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keystone: exam 1 > Calcium and Bone Disorders > Flashcards

Calcium and Bone Disorders Flashcards

1
Q

Normal PTH, high calcium suggests:

A

Primary hyperparathyroidism
or
Familial Hypocalciuric Hypercalcemia

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2
Q

Name 5 causes of PTH independent hypercalcemia

A 
Malignancy
Granulomatous disease
Vitamin A toxicity
VItamin D toxicity
Milk alkali syndrome
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3
Q

Main defense against hypercalcemia

A

PTH suppression

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4
Q

Phosphorus level in primary hyperparathyroidism

A

normal-low b/c increased PTH mediated renal excretion

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5
Q

Best approach of treatment for primary hyperparathyroidism

A

Parathyroidectomy

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6
Q

Describe the expected levels in primary hyperparathyroidism:
Ca:
PTH:
Phosphorus:

A

Ca: increased
PTH: increased
Phosphorus: low-normal

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7
Q

If patient’s serum calcium is not too high, has osteoporosis and refuses to have parathyroidectomy to treat his primary hyperparathyroidism, you should treat with ____

A

bisphosphonate

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8
Q

If patient’s serum calcium is very high and refuses to have parathyroidectomy to treat his primary hyperparathyroidism, you should treat with ____

A

Cinacalcet = calcimiertric

Mimics calcium → binds Ca sensing receptors (CaSR) on parathyroid tissue → decrease PTH secretion → decrease Ca level

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9
Q

Cinacalcet (calcimiertric) treats all of the following except:
A. Severe secondary hyperparathyroidism
B. Hypercalcemia due to parathyroid carcinoma
C. Familial Hypocalciuric Hypercalcemia
D. Primary hyperparathyroidism

A

C

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10
Q

Describe the expected levels in Familial Hypocalciuric Hypercalcemia
Ca:
PTH:
Urinary Ca:

A

Ca: mildly elevated
PTH: normal - slightly elevated
Urinary Ca: VERY low
Distinguishes FHH from primary hyperparathyroidism

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11
Q

Name the disorder:

Inactivating mutation in gene of calcium-sensing receptor

A

Familial Hypocalciuric Hypercalcemia

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12
Q 
Which of the following is NOT a symptom of hypercalcemia?
A. Fatigue
B. Tetany
C. Bradycardia
D. HTN 
E. Polyuria
A

B. sign of HYPOcalcemia

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13
Q

Describe the expected levels in Milk Alkali Syndrome:
Ca:
PTH:

A

Ca: increased
PTH: low

Normal PTH-rP, 25 OHD, 1,25 (OH)2D, Vitamin A, SPEP to rule out other PTH independent causes

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14
Q

Acute therapy of PTH independent hypercalcemia

A

Fluids to induce natriuresis

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15
Q

Intermediate therapy of PTH independent hypercalcemia

A

IV bisphosphnates:
Zoledronic acid
Pamidronate

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16
Q

Describe the expected levels in PTH independent hypercalcemia:
Ca:
PTH:

A

Ca: high
PTH: low
Trying to unsuccessfully correct calcium b/c another process is driving calcium up

17
Q

Hypercalcemia of malignancy w/ PTHrP seen in (2)

A

Lung

Renal cell

18
Q

Hypercalcemia of malignancy w/ 1,25 (OH)2 vitamin D seen in (2)

A

Lymphoma

Leukemia

19
Q

Most common cause of hypercalcemia in hospitalized patients

A

Hypercalcemia of malignancy

20
Q 
Describe the expected levels in hypoparathyroidism:
PTH:
Ca:
Urine Ca:
Phosphorus:
A

PTH: Low (Normal: should be high in low Ca)
Ca: Low
Urine Ca: High (PTH normally promotes renal calcium reabsorption)
Phosphorus: High (PTH normally promotes renal P excretion)

21
Q

Treatment of hypoparathyroidism

A

Calcium

Calcitriol (1,25 OH2D)

22
Q 
Which of the following is NOT a symptom of hypocalcemia?
A. Parasthesia
B. Tetany
C. Confusion/fatigue/depression
D. QT shortening
E. Seizures
A

D. QT prolongation

23
Q

Inflating a blood pressure cuff to 20 mmHg above systolic blood pressure for 3 minutes inducing the Carpopedal spasm

A

Trousseau’s sign

Sign of hypocalcemia

24
Q

Elicited by tapping facial nerve → contraction of (contralateral/ipsilateral) facial muscles

A

Ipsilateral

Chvostek’s sign

25
Q

All of the following are treatments for hypoparathyroidism EXCEPT:
A. Calcium
B. Vitamin 25(OH)2D
C. Human recombinant PTH

A

B. Vitamin 1,25(OH)2D: Must be active form b/c PTH not available to activate.

A. IV if tetany. Oral otherwise
C. Just approved. Not ideal.

26
Q

When you see hypocalcemia, check ___ to evaluate for cause.

A

PTH

27
Q

Low calcium, high PTH suggests (4)

A

Poor calcium intake
Vitamin D deficiency
PTH resistance: pseudohypoparathyroidism
Vitamin D resistance

28
Q 
Describe the expected lab values for Vitamin D deficiency:
Ca:
PO4:
PTH:
25(OH)D:
1,25 (OH)2D:
A 
Ca: low
PO4: low b/c PO4 b/c need vit D to absorb
PTH: high
25(OH)D: low
1,25 (OH)2D: low/normal
29
Q 
Describe the expected lab values for PTH resistance (pseudohypoparathyroidism):
Ca:
PO4:
PTH:
25(OH)D:
1,25 (OH)2D:
A 
Ca: low 
PO4: high
PTH: high
25(OH)D: normal
1,25 (OH)2D: low
30
Q 
Describe the expected lab values for Vitamin D resistance:
Ca:
PO4:
PTH:
25(OH)D:
1,25 (OH)2D:
A 
Ca: low
PO4: low
PTH: high
25(OH)D: normal/low
1,25 (OH)2D: high b/c try to make more vit D to overcome resistance due to defective receptor
31
Q

T/F: Treatment for Vitamin D deficiency includes calcitriol, the activated form.

A

False. Treat with Vitamin D2 or D3.

o No need for activated form (calcitriol) since patient can make PTH

32
Q 
Which disorder?
Ca: low
PO4: low
PTH: high
25(OH)D: normal/low
1,25 (OH)2D: high
A

Vitamin D resistance

33
Q 
Which disorder?
Ca: low 
PO4: high
PTH: high
25(OH)D: normal
1,25 (OH)2D: low
A

PTH resistance (pseudohypoparathyroidism)

34
Q 
Ca: low
PO4: low 
PTH: high
25(OH)D: low
1,25 (OH)2D: low/normal
A

Vitamin D deficiency

keystone: exam 1 (12 decks)

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