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Calcium-Phosphate homeostasis Flashcards

1
Q

During aging, what happens to the amount of calcium absorbed from dietary intake?

A

Decreases

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2
Q

Hyperreflexia, spontaneous twitching, muscle cramps, and tingling/numbness are symptoms of?

A

Hypocalcemia

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3
Q

What is an indicator of hypocalcemia that deals with twitching of the facial muscles elicited by tapping on the facial nerve?

A

Chvostek sign

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4
Q

What is an indicator of hypocalcemia that deals with carpopedal spasm upon inflation of a blood pressure cuff?

A

Trousseau sign

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5
Q

Decreased QT interval, constipation, lack of appetite, polyuria, polydipsia, muscle weakness, hyporeflexia, lethargy, and coma are symptoms of?

A

Hypercalcemia

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6
Q

An increase in membrane excitability and generation of spontaneous AP are seen in hypocalcemia or hypercalcemia?

A

Hypocalcemia

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7
Q

If you increase plasma protein concentration, what happens to the total calcium concentration?

A

Increases

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8
Q

If you increased phosphate concentration, what happens to the ionized calcium concentration?

A

Decreases

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9
Q

When free ionized calcium concentration increases because less calcium is bound to albumin describes what term?

A

Acidemia

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10
Q

When free ionized calcium concentration decreases because more calcium is bound to albumin describes what term?

A

Alkalemia

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11
Q

What is alkalemia most often accompanied by?

A

Hypocalcemia

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12
Q

To maintain calcium balance, kidneys must excrete the same amount of calcium that is absorbed by?

A

GI tract

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13
Q

What cells of the parathyroid gland synthesize and secrete PTH?

A

Chief cells

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14
Q

When is PTH stimulation for secretion?

A

When there’s a decrease in calcium concentration in plasma

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15
Q

What inhibits PTH synthesis and secretion?

A

Increased extracellular calcium

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16
Q

What causes decrease synthesis and storage of PTH, increase breakdown of stored PTH and release of inactive PTH fragment into circulation?

A

Chronic hypercalcemia

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17
Q

What causes increase synthesis and storage of PTH and hyperplasia of parathyroid glands (secondary hyperparathyroidism)?

A

Chronic hypocalcemia

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18
Q

What is the result of chronic magnesium depletion and inhibits PTH synthesis, storage, and secretion?

A

Severe hypomagnesemia

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19
Q

What is the most often cause of severe hypomagnesemia?

A

Alcoholism

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20
Q

What is the PTH action on bone?

A

Resorption

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21
Q

Phosphate reabsorption, calcium reabsorption, and urinary cAMP are the results of PTH action on what structure?

A

Kidney

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22
Q

Increased calcium absorption indirectly via vitamin D (1, 25-dihydroxycholecalciferol) are the results of PTH action on what structure?

A

Intestine

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23
Q

Vitamin D increases the concentration of what in the plasma?

A

Calcium and phosphate

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24
Q

Cholecalciferol is equivalent to?

