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Y3 MedEd > Bones > Flashcards

Bones Flashcards

1
Q

Factors that increase calcium (2)

A

PTH

Calcitriol (activated vitamin D)(1,25-(OH)2D3)

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2
Q

Factors that decrease calcium

A

Calcitonin

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3
Q

Where is calcitonin synthesised

A

parafollicular cells

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4
Q

Describe the synthesis of calcitriol

A

Vitamin D from diet and UV light
25 hydroxylase in the liver converts it to 25-hydroxyD3
1alpha hydroxylase and PTH in the kidneys convert it to calcitriol

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5
Q

Where does PTH have its effects

A

Kidneys
Bone
Small intestines

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6
Q

Where does calcitriol have its effects

A

Kidneys
Bone
Small intestines

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7
Q

Effect of PTH in the kidneys (3)

A

1α-hydroxylase stimulation
Increased calcium reabsorption
Increased phosphate excretion

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8
Q

Effect of PTH in the bone

A

Increased bone resorption

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9
Q

Effect of PTH in the small intestines (2)

A

Increased calcium absorption

Increased phosphate absorption

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10
Q

Effect of calcitriol in the kidneys (2)

A

Increased calcium reabsorption

Decreased phosphate reabsorption

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11
Q

Effect of calcitriol in bone

A

Increased bone formation

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12
Q

Effect of calcitriol in the small intestines (2)

A

Increased calcium absorption

Increased phosphate absorption

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13
Q

Resultant effect of PTH

A

↑ Calcium

↓ Phosphate

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14
Q

Resultant effect of calcitriol

A

↑ ↑ Calcium

↓ Phosphate

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15
Q
  1. Which hormone decreases blood calcium levels?
A

Calcitonin

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16
Q
  1. Which hormone, out of PTH and calcitriol, raises blood calcium levels the most?
A

Calcitriol

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17
Q
  1. Which enzyme does PTH activate in the kidneys?
A

1α-hydroxylase

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18
Q
  1. What does PTH do to your blood phosphate levels?
A

Decreases

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19
Q
  1. Why may the UK population be generally vitamin D deficient?
A

Less sunlight (UV)

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20
Q

What decreases PTH production

A

Calcitriol and increased calcium

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21
Q

What happens in primary hyperparathyroidism

A

Autonomous secretion of PTH uninhibited by calcium

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22
Q

What happens in secondary hyperparathyroidism

A

Physiological response to hypocalcaemia

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23
Q

Signs of hypocalcaemia (4)

A

CATs go numb

Convulsions
Arrhythmias (e.g. prolonged QT interval)
Tetany
Paraesthesia (hands, mouth, feet, lips)

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24
Q

What are the signs you can elicit in hypocalcaemia (2)

