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Clinical Pathology II > Calcium/Phosphorus > Flashcards

Calcium/Phosphorus Flashcards

1
Q

Normal: Serum Ca/Ph & Urine Ph/Ca

A

-Serum Ca: 8.5-10.5
-Serum Ph: NL
-Urine Ph: NL
-Urine Ca: NL

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2
Q

“What Hormones are associated with Increased Calcium”

A

-“PTH”: Quickly
-“Active D3”: Slower Acting

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3
Q

“What hormones are associated with decreased calcium”

A

-“Calcitonin”: Slow

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4
Q

Primary Hyperthyroidism
-Serum Ca
-Serum P
-Urine P
-Urine Ca

A

-Serum Ca: Increased
-Serum P: Decreased
-Urine P: Increased
-Urine Ca: Increased

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5
Q

Secondary Hypoparathyroidism
-Serum Ca
-Serum P
-Urine P
-Urine Ca

A

-Serum Ca: Decreased/Normal
-Serum P: Increased
-Urine P: Decreased
-Urine Ca: Increased

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6
Q

Tertiary Hyperparathyroidism
-Serum Ca
-Serum P
-Urine P
-Urine Ca

A

-Serum Ca: Increased
-Serum P: Increased
-Urine P: Decreased
-Urine Ca: Increased

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7
Q

When do we have a positive/negative calcium balance?

A

-Positive: Childhood for skeletal growth
-Negative: Old age/disease states (Calcium output > input)

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8
Q

Hormones involved in increasing plasma calcium

A

• Parathyroid hormone (PTH)
• 1,25 dihydroxycholecalciferol

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9
Q

Plasma calcium lowering hormone

A

Calcitonin: C-Cells in the thyroid gland

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10
Q

How does PTH act on bone?

A

Stimulates osteoclastic activity (release of CaPO4)

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11
Q

How does PTH act on the kidney?

A
  1. Excretion of phosphorus (decreased reabsorption)
  2. Reabsorption of Ca2+ in kidney
  3. Activation of D3
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12
Q

1,25 DHCC: Actions

A

Absorption of calcium from intestine
-Deposition & resorption of calcium salts in bone
-Direct PTH-like effects on renal tubule

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13
Q

Total Calcium: Normal limits

A

8.5-10.5mg/dL

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14
Q

MCC of hypercalcemia

A

Hyperparathyroidism

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15
Q

MCC of hypercalcemia

A

Hyperparathyroidism

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16
Q

Decreased Serum Calcium levels induced _______ secretion of PTH

A

Increased

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17
Q

Serum Calcium Testing is used to evalutate

A

Parathyroid function and calcium metabolism

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18
Q

Excess vitamin D ingestion can:

A

Increased Serum calcium by increasing GI & renal absorption

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19
Q

Intestinal malabsorption & renal failure is associated w/:

A

Low serum calcium

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20
Q

Plasma albumin levels ______ calcium

A

Parallel

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21
Q

Low pH = ______ ionized calcium

A

Increased

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22
Q

High pH = _____ ionized calcium

A

Decreased

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23
Q

Normal Calcium findings: Adult

A

*8.5-10.5 mg/dL

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24
Q

*Mneumonic for remembering hypercalcemia

A

“CHIMPS”
-Cancers
-Hyperthyroidism
-Iatrogenic
-Multiple Myeloma
-Primary Hyperparathyroidism
-Sarcoidosis

