Calcium Disorders

Question 1

Hypercalcemia most common cause

Answer 1

primary hyperparathyroidism
(PTH)
but then
Primary hyperparathyroidism and
cancer account for 90% of
hypercalcemia patients.

Question 2

Hypercalcemia cx fx and epidemiology

Answer 2

Most of the patients are asymptomatic. For those with severe, acute
symptomatic hypercalcemia, there is a high prevalence of cancer and the
hypercalcemia of malignancy which is from a PTH-like particle

Question 3

Hypercalcemia. Less common causes

Answer 3

Vitamin D intoxication
Sarcoidosis and other granulomatous diseases
Thiazide diuretics
Hyperthyroidism
Metastases to bone and multiple myeloma

Question 4

Acute, symptomatic hypercalcemia presents with

Answer 4

confusion, stupor, lethargy, and constipation.

Question 5

Hypercalcemia Cardiovascular features

Answer 5

Short QT and hypertension

Question 6

Hypercalcemia Bone lesions

Answer 6

Osteoporosis

Question 7

HypercalcemiaRenal fx

Answer 7

Nephrolithiasis
Diabetes insipidus
Renal insufficiency

Question 8

Hypercalcemia tx

Answer 8

Saline hydration at high volume
Bisphosphonates: pamidronate, zoledronic acid. they take days to work
Calcitonin (works faster than bisphosphonates) is very good for emergencies too

Furosemide is not used when urine output is adequate with hydration alone.

Question 9

Dialysis would be used only for

those in_______ +hypercalcemia

Answer 9

renal failure

Question 10

hypercalcemia
when it is from sarcoidosis or any
granulomatous disease. Tx

Answer 10

Prednisone

Question 11

Primary hyperparathyroidism causes

Answer 11

Solitary adenoma (80%–85%)
Hyperplasia of all 4 glands (15%–20%)
Parathyroid malignancy (1%)

Question 12

Primary hyperparathyroidism often presents as

Answer 12

an asymptomatic elevation in

calcium levels found on routine blood testing

Question 13

Primary hyperparathyroidism other symptoms

Answer 13

signs of acute, severe hypercalcemia
Osteoporosis
Nephrolithiasis and renal insufficiency
Muscle weakness, anorexia, nausea, vomiting, and abdominal pain
Peptic ulcer disease (calcium stimulates gastrin)

Question 14

hyperparathyroidism Lab test
Ca
PTH
Phosohate level
Chloride level
QT segment
BUN
Alkaline Phosphatase

Answer 14

↑Ca
↑PTH
↓ Phosohate level
↑Chloride level
↓QT segment
\+-↑BUN n creatinine
\+-↑Alkaline Phosphatase

Question 15

Additional testing for hyperparathyroidism

Answer 15

Bone x-ray is not a good test for
bone effects of high PTH. DEXA
densitometry is better.

Question 16

hyperparathyroidism Preoperative imaging of the neck with

Answer 16

sonography or nuclear

scanning may be helpful in determining the surgical approach.

Question 17

hyperparathyroidism tx

Answer 17

Surgical removal of the involved parathyroid glands is the standard of care.
When surgery is not possible, give cinacalcet. Cinacalcet inhibits the release of
PTH.

Question 18

Indications for removal of parathyroids:

Answer 18

• Bone disease (e.g., osteoporosis)
• Renal involvement including stones
• Age under 50 years
• Calcium level consistently 1 point above normal

Question 19

Primary hypoparathyroidism is most often a complication of

Answer 19

prior neck
surgery, such as for thyroidectomy, in which the parathyroids have been
removed

Question 20

Hypocalcemia other causes

Answer 20

Hypomagnesemia:
Renal failure:
Vitamin D deficiency

Question 21

Renal failure patho. why it causes hypoCa

Answer 21

The kidney converts 25 hydroxy-D to the more active 1,25 hydroxy-D

Question 22

Vitamin D deficiency labs
PO4
Alkaline phosphatase
PTH

Answer 22

Unlike hypoparathyroidism, vitamin D deficiency has
low phosphate levels and elevated alkaline phosphatase. PTH is elevated
because calcium is low.

Question 23

Choose ____________as the best test of

vitamin D levels.

Answer 23

25-hydroxyvitamin D

Question 24

Vitamin D CxFx

Answer 24

Rickets: Childhood disease of impaired long bone growth and craniotabes
(soft skull bones)
Osteomalacia: Adult disease of bone impairment (milder than rickets) and
muscle pain

Question 25

Hypocalcemia cx fx

Answer 25

Signs of neural hyperexcitability in hypocalcemia:
Chvostek sign (facial nerve hyperexcitability)
Carpopedal spasm
Perioral numbness
Mental irritability
Seizures
Tetany (Trousseau sign

Question 26

Hypocalcemia Paraclínicos

Answer 26

EKG shows a prolonged QT that may eventually cause arrhythmia.
Slit lamp exam shows early cataracts.

Question 27

Neuro cxfx
Low calcium vs
High calcium

Answer 27

Low calcium = twitchy and
hyperexcitable
High calcium = lethargic and slow

Question 28

Hypocalcemia Tx

Answer 28

Replace calcium and activated vitamin D. This is done orally if symptoms are
mild or absent and intravenously if symptoms are severe.

Question 29

Paget Disease of Bone PAtho

Answer 29

osteoclasts and osteoblasts work out of sync, deforming the bone..

Question 30

Paget Disease of Bone labs

Answer 30

usually presents as an asymptomatic elevation in alkaline
phosphatase accompanied by normal gamma-glutamyl transpeptidase (GGTP)
and normal bilirubin, with abnormalities found on skeletal survey

Question 31

Paget Disease of Bone cxfx

Answer 31

usually presents as asymptomatic

In symptomatic disease, the most common symptom is bone pain

Question 32

Paget Disease of Bone most accurate test

Answer 32

nuclear (technetium) bone scan finding patchy areas of

osteoblastic activity.

Question 33

Paget Disease of Bone outputs

Answer 33

can become
osteosarcoma
Paget disease gives high-output CHF.

Question 34

Paget Disease of Bone. What is the treatment in asymptomatic disease?

Answer 34

No therapy needed

Question 35

Paget Disease of Bone. TX When there is pain,

Answer 35

bisphosphonates.

Question 36

Paget Disease of Bone.
When the question asks “What will relieve bone pain?” and NSAIDs have
failed or are not in the choices

Answer 36

choose calcitonin.

Question 37

Bisphosphonate Adverse Effects

Answer 37

Jaw necrosis
Flulike
symptoms
Esophagitis

Question 38

PPIs SE

Answer 38

Low calcium
Low magnesium
Low iron
Low B12
C. difficile
Pneumonia

Question 39

Octreotide,

Lanreotide SE

Answer 39

Gallstones

Cholecystitis

Question 40

Cabergoline SE

Answer 40

Heart valve

disease