A

Trousseau’s sign

Chvostek’s sign

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25
Signs of hypercalcaemia (6)
”Stones, bones, thrones, abdominal moans, psychiatric overtones” ``` Renal stones Bone pain/damage Polyuria Abdo upset (nausea, constipation, pain) Psychiatric conditions (depression, anxiety) ``` AND PANCREATITIS!
26
RF for PHPT (3)
MEN-1 or MEN-2 | Hypertension
27
Which s/s are seen in PHPT
Signs and symptoms Often asymptomatic Hypercalcaemia: ”Stones, bones, thrones, abdominal moans, psychiatric overtones”
28
Causes of secondary SHPT (3)
Vitamin D deficiency (Poor dietary intake Poor sunlight Malabsorption) Chronic kidney disease Liver disease
29
Signs and symptoms of SHPT (4)
Fractures/bone pain Proximal myopathy Fatigue Hypocalcaemia: ”CATs go numb” Rickets in children
30
Causes of proximal myopathy (3)
COT = Cushing’s, osteomalacia, thyrotoxicosis
31
``` PHPT: Calcium Phosphate PTH Vit D ALP ```
``` Calcium: increased Phosphate: decreased PTH: increased (or normal) Vit D: normal ALP: increased (or normal) ```
32
``` Osteomalacia (vit D deficiency): Calcium Phosphate PTH Vit D ALP ```
``` Calcium: decreased Phosphate: decreased PTH: increased Vit D: decreased ALP: increased ```
33
``` Osteomalacia (CKD): Calcium Phosphate PTH Vit D ALP ```
``` Calcium: decreased Phosphate: increased PTH: increased Vit D: decreased ALP: increased ```
34
Bloods (9) and imaging (and why, 3) for hyperparathyroidism
X-rays/CT (extent of bone disease) CT KUB (for renal stones) Cervical U/S (before surgery)
35
Mx of acute hypercalcaemia in PHPT (2)
IV fluids | Bisphosphonates (if calcium remains high)
36
Mx of acute hypocalcaemia in SHPT
IV calcium infusion | (calcium gluconate)
37
What is calcium gluconate used for
Hyperkalaemia | Hypocalcaemia
38
Mx of PHPT (not acute)
Surgical (1st line) Total parathyroidectomy Medical Cinacalcet (if unsuitable for surgery) (drug class: calcimemetic)
39
Mx of SHPT (not acute)
Medical Calcium Vitamin D (inactive - ergocalciferol)
40
Mx of osteomalacia due to CKD
Treat CKD Calcium Vitamin D (active - alfacalcidol)
41
``` A 63 year old man is furious that he has been waiting an hour for his appointment. When he finally talks to the doctor, he admits to generalised bone pain and muscle weakness. His blood results reveal the following: Calcium 2.08 mmol/L      (2.1-2.6) Phosphate 0.74 mmol/L      (0.8-1.4) ALT 29 iu/L                   (3-40) ALP 343 umol/L        (30-100) ``` Whats the diagnosis
Osteomalacia (vit D deficiency)
42
``` A 75 year old woman presents with polyuria, constipation. She admits that her mood has been low over the past few weeks. Her blood results reveal the following: Calcium 2.88 mmol/L      (2.1-2.6) Phosphate 0.75 mmol/L      (0.8-1.4) PTH 5 pmol/L            (0.8-8.5) Fasting glucose 4.5 mmol/L ``` Diagnosis?
Primary hyperparathyroidism
43
Define Pagets disease
disorder of bone remodelling (i.e. formation and resorption) – genetic factors play a role
44
What are the three phases of Paget's disease
``` 1. Lytic phase Hyperactive osteoclasts -> resorption 2. Mixed phase Compensation by osteoblasts 3. Sclerotic phase Hyperactive osteoblasts -> formation (woven bone, not lamellar) ```
45
RF of Paget's disease
Elderly | FHx
46
Symptoms of Paget's disease (2 main causes of presenting)
``` Often asymptomatic Bone pain (insidious onset) Femur Pelvis Skull Nerve compression Hearing loss (sensorineural) Sciatica ```
47
Signs of Paget's disease (3)
``` Bone bossing Skull Femur Tibia Thoracic kyphosis Warm skin over painful area (high metabolic activity) ```
48
``` Pagets disease: Ca PO4 PTH Vit D ALP ```
``` Ca2+ normal PO43- normal PTH normal Vit D normal ALP ↑ ```
49
Ix for Pagets disease (11)
``` Bloods (FBC, CRP) U&E LFTs (ALP) Calcium Phosphate PTH Vitamin D Serum CTX (bone resorption marker) Serum P1NP (bone formation marker) ``` Imaging X-rays Bone scan (Tec99)
50
Which special Ix for Pagets (3)
``` Serum CTX (bone resorption marker) Serum P1NP (bone formation marker) Bone scan (Tec99) ```
51
Define osteoporosis
Definition: reduced bone density
52
Causes of primary osteoporosis
``` Post-menopausal Old age (>50 years ```
53
Causes of secondary osteoporosis (5 main ways)
``` Drugs – steroids, thyroxine Endo – Cushing’s disease, osteomalacia, hyperT Cancer – multiple myeloma MSK – SLE, rheumatoid arthritis GI – coeliac disease, IBD ```
54
Drugs that can cause osteoporosis (2)
Steroids, thyroxine
55
Endo problems that can cause osteoporosis (3)
Cushing’s disease, osteomalacia, hyperthyroidism
56
Cancers that can cause osteoporosis
MM
57
MSk problems that can cause osteoporosis (2)
SLE, RA
58
GI problems that can cause osteoporosis (2)
coeliac disease, IBD
59
Imaging for osteoporosis
DEXA scan
60
What is a T score and what is a Z score in osteoporosis
T-score: Patient’s BMD compared to young, healthy adult Z-score: Patient’s BMD compared to age-matched BMD
61
What are the different classifications of osteoporosis
Normal 0 Osteopaenia -1--2.5 Osteoporosis >2.5
62
``` Calcium 3.8 mmol/L        (2.1-2.6) Phosphate 0.74 mmol/L      (0.8-1.4) PTH 6.6 pmol/L         (0.8-8.5) ALP 46 umol/L          (30-100) ``` What does this show?
PHPT - PTH is inappropriately normal

Y3 MedEd (34 decks)

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