Metabolic Diseases

Question 1

give example of a qualitative and quantitative bone defect

Answer 1

qualitative: osteomalacia
quantitative: osteoporosis

Question 2

what is the pathology of osteomalacia

Answer 2

softer bones due to decreased osteoid mineralisation

Question 3

risk factors for osteomalacia

Answer 3

vit d deficiency, phosphorus deficiency, calcium deficiency,
alcohol, CKD, refeeding synd

Question 4

what is seen on examination in osteomalacia

Answer 4

small bone deformities, bow leg, square head, pigeon chest

Question 5

presentation of hypocalcaemia

Answer 5

cramps, paraesthesia, fatigue, seizure, brittle nail

Question 6

symptoms of osteomalacia

Answer 6

bone pain, pathological fractures, hypocalcaemia symptoms

Question 7

investigations of osteomalacia

Answer 7

xr,

Question 8

what is seen on x-ray in osteomalacia

Answer 8

pseudofractures; Looser’s zones

Question 9

management of osteomalacia

Answer 9

vit D, Ca & phosphate supplements

Question 10

what is rickets

Answer 10

osteomalacia in children

Question 11

risk factors for osteoporosis

Answer 11

CCS, malnutrition, CKD, cancer, Cushing’s, hyper/hyperparathyroidism,

Question 12

pathology of osteoporosis

Answer 12

bone mineral density < 2.5

Question 13

investigations for osteoporosis

Answer 13

DEXA scan, normal serum Ca & phos

Question 14

what is type 1 osteoporosis

Answer 14

post-menopause

Question 15

what is type 2 osteoporosis

Answer 15

old age related

Question 16

what type of osteoporosis is more likely in hip fractures

Answer 16

type 2

Question 17

what type of osteoporosis is more likely in colles fracture

Answer 17

type 1

Question 18

management optics of osteoporosis

Answer 18

calcium and vit d supplements, biphosphonate, +- desunomab, +- strontium, +- HRT

Question 19

example, mechanism and side effects of biphosphonates

Answer 19

alendronate,

Question 20

mechanism of desunomab

Answer 20

decreases osteoclast activites

Question 21

mechanism of strontium

Answer 21

increases osteoblast activity

Question 22

why can osteoporosis occur post menopause

Answer 22

< protective oestrogen

Question 23

what does a DEXA scan measure

Answer 23

bone mineral density

Question 24

pathology of paget’s disease

Answer 24

increased bone turnover, increases osteoblasts and osteoclasts, thick/brittle bone layed

Question 25

which bone are commonly affected by paget's disease

Answer 25

axial skeleton, femur, tibia

Question 26

presentation of paget's disease

Answer 26

asymptomatic, elderly, pain, bony deformity, pathological fractures

Question 27

complications of paget's disease

Answer 27

osteoarthritis, hypercalcaemia, nerve compression, osteosarcoma, high output heart failure

Question 28

what clinical sign can be seen in paget's disease of the tibia

Answer 28

saber tibia

Question 29

investigations for paget's disease

Answer 29

>ALP, normal Ca, normal phosphorus, XR, bone scan

Question 30

what is seen on xr in paget's disease

Answer 30

thick trabeculae, lysis+ sclerosis

Question 31

management of paget's disease

Answer 31

analgesia, bisphosphonates, calcitonin, +- joint replacement

Question 32

cause of primary hyperparathyroidism

Answer 32

adenoma, hyperplasia, malignancy of parathyroid

Question 33

cause of secondary hyperparathyroidism

Answer 33

hypocalcaemia from < vit D or CKD

Question 34

cause of tertiary hyperparathyroidism

Answer 34

parathyriod hyperplasia after prolonged secondary hyperparathyroidism

Question 35

presentation of hyperparathyroidism

Answer 35

fatigue, depression, bone pain, myalgia, kidney, osteoporosis

Question 36

is phosphate normal in primary hyperparathyroidism

Answer 36

yes