Parathyroids

Question 1

What mineral adds strength to bone?

Answer 1

Calcium phosphate

Question 2

Most Ca is contained where?

Answer 2

Skeleton

Question 3

PT glands are stimulated by:

Answer 3

Hypocalcaemia

Question 4

Effects of PTH

Answer 4

Increased Oc resorption
Reabsorption of Ca in kidneys
Excretion of phosphate
Synthesis and activation of Vitamin D

Question 5

Active form of Vitamin D

Answer 5

1,25-dihydroxycholecalciferol

Question 6

What converts Vitamin to active form in kidney?

Answer 6

PTH

Phosphate

Question 7

When is calcitonin secreted?

Answer 7

Severe hypercalcaemia to decrease serum Ca (inhibits Ocs, decreases absorption)

Question 8

Symptoms of hypercalcaemia

Answer 8

Stones, bones, moans and groans

Tired, confused, depression, kidney stones, cardiac arrhythmias, muscle weakness, constipation, thirsty

Question 9

Symptoms of hypocalcaemia

Answer 9

Cramp and tetany (increased excitability of skeletal muscle), pins and needles, breathing problems

Question 10

Levels of PTH and Ca in primary hyperparathyroidism

Answer 10

High PTH, high Ca

Question 11

Levels of PTH and Ca in secondary hyperparathyroidism

Answer 11

High PTH, low Ca

Question 12

Levels of PTH and Ca in tertiary hyperparathyroidism

Answer 12

High PTH, High Ca

Question 13

Treatment of hyperparathyroidism

Answer 13

Surgery if renal impairment/stones/osteoporosis/

Question 14

Causes of hypoparathyroidism

Answer 14

DiGeorge syndrome, thyroid surgery, tumour, autoimmune, hypomagnaesaemia

Question 15

Serum Ca and phosphate levels in hypoparathyroidism

Answer 15

Hypocalcaemia, hyperphosphataemia

Question 16

Signs of hypocalcaemia

Answer 16

Chvostek sign: twitching of facial muscles when tapping facial nerve
Trousseau’s sign: inflation of BP cuff causes muscle tetany in hand/wrist (carpopedal spasm)

Question 17

Treatment of hypoparathyroidism

Answer 17

Ca and Vit D supplements

Question 18

Pseudohypoparathyroidism

Answer 18

Genetic

Resistance of PTH = high PTH, low Ca, high phosphate

Question 19

Complications of pseudohypoparathyroidism

Answer 19

Subcutaneous calcification, mental retardation, brachydactyly (blunt 4th metacarpal), obesity, bone abnormalities

Question 20

Levels of Ca, phosphate and PTH in Vitamin D deficiency

Answer 20

Low Ca and phosphate, high PTH = weak bone
Osteomalacia (gait deformities due to muscle weakness)
Rickets (bone deformity)

Question 21

What are T scores in DEXA?

Answer 21

Compares BMD to mean result of young adult females

Question 22

What are Z scores in DEXA?

Answer 22

Compares BMD to females of same age

Question 23

Normal T score

Answer 23

Within 1 SD

Question 24

Osteopenia T score

Answer 24

Between 1-2.5 SD below

Question 25

Osteoporosis T score

Answer 25

Over 2.5 SD below

Question 26

Investigations in osteoporosis

Answer 26

Bone biochemistry (Ca, PTH, ALP) Coeliac antibodies (malabsorption of Ca and Vit D) Protein electrophoresis/Bence Jones proteins (myeloma) Testosterone in males (hypogonadism)

Question 27

Management of osteoporosis

Answer 27

Exercise, diet, smoking cessation, limit alcohol, prevent falls (walking aids) Ca and Vit D supplements Bisphosphonates (anti-resorptive, alendronate, zoledronate) HRT (early menopause) Recombinant PTH (Teriparitide) Denusomab (RANKL) Strontium

Question 28

How do you test for MM?

Answer 28

Bence Jones proteins | Congo red stain - apple green birefringence

Question 29

Causes of hypocalcaemia

Answer 29

Hypoparathyroidism, Vit D deficiency, CKD, pancreatitis

Question 30

Treatment of acute hypocalcaemia

Answer 30

IV Calcium Gluconate 10% (10ml over 10 mins in glucose/saline)

Question 31

Ca release from cells is dependent on:

Answer 31

Mg

Question 32

In Mg deficiency, IC Ca is:

Answer 32

High = PTH inhibited = cells less sensitive to PTH

Question 33

Causes of hypomagnaesaemia

Answer 33

Alcohol, thiazides, PPIs, GI illness, pancreatitis, malabsorption

Question 34

Pseudopseudohypoparathyroidism

Answer 34

Normal Ca, high PTH

Question 35

CKD can cause:

Answer 35

Secondary hyperparathyroidism (high PTH, low Ca)

Question 36

Pros of using FRAX calculator

Answer 36

Uses BMD | Calculates 10 year risk

Question 37

Cons of using FRAX calculator

Answer 37

Underestimates vertebral # risk | Same risk applied to all secondary causes

Question 38

Pros of using Q#

Answer 38

More variables | Smoking and alcohol in quantities

Question 39

Cons of using Q#

Answer 39

Does not include BMD

Question 40

Who is assessed for osteoporosis?

Answer 40

Anyone over 50 with risk factors | Anyone under 50 with strong clinical risk factors (steroids/early menopause)

Question 41

Who is referred for DEXA?

Answer 41

10 year risk of fracture over 10%

Question 42

When is only the Z score reported?

Answer 42

If under 20 years

Question 43

When do you treat osteoporosis?

Answer 43

T score greater than 2.5 SDs | Steroids over 7.5mg and T score 1.5 SDs

Question 44

Effect of corticosteroids on bone

Answer 44

Decrease Ob activity Decrease Ca absorption Inhibit gonadal and adrenal steroid production

Question 45

Symptoms of Paget's

Answer 45

Bone pain, deformity, deafness, compression neuorpathies, osteosarcoma, raised ALP

Question 46

Osteogenesis imperfecta signs:

Answer 46

Dentogenesis imperfecta, blue sclera, childhood fractures

Question 47

Causes of hypercalcaemia

Answer 47

Primary/tertiary hyperparathyroidism, malignant, Vit D, thiazides, sarcoid, TB, FHH, Paget's

Question 48

Primary hyperparathyroidism

Answer 48

Overactivity of PT glands | High Ca, High PTH, increased urinary Ca

Question 49

Treatment of acute hypercalcaemia

Answer 49

0.9% saline 2-4 hours Loop diuretics (AVOID thiazide) Bisphosphonate

Question 50

Secondary hyperparathyroidism

Answer 50

Response to low Ca | Low Ca, High PTH

Question 51

Tertiary hyperparathyroidism

Answer 51

PT becomes autonomous after secondary | High Ca, High PTH

Question 52

FHH

Answer 52

High Ca, normal PTH, low urinary Ca Autosomal dominant Asymptomatic