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Endo > 9 - Mineral Disorders > Flashcards

9 - Mineral Disorders Flashcards

1
Q

corrected Ca eqn

A

Serum Ca + 0.8 (4 - albumin)

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2
Q

what stim/inhib PTH secretion?

A

stim - low Ca, high phos

inhib - calcitriol

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3
Q

action of calcitriol

A

overall - inc Ca and phos in extracellular fluid
inc Ca and phos absorption in gut
inc osteoblast formation of matrix proteins
inc osteoclast activity
inc Ca and phos reabsorption in kidney

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4
Q

MCC of hypercalcemia in gen pop vs hospital

A

gen pop - primary hyperPTH

hospital - malignancy

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5
Q

lab findings for primary hyperPTH

A

high Ca, low phos, high PTH

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6
Q

osteitis fibrosa cystica

A

assoc w/ severe primary or secondary hyperPTH
inc num osteoclasts and fibroblasts > bone cysts
accumulation of hemosiderin gives them brown appearance

severe hyperCa and bone pain

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7
Q

causes of 2ndary hyperPTH

A

renal insufficiency - inc phos, dec calcitriol > dec Ca

malabsorption - dec Ca from vit D def

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8
Q

labs in hyperPTH 2/2 renal insufficiency

A

low Ca, high phos, high PTH

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9
Q

tertiary hyperPTH

A

consequence of 2ndary hyperPTH

autonomous PTH secretion due to PT gland hyperplasia

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10
Q

mechs of malignancy related hyperCa (4)

A

PTH-rp (related protein)
cytokines which activate osteoclasts
bone mets which are osteolytic
ectopic production of calcitriol (lymphoma)

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11
Q

tumors that make PTH-rp

A

solid tumors - SCC, renal/bladder, breast, ovarian

HTLV1 leukemia

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12
Q

familial hypocalciuric hypercalcemia - inheritance, cause, findings/course

A

AD
inactivating mutation of Ca sensing receptor - higher set point for Ca related PTH secretion
benign, asymptomatic, no tx

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13
Q

signs/sx of hyperCa

A

bones - osteoporosis, fractures, osteitis fibrosa cystica, bone pain/arthralgia

stones - nephrolithiasis, renal failure

moans - abd probs - nausea, constipation, PUD, acute pancreatitis

groans - psych - AMS, lethargy/coma, psychosis, dec concentration, depression

band keratopathy
HTN, arrhythmias, shortened QT

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14
Q

acute mgmt of hyperCa

A

hydrate aggressively w/ IV saline
loop diuretic - furosemide
dec bone resorption w/ bisphosphonates or calcitonin
glucocorticoids if vit D intoxication
gallium nitrate or plicamycin for refractory hyperCa
dialysis

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15
Q

major causes of hypoCa (3)

A

vit D def
exhaustion of skeletal Ca stores from repeated pregnancy
hypoPTH

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16
Q

clinical features of osteomalacia

A 
low serum Ca, phos product
elevated alk phos
bone pain, prox musc weakness
deformity
pseudofractures - indicate severe deficiency
17
Q

clinical features of hypoCa

A 
perioral/tongue/extremity paresthesias
facial spasms
myalgias/muscle cramps
tetany
carpopedal spasms
Chvostek's sign
Trousseaus's sign
arrhythmia - prolonged QT
18
Q

tx of acute/severe hypoCa

A

give Ca (PO or IV)
normalize Mg
give calcitriol
thiazide (+amiloride to avoid hypoK)

Endo (20 decks)

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