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44 Cards in this Set
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Definition:
Disease of impaired bone mineralization |
Osteomalacia
(Mineralization = Malacia) |
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Osteomalacia in children
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Rickets
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Basic etiology of Osteomalacia
(4) |
Decreased Calcium absorption;
Dietary Calcium deficiency; Vitamin D deficiency; Hypophosphatemia |
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Causes of dietary Calcium deficiency
(3)* |
Malabsorption syndromes;
Gastrectomy; Dumping syndrome |
Might Go Dump
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Main Causes of Vitamin D deficiency
(2) |
Hepatobiliary and Pancreatic diseases
(loss of bile acids or pancreatic lipase reduce absorption of fat-soluble vitamins); Renal Osteodystrophy |
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Causes of Hypophosphatemia
(2) |
Renal Tubular Acidosis;
Falconi's syndrome |
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Dx:
Bone pain, weakness, difficulty walking: broad-based waddling gait w/ short strides; thoracic kyphosis |
Osteomalacia
(Rickets in children) |
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What do blood tests show to Dx Osteomalacia?
(3) |
Labs:
1. Low - nml Calcium; 2. Low - nml Phosphate; 3. High Alk-phos (possible high PTH) |
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Tx for Osteomalacia
(2) |
Tx underlying disorder;
Calcium and Vitamin D supplements |
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Definition:
Systemic disorder resulting in a reduction of bone mass that leads to increased risk of fracture |
Osteoporosis
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Risk factors for Osteoporosis
(6) |
Elderly Female;
Post-menopause; Family Hx; Smoking; Thin body; Sedentary lifestyle |
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Pathophysiology of Osteoporosis
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Reduction of bone mass occurs due to an imbalance b/t bone aquisition and bone reabsorption; w/o change in the ratio of mineral to organic bone
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Histology of Osteoporosis
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Decreased cortical thickness and number (and size) of cancellous bone trabeculae
(especially horizontal) |
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When does osteoporosis usually become symptomatic?
(2) types |
when Fracture occurs:
Vertebral body fracture; Hip fracture |
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Dx lab blood test results for Osteoporosis
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Everything is normal:
Serum Ca++ and PO4- are usu normal; Alk-phos is normal unless there is a fracture, then it's increased |
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How is bone mineral density measured?
(2) Dx results |
Dual X-ray Absorptiometry (DEXA) scan
T-score < -2.5 = Osteoporosis T-score -2.5 to -1 = Osteopenia |
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Differential in Osteoporosis
(4)* |
Malignancy;
Hyperparathyriodism; Osteomalacia; Padget's disease of the bone |
May HOP
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Prevention and Tx for Osteoporosis
(4) |
Dietary Calcium and Weight-bearing exercises;
Estrogen replacement therapy; Calcitonin; Bisphosphonates (Alendronate) w/ Vitamin D and Calcium supplements |
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Definition:
Chronic Dz of adult bone in which localized areas of bone becomes hyperactive, and the normal bone matrix is replaced by softened and enlarged bone |
Padget's Disease of the bone
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If Alkaline Phos is elevated, what is the next step?
(2) |
Send GGT to determine if it is Hepatic (elevated GGT) or bone (not elevated)
or Check to see if it is heat-labile (Bone), where hepatic is not |
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Histology:
Hyperactive bone turnover w/ enlarged multinucleated osteoclasts |
Padgets Disease of the bone
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Dx:
45-yo male is found to have an elevated alkaline phosphatase during a routine blood test. No other abnormalities were found. Further workup reveals the enzyme to be heat labile |
Padget's Disease of the bone
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Radiologic finding:
area of hyperlucency of the bone surrounded by a hyperdense border |
Padget's Disease of the bone
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Tx for Padget's Disease of the Bone for:
1. Pain relief 2. Anatomic deformity or impingement 3. to Decrease bone reabsorption 4. to assist w/ cardiac failure or neurologic deficits |
1. Pain = Indomethacin
2. Deformity = Osteotomy of the bone 3. Decrease Reabsorption = Bisphosphonates 4. Assist in CardiacNeuro = Calcitonin |
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What is the Normal serum Calcium range?
