Calcium Homeostasis and Disorders

Question 1

how does PTH increase serium calcium?

Answer 1

absorption from gut

resorption from bone

Question 2

where can you get Vit D from?

Answer 2

sun and diet

Question 3

what does acute hypercalcaemia present with?

Answer 3

thirst
dehydration
confusion
poluria

Question 4

what does chronic hypercalcaemia present like?

Answer 4

myoptahy
osteopaenia, fractures
depression
hypertension
abdo pain- pancreatitis uclers, renal stones

Question 5

moans, groans, bones, stones

depression, constipation, sore bones, renal stones

Answer 5

hypercalcaemia

Question 6

if suspected hypercalcaemia what should you test?

Answer 6

PTH

Question 7

if high Ca and high Alk Phos

Answer 7

sarcoidosis
thrytoxicosis
bone metas

Question 8

if high Ca and low Alk Phos

Answer 8

myeloma
Vit D excess
mild alkali syndrome

Question 9

main 2 causes of hypercalcaemia?

Answer 9

primary hyperparathyroidism

maligancy

Question 10

how do you diagnose primary hyperparathyroidism

Answer 10

increased serum calcium
increase serum PTH
increase calcium in urine

Question 11

how do you treat acute hypercalcaemia?

Answer 11

fluids-rehydrate with saline
consider loop diuretics once rehydrated

bisphosphonates
steroids- e.d 40-60mg prednislone for sarcoidosis

Question 12

management for primary hyperparathyroidism?

Answer 12

surgery or nothing

Question 13

indications for surgery for primary hyperparathyroidism?

Answer 13

bone disease
gastric ulcers
renal stones
osteoporosis

eGFR

Question 14

chovsteks sign (tapping over facial nerve)
Trousseau sign (carpopedal spasm)

Answer 14

hypocalcaemia

Question 15

paraesthesia- fingers and toes
muscle cramps
muscle weakness
fatigue
bronchospasm
fits
QT prolongation

Answer 15

hypocalcaemia

Question 16

causes of hypocalcaemia

Answer 16

hypoparathyroidism
vit D deficiency
chronic renal failure
hyperventiliation
pancreatits

Question 17

causes of hypoparathyroidism?

Answer 17

congenital
autoimmune
destruction
idiopathic

Question 18

how do you treat acute hypoglycaemia?

Answer 18

IV calcium gluconate

Question 19

long term management of hypoglycaemia?

Answer 19

calcium supplements

Vit D- tablets or injection

Question 20

what is calcium release from cells dependent on?

Answer 20

magnesium

Question 21

what can cause hypomagnasemia?

Answer 21

alcohol
thiazides
PPIs
GI illness
pancreatitis
malabsorption

Question 22

genetic defect in GNAS 1 gene
low calcium but high PTH

bony abnormalities
obesity
subcutaneous calcification
learning disability
brachdactyly (4th metacarpal)

Answer 22

Pseudohypoparathyroidism

Question 23

what is pseudo-pseudohypoparathyroidism

Answer 23

same as pseudohypoparathyroidism but normal calcium level

Question 24

what is rickets and osteomalacia

Answer 24

vit D deficiency

Question 25

what can cause Vit D deficiency?

Answer 25

``` lack in diet lack of sunlight chronic liver failure malabsorption-coeliac drugs-anticonvulsants ```

Question 26

what is osteopenia?

Answer 26

low bone mass

Question 27

how do you assess bone density?

Answer 27

DEXA scans

Question 28

what lifestyle management advice should you give for someone with osteoporosis?

Answer 28

``` high intensity strength training low impact weight bearing exerrcise avoid excess alcohol avoid smoking fall prevention try to get more calcium from diet ```

Question 29

what are alendronate and risedronate?

Answer 29

bisphosphonates

Question 30

how long should you take bisphosphonates for?

Answer 30

5 years cause can cause osteonecrosis of jaw

Question 31

what is Densumab?

Answer 31

a monoclonal anitobody for osteoporosis treatment its an SC injection which can cause cellutlits, eczema and hypocalcaemia

Question 32

drug therapy for osteoporosis?

Answer 32

``` vit D and calcium supplements bisphosphonates Denosumab Teriparatide HRT ```

Question 33

what is Teriparatide?

Answer 33

recombinant parathyroid hormone which stimulates bone growth . once daily injection

Question 34

what is strontium rabelate?

Answer 34

antiresorptive agent