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25
What bone diseases are associated with hypocalcemia?
Osteomalacia & Rickets
26
________ can bind phosphorus and decrease absorption
Antacids
27
There is a _____ relationship between calcium and phospohrus
Inverse*
28
Renal failure is associated with
Hyperphosphatemia
29
Vitamin D deficiency, Rickets and Osteomalacia are assocaited with:
Hypocalcemia & Hypophosphatemia (Decreased Ca, Increased PTH, More phosphorus excreted in urine)
30
Hyperparathyroidism: PTH, Serum Calcium, Phosphorus Levels
-Increased PTH -Increased Serum Calcium -Decreased Phosphorus
31
Hypoparathyroidism: PTH, serum calcium, serum phosphate
-Decreased PTH -Decreased Serum Calcium -Increased Serum Phosphate (ALP normal)
32
Most common cause of Hyperparathyroidism
Adenoma
33
Signs/Symptoms of Hypocalcemia
• Tetany • Paresthesia: Early • Convulsions: Later • Neuromuscular irritability (muscular twitching) (Chvostek’s sign Trousseau’s test) • Mental changes: Irritability & Psychosis
34
Hyperparathyroidism-Primary Findings
• Increased PTH • Hypercalcemia • Hypophosphatemia • Increased ALP • Increased serum vitamin D • Hyperphosphaturia • Hypercalciuria
35
“Stones” (Hypercalcemia)
Nephrolithiasis-Most frequent clinical manifest.
36
“Bones” (Hypercalcemia)
Metabolic bone disease-Osteoporosis, Fracture
37
“Psychiatric Overtones” (Hypercalcemia)
Depressed Nervous System-Fatigue, depression, confusion, coma
38
“Groans” (Hypercalcemia)
Peptic Ulcer & Constipation
39
Thrones” (Hypercalcemia)
Polyuria
40
MC Cause of Secondary Hyperthyroidism
Chronic Kidney Disease*
41
Lab Findings w/ CKD
• Increased PTH • Hypocalcemia or normocalcemia* • Hyperphosphatemia* • Decreased serum vitamin D* • Decreased phosphate in urine* • Hypercalciuria
42
Tertiary Hyperparathyroidism is a progression of
Secondary hyperparathyroidism
43
Tertiary Hyperparathyroidism: Lab Findings
• Significant elevation of PTH* • Hypercalcemia • Hyperphosphatemia
44
Liver Disease: ____ BUN
Decreased
45
Kidney Disease: ____ BUN
Increased
46
BUN: Interfering Factors
• Changes in protein intake can alter BUN • Over (decreased)/under (increased) hydration • Certain drugs
47
Any cause of reduced renal blood flow or increased production of urea
Prerenal azotemia
48
Renal Azotemia
• Glomerulonephritis • Pyelonephritis • Acute tubular necrosis • Nephrotoxic drugs
49
Any obstruction of the urinary tract
Post-renal azotemia
50
MCC of post-renal azotemia
Prostatic Hypertrophy
51
Decreased levels of BUN
• Severe liver damage • Overhydration • Malnutrition
52
Creatinine is elevated in all diseases of the ____ in which ___% or more of the nephrons are destroyed
Kidney; 50%
53
Creatinine: Critical values
• >4 mg/dL indicates serious impairment in renal function (Shut down of kidneys)
54
Creatinine: Critical values
• >4 mg/dL indicates serious impairment in renal function (Shut down of kidneys)
55
Rhabdomyolysis
-Breakdown of skeletal muscle & statins, exercise -Causes fatigue, myalgia and dark urine (decreased urine output)
56
Elevations in Creatinine
-Creatine, increased muscle mass, exertion & dehydration
57
Decreased Levels of Creatinine
• Decreased muscle mass -Overhydration
58
Decreased Levels of Creatinine
• Decreased muscle mass -Overhydration
59
BUN: Creatinine Ratio
• Normal: 10:1 • Pre-renal disease: >10:1 • Renal disease: 10:1-Elevations of BUN/Creatinine (100:10) • Post-renal disease: >10:1
60
• Nitrogenous compound that is a product of purine catabolism
Uric Acid
61
• Nitrogenous compound that is a product of purine catabolism
Uric Acid
62
MCC for hyperuricemia
Renal Disease
63
Uric Acid: Increased Levels
• Gout • Hematologic conditions: Infections, PCV • Malignancies • Chronic renal disease • Increased ingestion of purines
64
Uric Acid: Increased Levels
• Gout • Hematologic conditions: Infections, PCV • Malignancies • Chronic renal disease • Increased ingestion of purines
65
Uric Acid: Decreased Levels
• Aspirin • Vitamin C • Liver disease

Clinical Pathology II (10 decks)

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