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Chapter 1 Flashcards

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1
Q

Regulators of calcium

A

Bone
GI
Kidneys

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2
Q

Stimulators of PTH secretion

A

decreased serum Ca
Mild decreases in serum magnesium
Increases in serum phosphorus

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3
Q

Inhibitors of PTH secretion

A

Increase in Calcium
Severe decreases in magnesium
Calcitriol

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4
Q

how to adjust calcium for albumin

A

For every 10 below normal for albumin (40), increase serum calcium by 0.2

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5
Q

Degrees of hypercalcemia

A

2.5-3; mild
3-3.5; moderate
>3.5 severe

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6
Q

Approach hypercalcemia

A 
PTH vs non PTH mediated
Non PTH mediated;
-CA; humoral vs osteolytic hypercalceia
-Vit D mediated
-Genetic (FHH)
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7
Q

Humoral hypercalcemia

A 
PTHrp 
-squamous cell
-adenoCA (breast, ovary)
-RCC
-transitional cell carcinoma (bladder)
**when present likely means high tumor burden since each cell only secretes small amount PTHrp
Calcitriol
-secreted by B cells in lymphoma (less common)
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8
Q

Osteolytic hypercalcemia

A

due to invasion of bone; multiple myeloma, adenoma breast, some lymphomas

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9
Q

Vitamin D mediated

A

-Granulomatous disease; TB, sarcoid
-Endocrine; thyrotoxicosis (increased bone turnover), primary adrenal insufficiency (decrease vascular volume and calcium clearance), phew (produces PTHrp)
-prolonged immobilization
Drugs: thiazide diuretics, lithium, vit D

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10
Q

Treatment hypercalcemia

A
  • IVF
  • Lasix
  • bisphosphonates
  • Calcitonin
  • steroids
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11
Q

Bisphosphonates

A

inhibits osteoclast effects

  • great affinity for bone and resistant to degradation effects which account for their long half life
  • poor absorption GI so IV route necessary
  • effect begins within 2 days and nadir 7 days
  • can last several weeks to months
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12
Q

Calcitonin

A
  • inhibits bone resumption and increase real excretion of calcium
  • onset 4-6 hours, nadir 12-24 hours
  • not as effective as calcium lowering agent as bisphosphonates but is faster onset when dealing with dangerously high levels of calcium (>4)
  • tachyphylaxis develops in 48-72 hours
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13
Q

Steroids in treatment hypercalcemia

A
  • Only effective if hypercalcemia mediated by hematologic cancers (lymphoma or MM) or granulomatous diseases
  • give equivalent of hydrocortisone 2-300 mg/day IV 3-5 days
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14
Q

Calcium >3.5 asymptomatic

A

could use IVF + bisphosphonates vs calcitonin

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15
Q

Calcium >3.5 symptomatic

A

IVF + calcitonin +/- bisphosphontes +/- steroids

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16
Q

EKG hypercalcemia

A

Shortening QT
Osborn (j) waves; positive deflection at J point (also see in hypothermia)
Ventricular irritability and VF arrest

17
Q

EKG hypocalcemia

A

QT prolongation

Dysrrhythmias uncommon

18
Q

Hypocalcemia values

A
  1. 2-2.6- mild

1. 9-2.2 niderate

19
Q

Sx hypocalcemia

A

Increased neuromuscular irritability; tetany
Chovstek
Trousseau
Perioral and fingertip parasthesia
Spontaneous muscle cramps
Feared: contraction of respiratory and laryngeal spasm

20
Q

Approach hypocalcemia

A

PTH abnormalities (low PO4)

  • hypoparathyroidism; surgery, radiation, autoimmune (polyglandular autoimmune syndrome, infiltrative
  • functional hypopara: Mg deficiency
  • PTH resistance; pseudohypoparathyroidism

Vitamin D abnormalities (High PO4)

  • Vit D deficiency; nutritional, malabsorption
  • Altered vit D metabolism: cirrhosis, CKD

Drugs
-calcitonin, bisphosphonates, plicamycin, loop diuretics

Acute causes: pancreatitis, rhabdomyolysis, tumor lysis syndrome, transfusion blood products (citrate), toxic shock syndrome

Others: malabsorption, hypoalbuminemia

21
Q

Treatment Hypocalcemia (severe)

A

IV; calcium gluconate preferred over calcium chloride due to less tissue necrosis if extravasated

  • 1-2 grams calcium gluonate administered over 10-20 minutes (faster administration can result in prolonged QT)
  • Infusion cannot contain bicarb or phosphate because can precipitate into insoluble calcium salts
22
Q

Anti-Ro, Anti-La also known as SS-A and SS-B

A

Sjogren’s syndrome

23
Q

Anti-Smith

A

Lupus

  • 99% people with autoantibody have disease, but only 20% pts with SLE have anti-smith
  • associated with CNS involvement, kidney disease, lung fibrosis and pericarditis but not associated with disease activity
24
Q

Anti-nRP/anti-U1-RNP

A

Highly associated with mixed connective tissue disease

25
Q

Anti-Scl-70

A

Scleroderma

  • sensitivity for scleroderma is 34%, but higher for diffuse cutaneous involvement (40%)
  • specificity 99-100
  • found in 5% pts with SLE
26
Q

Anti-Jo1

A

polymyositis/dermatomyositis
Rarely found in other connective tissue disease
Most associated with ILD
20-40% of polymyositis is positive for anti-Jo

27
Q

Anti-DsDNA

A

Specific for SLE
Sensitivity 25-85%
Titers correlate with disease activity

28
Q

Anti-histone antibodies

A

Drug induced lupus 75-95%

29
Q

Anti-gp210
anti-p62
Anti sp100

A

Primary biliary cirrhosis

30
Q

Anti-centromere antibodies

A

CREST, PBC, proximal scleroderma

31
Q

Anti-PM-Scl

A

polymyositis/systemic sclerosis overlap syndrome

Residency general knowledge (1 decks)

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