 bones most likely effected in Pagets?
``` localised and patchy with new born being soft and spongy, prone to deformity and fractures Pelvis Lumbar spine Humerus Femur Tibia Clavicle Skull ```
44
4 key features seen in the bone of someone with Paget's disease?
Increase in multinucleated osteoclasts Increase in osteoblasts Increased fibrosis Bone matrix becomes disorganised
45
What 2 investigations would you do for someone with suspected Paget's disease? What abnormalities would you see on both?
Bone profile - normal phosphate and calcium but abnormally high ALP X-ray - Cortical thickening and thickened trabecular pattern
46
Pagets disease is the only disease that does what to the bone?
Causes bony expansion
47
What is used as treatment for Pagets disease?
bisphosphonates - Oral risedronate 30mg OD for 2 months or IV zoledronic acid 5mg one dose
48
What are the main 2 ways in which effectiveness of Pagets disease treatment is assessed?
Level of ALP | Level of bone pain
49
What scan is performed to assess Paget's disease?
bone scintigraphy Assesses level of technetium uptake Technetium isotope bone scintigraphy
50
6 most common sites for a pathological fracture to occur?
``` Thoracic vertebrae Lumbar vertebrae Skull Femur Ribs Pelvis ```
51
7 big cancers that are known to spread to the bone?
3 pairs - lungs, breast, kidney 2 midline glands - thyroid, prostate 2 Ms - myeloma, melanoma
52
What 4 investigations can be done for a pathological fracture?
X-ray Bone profile MRI Techetium isotope scintography
53
What is raised in a bone profile of a pathological fracture?
Calcium and ALP
54
How are metastases seen on an x-ray?
Sclerotic, lytic mixed lesions
55
3 treatments of bone metastases?
Bisphosphonates Radiotherapy Orthopaedic surgery
56
What is polymyalgia rheumatica and what are 4 locations where it usually occurs?
Pain or stiffness caused by blood vessel inflammation that usually occurs in the shoulders, neck, upper arms and hips
57
3 main features of temporal arteritis? what is the concern if it is left untreated?
Headache temple tenderness jaw claudication
58
4 risk factors for polymyalgia rheumatica?
Viral or bacterial infection Genetics over 65 female twice as likely
59
Presenting complaints in polymyalgia rheumatica?
vague symptoms of weight loss, pain, mild fever | Stiffness in neck, arms and shoulders
60
What 3 things will blood tests show in polymyalgia rheumatica?
Abnormal LFTs Mild anaemia Raised ESR and CRP
61
What is the full steroid treatment course in polymyalgia rheumatica?
40mg Prednisolone for 1 week then a reducing dose over 12-18 months
62
What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in osteoporosis?
Dont change
63
What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Osteomalacia?
``` Calcium decreases Phosphate decreases ALP increases Urea stays the same Urine Ca decreases ```
64
What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Renal bone disease?
``` Calcium decreases Phosphate increases ALP increases Urea increass Urine Ca decreases ```
65
What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Paget's Disease?
``` Calcium is the same Phosphate is the same ALP increases loads Urea is the same Urine Ca increases ```
66
What happens to Calcium, Phosphate, ALP, Urea and Urine Ca in Hyperparathyroidism?
``` Calcium increases Phosphate decreases ALP increases Urea is normal Urine Ca increases ```
67
What is osteoarthritis?
Disintegration of articular cartilage usually accompanied by osteophyte formation
68
What are some predisposing factors to the development of osteoarthritis?
``` Previous damage Avascular necrosis of the joint Disease of the joint - rheumatoid, gout Hypermobility Endocrine diseases - acromegaly, diabetes, hyperparathyroidism Obesity Occupation Hereditory ```
69
Which joints are most effected in osteoarthritis?
Knees Hips Sometimes elbows and shoulders Women = DIP joints
70
How is the pain characterised in osteoarthritis?
Worse late in evenings after use Morning stiffness less than an hour Can impair mobility
71
What can be felt on examination of joints with osteoarthritis?
Crepitus | Bony swelling - herbedens (DIJ) and bouchards (PIJ)
72
4 signs of osteoarthritis on xray?
Sclerotic changes Subchondral cysts Loss of joint space Osteophytes
73
What can be put into joints of osteoarthritis to reduce pain?
Intra-articular injection of steroids such as methylprednisolone
74
Surgical treatment of osteoarthritis?
Arthroplasty
75
What form of Rheumatoid arthritis is most likely to lead to old, frail individuals with fragile skin and peripheral neuropathy/vasculitis?
Seropositive RA
76
What medication can be used in RA if there is evidence of active disease?
DMARDs
77
What is the predominant pathophysiology thought to be developing in RA?
Autoimmune response that effects the synovial membranes and causes joint destruction
78
Is inflammation present in OA/RA?
Only in RA really
79
What generalised symptoms may be present in RA that arent present in OA?
Feelings of fatigue, weakness, anaemia
80
What can be found in the blood that is specific to rheumatoid arthritis?
Rheumatoid factor
81
What is the antibody present in the blood of those with RA?
Anti-CCP
82
4 blood tests in RA?
CRP ESR Anti-CCP Rheumatoid factor
83
How does drug metabolism change over time?
decreases as liver enzymes become less active
84
How does drug excretion change as we age?
Glomerular filtration and renal plasma flow decrease
85
What is the difference between a stroke and a TIA?