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8.5 - 10.2 mg/dL
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Etiology of Hypocalcemia
(8)* |
IV STRAP:
Insufficient PTH; Vitamin D deficiency; Sepsis / Severe Mg deficiency; Toxins; Rhabdomyolysis; Albright's Osteodystrophy (Pseudohypoparathyroidism); Pancreatitis |
IV STRAP
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Osteoporosis Risk factors
(8)* |
FACELESS:
Family history; Alcohol; Corticosteroids; Elderly Female; Low Calcium; Estrogen low (Menopause); Smoking; Sedentary lifestyle |
FACELESS
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First sign/Sx of Hypocalcemia
Name and describe (2) other common signs seen in PE |
first sign:
Circumoral Paresthesia Chvostek's sign: Facial muscle spasm w/ tapping of the facial nerve Trousseau's sign: Carpal spasm after occluding blood flow in forearm w/ BP cuff |
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What is seen w/ EKG for Hypocalcemia?
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Prolonged QT and ST intervals
(also peaked T-waves can be seen as in HyperK) |
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How can Calcium correct for Hypoalbuminemia?
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Adjust Calcium upward by 0.8mg/dL for each 1.0g/dL of albumin below normal
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Toxins that cause low calcium
(5)* |
Can Produce A Calcium Fall:
Cimetidine; Phenytoin; Alcohol; Citrate; Fluoride |
Can Produce A Calcium Fall
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Etiology of Hypercalcemia
(14)* |
CHIMPANZEES:
Calcium supplementation; Hyperparathyroidism / Hyperthyroidism; Immobility; Meds / Multiple Myeloma; Padget's Dz; Addison's Dz / Acromegaly; Neoplasm metastasis; Zollinger-Ellison syndrome; Excess Vit-A; Excess Vit-D; Sarcoidosis or TB (granulomatous dz) |
CHIMPANZEES
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MCC of hypercalcemia
MCC for inpatient? |
Primary Hyperparathyroidism
Inpatient: Malignancy |
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Dx:
malaise, HA, diffuse aches, dehydration, N/V, nodules on skin, cornea, conjunctiva and kidneys |
Hypercalcemia
(nodules are calcifications) |
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Drugs that cause Hypercalcemia
(5)* |
C-TALE:
Calcium supplementation; Thiazides; Antacid abuse; Lithium; Excess Vitamin D |
C-TALE
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Dx:
"Stones, bones, groans and psychiatric overtones" |
Hyperparathyroidism
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Tx for Primary Hyperparathyroidism patient w/ underlying cardiac failure
(drug and maintenance) |
Lasix to maintain diuresis
and Pulmonary artery pressure monitoring to avoid volume overload |
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Pathophysiology behind Renal Osteodystrophy
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Nephron loss reduces phosphate excretion, causing hyperphosphatemia, which lowers serum calcium and increases PTH secretion
(secondary parahyperthyroidism) |
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(3) Bone lesions assoc w/ Secondary Hyperparathyroidism
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Osteitis Fibrosa Cystica;
Adynamic Bone Dz; Osteomalacia |
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Definition:
Normal bone is replaced by fibrous tissue, primitive woven bone and cysts |
Osteitis Fibrosa Cystica
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Dx:
bone pain, proximal muscle weakness, pruritis, soft-tissue ulcerations, diffuse soft-tissue calcifications |
Secondary Hyperparathyroidism
(Renal Osteodystrophy) |
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Goal and Tx for Secondary Hyperparathyroidism /
Renal Osteodystrophy (2 drugs and 2 if drugs dont work) |
Goal:
Normalize calcium-phos balance Tx: 1. Aluminum-containing antacids: reduce GI absorpt of PO4- 2. Vit-D w/ Calcitrol: inc serum Ca++ and reverse bone damage 3. Subtotal parathyroidectomy 4. Renal transplant |
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If patient has hypocalemia or hypophosphatemia (or both) what is the next step?
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Check for Hypomagnesemia:
Ca++ and PO4- will not elevate if Magnesium is low |
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Dx:
Rapid transfer of Calcium into bones following removal of hyperactive parathyroid What electolyte disorder can it cause? |
Hungry Bone syndrome
can cause: Hypomagnesemia |
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