A

Vitamin D

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25
CYP1-alpha gene produces what kidney enzyme?
1alpha-hydroxylase
26
Where are PTH receptors located on?
Osteoblasts
27
Vitamin D and PTH act synergistically to stimulate?
Osteoclast activity and bone resorption
28
What induces stem cells to differentiate into osteoclast precursors, mononuclear osteoclasts, and finally mature multinucleated osteoclasts?
M-CSF (macrophage colony-stimulating factor)
29
What is a cell surface protein that is the primary mediator of osteoclast formation?
RANKL
30
What is the cell surface protein receptors on osteoclasts and osteoblasts precursors?
RANK
31
What is a soluble protein produced by osteoblasts and inhibits RANKL/RANK interaction?
OPG (osteoprotegerin)
32
What increases RANKL? | What decreases OPG?
1) PTH and vitamin D | 2) PTH
33
Inhibition of the sodium/phosphate transporter (NPT) by PTH causes?
Phosphaturia (increased excretion of phosphate in urine)
34
The cAMP generated in what cells caused it to be excreted in the urine?
Cells of the proximal tubule
35
What stimulates 1alpha-hydroxylase activity?
PTH
36
PTH stimulates calcium reabsorption in what area of the kidney?
Ascending limb of Henle's loop and distal tubule
37
What effect does vitamin D have in the small intestine?
Increases calcium and phosphate absorption
38
What effect does vitamin D have in the kidney?
Promotes phosphate reabsorption (stimulates NPT2a expression)
39
What effect does vitamin D have in the parathyroid gland?
1) Inhibits PTH gene expression | 2) Stimulates CaSR gene expression
40
What decreases blood calcium and phosphate concentration by inhibiting bone resorption?
Calcitonin
41
Calcitonin receptors are expressed on?
Osteoclasts
42
What does calcitonin do to osteoclasts?
Decreases activity and number
43
What is the major stimulus of calcitonin?
Increased plasma calcium
44
What causes a decrease in calcitonin but no effect in calcium metabolism?
Thyroidectomy
45
What causes an increase in calcitonin but no effect in calcium metabolism?
Thyroid tumors
46
What stimulates intestinal calcium absorption and renal tubular calcium reabsorption and is one of the most potent regulators of osteoblast and osteoclast function?
Estradiol-17beta
47
What promotes survival of osteoblasts and apoptosis of osteoclasts; favoring bone formation over resorption?
Estrogen
48
What promotes bone resorption and renal calcium wasting and inhibits intestinal calcium absorption?
Cortisol
49
Patients treated with high levels of a glucocorticoid can develop?
Glucocorticoid induced osteoporosis
50
What do patients with primary hyperparathyroidism present with?
1) Hypercalciuria (stones) 2) Increased bone resorption 3) Constipation (Stones, bones, and groans)
51
Patients with primary hyperparathyroidism excrete excessive amounts of?
Phosphate, cAMP, and calcium
52
What is the treatment for primary hyperparathyroidism?
Parathyroidectomy
53
What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with primary hyperparathyroidism?
1) Increased 2) Increased 3) Decreased 4) Increased
54
What levels are low in the blood with secondary hyperparathyroidism?
Calcium
55
What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with secondary hyperparathyroidism caused by renal failure?
1) Increased 2) Decreased 3) Increased 4) Decreased
56
What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with secondary hyperparathyroidism caused by Vitamin D deficiency?
1) Increased 2) Decreased 3) Decreased 4) Decreased
57
Thyroid and parathyroid surgery are some causes of?
Hypoparathyroidism
58
What is the treatment for hypoparathyroidism?
Oral calcium supplement
59
What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with hypoparathyroidism?
1) Decreased 2) Decreased 3) Increased 4) Decreased
60
What disorder is inherited in autosomal dominant fashion and results in the G(s) for PTH in bone and kidney being defective? Patients present with short stature, short neck, obesity, subcutaneous calcification, shortened metatarsals and metacarpals
Albright hereditary osteodystrophy | Pseudohypoparathyroidism type 1a
61
What condition develop in Albright hereditary osteodystrophy?
Hypocalcemia and hyperphosphatemia
62
What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with Albright hereditary osteodystrophy?
1) Increased 2) Decreased 3) Increased 4) Decreased
63
Humoral hypercalcemia of malignancy increase the levels of what peptide that binds and activates the same receptor as PTH?
PTHrP (PTH related peptide)
64
What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with Humoral hypercalcemia of malignancy
1) Decreased 2) Increased 3) Decreased 4) Decreased
65
What autosomal dominant disorder is caused by mutations that inactive CaSR in parathyroid glands resulting in decrease of urinary calcium excretion and increase in serum calcium?
Familial hypocalciuric hypercalcemia (FHH)
66
What are the levels of 1) PTH, 2) Serum Ca2+, 3) Urine Ca2+, 4) Phosphate 5) Vitamin D in patients with Familial hypocalciuric hypercalcemia (FHH)?
1) Normal or increased 2) Increased 3) Decreased 4) Normal 5) Normal
67
What disorder presents with insufficient amount of calcium and phosphate available to mineralize growing bone and characterized by growth failure and skeletal deformities in children?
Rickets
68
What disorder presents with insufficient amount of calcium leading to new bone failing to mineralize and is characterized by bending and softening of weight-bearing bones in adults?
Osteomalacia
69
What is decreased with vitamin D-dependent rickets type 1?
1alpha-hydroxylase
70
What is decreased with vitamin D-dependent rickets type 2?
Vitamin D receptor
71
Both rickets and osteomalacia are characterized by?
Vitamin D deficiency
72
PTH, estrogen, calcitonin, or RANKL inhibitors can all be used to treat?
Osteoporosis

NE Exam 3 (20 decks)

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