They are both disturbances of cerebral function due to a presumed vascular origin but TIA lasts less than 24 hours and stroke last longer
86
Risk factors for atherosclerosis?
``` High blood pressure Smoking Diabetes elevated blood lipids OCP Obesity ```
87
3 reasons why a CT scan used in stroke?
Confirm the diagnosis Identify if there is any haemorrhage Determine underlying pathology
88
Benefits of an early CT scan vs a late CT scan on type of stroke identifiable?
Early - haemorrhagic | 2-4 days - ischaemic
89
Symptoms of a haemorrhagic stroke vs an ischaemic?
Haemorrhagic usually accompanied by headache and more sudden onset Haemorrhagic nearly always a hypertensive patient whereas ischaemic isnt Usually vomiting with haemorrhagic not often with ischaemic Consciousness usually lost with haemorrhagic but not with ischaemic
90
If a stroke presents with an isolated motor impairment, where is it likely to have occured?
In the internal capsule
91
Which side of the brain is the speech centre in?
Usually the opposite to your dominant hand except half of left handed people where it is still on the left side
92
Difference between aphasia and dysphasia?
Aphasia is when speech is absent and dysphasia is when speech is impaired
93
2 types of dysphasia?
Expressive and receptive
94
How should you talk to someone with receptive dysphasia?
Speak slower in smaller sentences | Stand in front of the patient so they can see facial movements
95
what is the difference between dysarthria and dysphasia?
Dysarthria is a disorder of the muscles of articulation
96
What is dysphonia?
disease of the vocal cords, larynx or respiratory system
97
What is neglect?
When the patient becomes inattentive to the affected side
98
What area of the brain is usually effected which causes the patient to present with neglect?
Non-dominant parietal lobe
99
How can you see neglect present in body language? following an object? 2 tests?
Shift body away from stimulus, posture of head, eyes and body turned away Difficulty following an object past the effected side Alberts test or star cancellation test
100
3 motor disorders that can develop in stroke?
Hemiplegia Spasticity Apraxia
101
What is the usual presentation of spasticity in the upper and lower limbs following a stroke?
Flexion in the upper limbs and extension in the lower limbs
102
Name 2 thrombolytic drugs that can be used in the treatment of acute ischaemic stroke? time limit
Alteplase Streptokinase 4.5 hours
103
3 phases of stroke care?
Acute phase - 1-2 weeks rehabilitation phase - 2-12 weeks Up to 2 years - to regain full function
104
How long after someone has had a stroke do you then assess the severity and make a management plan?
2 weeks
105
What aspects of the patient need to be examined post stroke?
``` General medical and exercise tolerance Speech impairment Sensory impairment - sight, hearing, sensation Muscle tone - spasticity, tone Mental capacity Motivation Swallowing ```
106
What is the most common cause of death in stroke survivors?
IHD
107
3 factors that are associated with poor prognosis of survival in stroke that indicate extensive damage to cerebral hemisphere or brain stem invovlement?
Impaired consiousness Paralysis of conjugate deviation of the eye Dense paralysis
108
How does alteplase effect rates of mortality and morbidity in relation to ischaemic stroke?
decreases rate of morbidity but has little effect on mortality
109
How do you manage and assess dysphagia in the early days post stroke?
Assess by SLT before feeding Food through NG tube/PEG Gag reflex does not indicate in tact swallow
110
If a patient does not appear to improve 48 hours after stroke symptoms, what do you need think about as alternative diagnosis?
``` Acute infection - respiratory, urinary tract Subdural haematoma Subarachnoid haemorrhage Metabolic disorders - DKA Cardiac impairment Renal or hepatic failure Hypothermia Drugs ```
111
3 aspects of the stroke rehabilitation?
Physical rehabilitation Mental rehabilitation Social rehabilitation
112
What dose of aspirin in used in acute phase of stroke and in long term prophylactic prevention post stroke?
Acute phase = 150mg | Long term = 75mg OD
113
Before prescribing aspirin what needs to be excluded?
Cerebral haemorrhage
114
5 situations where long term anticoagulant therapy beneficial?
``` AF Completed ischaemic stroke TIA Valvular heart disease Prosthetic heart valves ```
115
List some complications of stroke?
``` Depression Epilepsy Venous thrombosis Painful stiff shoulder Persistent pain Fracture of long bones Peripheral nerve palsies Oedema of affected limb Bullae Contractures Foot drop ```
116
How does painful stiff shoulder develop after a stroke and what is its management?
Due to poor positioning and hemiplegia Results in painful capsulitis Treat with analgesia, heat packs and passive movements
117
Main prevention and treatment of stroke related physical complications?
Individually designed orthoses Foot rest when seated Surgery
118
What is the ABCD2 criteria for having another stroke at 7 days and 90 days?
``` Age - over 65 Blood pressure - over 140/90 Clinical features - unilateral weakness D - diabetic D - Duration over 60 mins or less than 60 mins ```
119
What are the points allocated for each criteria in the ABCD2 criteria?
``` Age over 65 is 1 point Blood pressure is 1 point Unilateral weakness is 2 points dibetic is 1 points duration over 60 mins is 2 points and under 60 mins is 1 point ```
120
If someone scores 6 or 7 on the ABCD2 criteria what is the chance of them suffering another stroke in 7 days and 90 days?
12% | 18%
121
If someone scores 0-3 on the ABCD2 criteria what is the chance of them suffering another stroke in 7 days or 90 days?
1% | 3%

Geriatrics (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions