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NE Exam 3 > Calcium-Phosphate homeostasis > Flashcards

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
Q

CYP1-alpha gene produces what kidney enzyme?

A

1alpha-hydroxylase

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26
Q

Where are PTH receptors located on?

A

Osteoblasts

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27
Q

Vitamin D and PTH act synergistically to stimulate?

A

Osteoclast activity and bone resorption

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28
Q

What induces stem cells to differentiate into osteoclast precursors, mononuclear osteoclasts, and finally mature multinucleated osteoclasts?

A

M-CSF (macrophage colony-stimulating factor)

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29
Q

What is a cell surface protein that is the primary mediator of osteoclast formation?

A

RANKL

30
Q

What is the cell surface protein receptors on osteoclasts and osteoblasts precursors?

A

RANK

31
Q

What is a soluble protein produced by osteoblasts and inhibits RANKL/RANK interaction?

A

OPG (osteoprotegerin)

32
Q

What increases RANKL?

What decreases OPG?

A

1) PTH and vitamin D

2) PTH

33
Q

Inhibition of the sodium/phosphate transporter (NPT) by PTH causes?

A

Phosphaturia (increased excretion of phosphate in urine)

34
Q

The cAMP generated in what cells caused it to be excreted in the urine?

A

Cells of the proximal tubule

35
Q

What stimulates 1alpha-hydroxylase activity?

A

PTH

36
Q

PTH stimulates calcium reabsorption in what area of the kidney?

A

Ascending limb of Henle’s loop and distal tubule

37
Q

What effect does vitamin D have in the small intestine?

A

Increases calcium and phosphate absorption

38
Q

What effect does vitamin D have in the kidney?

A

Promotes phosphate reabsorption (stimulates NPT2a expression)

39
Q

What effect does vitamin D have in the parathyroid gland?

A

1) Inhibits PTH gene expression

2) Stimulates CaSR gene expression

40
Q

What decreases blood calcium and phosphate concentration by inhibiting bone resorption?

A

Calcitonin

41
Q

Calcitonin receptors are expressed on?

A

Osteoclasts

42
Q

What does calcitonin do to osteoclasts?

A

Decreases activity and number

43
Q

What is the major stimulus of calcitonin?

A

Increased plasma calcium

44
Q

What causes a decrease in calcitonin but no effect in calcium metabolism?

A

Thyroidectomy

45
Q

What causes an increase in calcitonin but no effect in calcium metabolism?

A

Thyroid tumors

46
Q

What stimulates intestinal calcium absorption and renal tubular calcium reabsorption and is one of the most potent regulators of osteoblast and osteoclast function?

A

Estradiol-17beta

47
Q

What promotes survival of osteoblasts and apoptosis of osteoclasts; favoring bone formation over resorption?

A

Estrogen

48
Q

What promotes bone resorption and renal calcium wasting and inhibits intestinal calcium absorption?

A

Cortisol

49
Q

Patients treated with high levels of a glucocorticoid can develop?

A

Glucocorticoid induced osteoporosis

50
Q

What do patients with primary hyperparathyroidism present with?

A

1) Hypercalciuria (stones)
2) Increased bone resorption
3) Constipation

(Stones, bones, and groans)

51
Q

Patients with primary hyperparathyroidism excrete excessive amounts of?

A

Phosphate, cAMP, and calcium

52
Q

What is the treatment for primary hyperparathyroidism?

A

Parathyroidectomy

53
Q

What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with primary hyperparathyroidism?

A

1) Increased
2) Increased
3) Decreased
4) Increased

54
Q

What levels are low in the blood with secondary hyperparathyroidism?

A

Calcium

55
Q

What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with secondary hyperparathyroidism caused by renal failure?

A

1) Increased
2) Decreased
3) Increased
4) Decreased

56
Q

What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with secondary hyperparathyroidism caused by Vitamin D deficiency?

A

1) Increased
2) Decreased
3) Decreased
4) Decreased

57
Q

Thyroid and parathyroid surgery are some causes of?

A

Hypoparathyroidism

58
Q

What is the treatment for hypoparathyroidism?

A

Oral calcium supplement

59
Q

What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with hypoparathyroidism?

A

1) Decreased
2) Decreased
3) Increased
4) Decreased

60
Q

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

A

Albright hereditary osteodystrophy

Pseudohypoparathyroidism type 1a

61
Q

What condition develop in Albright hereditary osteodystrophy?

A

Hypocalcemia and hyperphosphatemia

62
Q

What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with Albright hereditary osteodystrophy?

A

1) Increased
2) Decreased
3) Increased
4) Decreased

63
Q

Humoral hypercalcemia of malignancy increase the levels of what peptide that binds and activates the same receptor as PTH?

A

PTHrP (PTH related peptide)

64
Q

What are the levels of 1) PTH, 2) Ca2+, 3) Phosphate, 4) Vitamin D in patients with Humoral hypercalcemia of malignancy

A

1) Decreased
2) Increased
3) Decreased
4) Decreased

65
Q

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?

A

Familial hypocalciuric hypercalcemia (FHH)

66
Q

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)?

A

1) Normal or increased
2) Increased
3) Decreased
4) Normal
5) Normal

67
Q

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?

A

Rickets

68
Q

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?

A

Osteomalacia

69
Q

What is decreased with vitamin D-dependent rickets type 1?

A

1alpha-hydroxylase

70
Q

What is decreased with vitamin D-dependent rickets type 2?

A

Vitamin D receptor

71
Q

Both rickets and osteomalacia are characterized by?

A

Vitamin D deficiency

72
Q

PTH, estrogen, calcitonin, or RANKL inhibitors can all be used to treat?

A

Osteoporosis

NE Exam 3 (20 decks)

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