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Year 5 path SW > Chempath 20: Clinical Chemistry CPC > Flashcards

Chempath 20: Clinical Chemistry CPC Flashcards

1
Q

What happens when you fall on an outstretched hand

A

Colles fracture

Radius fractures backwards away from the palm side

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2
Q

What fracture is caused by falling on a flexed wrist ?

A

Smith’s fracture

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3
Q

List 3 causes of hypercalcaemia ?

A

Primary hyperparathyroidism
Cancer
Sarcoidosis

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4
Q

How can you differentiate Primary hyperparathyroidism from cancer causing hypercalcaemia ?

A

Plasma PTH

0 in cancer and high in primary hyperparathyroidism

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5
Q

What is PTHrP ?

Give 2 locations where its produced ?

A

PTH related peptide

Produced by the placenta (so mothers calcium increases and baby can steal some)
produced by breast and secreted into breast milk

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6
Q

Why is PTHrP activation in cancer a bad prognostic feature ?

A

PTHrP stimulates cancer invasion of bone by turning on osteoclasts.

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7
Q

Which enzyme activates Vitamin D in the kidneys ?

A

1-alpha hydroxylase

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8
Q

How does vitamin D affect the kidneys ?

A

Activated vitamin D (calcitriol) causes increased reabsorption of calcium

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9
Q

Which tumours are featured in MEN1 ?

A

Pituitary tumour
Parathyroid tumour
Pancreas - islet cell tumour

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10
Q

What symptoms do you get with hypercalcaemia ?

A

Moans- depression, psychosis, coma
Groans- constipation, abdominal pain,
Bones- fractures, bone pain (osteitis fibrosa cystica)
Stones- renal colic (calcium oxalate stones)

Polydipsia and polyuria (nephrogenic diabetes insipidus)

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11
Q

Which organism causes recurrent UTIs in patients with calcium stones ?

A

Proteus mirabilis

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12
Q

Why are patients so dehydrated with Hypercalcaemia ?

A

Calcium acts like mannitol, it causes water to move with it into the urine causing a diuresis

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13
Q

How do you treat hypercalcaemia ?

A
  • Saline fluids (to rehydrate), 6L in 24 hrs, first L quickly over 1hr to deal with dehydration
  • Furusamide (causes calcium loss in the urine)
  • IV pamidronate (a bisphosphonate that stops bone resorption by causing osteoclast apoptosis. Only use in very high calcium)
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14
Q

Why is giving saline to hypercalcaemia patients with liver failure contraindicated ?

What do you give instead ?

A

They retain salt so can cause hypernatraemia

Dextrose Fluids

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15
Q

Which diuretics should be avoided in hypercalcaemia ?

A

Thiazides

They cause increased calcium reabsorption into the blood.

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16
Q

Which feature of Osteitis fibrosa cystica is described by this histology:

“Multinucleate giant cells in the bone”

A

Brown tumours

Giant cells are the activated osteoclasts

17
Q

A lady is noted to have hypercalcaemia, her chest X ray shows bilateral hilar lymphadenopathy.

What is the most likely diagnosis ?

A

Sarcoidosis

18
Q

A histology specimen of a patient with hypercalcaemia shows “non-caseating granuloma”.

What is the most likely diagnosis ?

A

Sarcoidosis

19
Q

What is the mainstay of treatment for sarcoidosis ?

A

Steroids

20
Q

How does sarcoidosis cause Hypercalcaemia ?

A
  • Macrophages in the lungs of people with sarcoidosis express 1-alpha-hydroxylase.
  • This causes increased activation of vitamin D (especially in the summer)
  • Activated Vitamin D causes increased calcium reabsorption from the kidneys and G.I tract
21
Q

What are the cardiac effects of hyper and hypokalaemia

A

Hyperkalaemia - asystole

Hypokalaemia - VF

22
Q

What are the mechanisms of hypercalcaemia of malignancy

A

PTHrP

Cancer invading the bone

23
Q

Describe features of primary hypercalcaemia

A

Causes efflux of calcium from bone and increased calcium reabsorption in kidney + increased absorption of calcium in the intestines
PTH - activates 1 alpha hydroxylase in kidneys - activates vitamin D - increases absorption of calcium in intestines

24
Q

Sign of hypercalcaemia

A

Band keratopathy

Calcium deposition across the front of the eye

25
Q

Complications of hypercalcaemia

A

Renal stones
Pancreatitis
Peptic ulcer disease
Skeletal changes - osteitis fibrosa cystica

26
Q

Management of renal stones

A

Lithotripsy
Cystoscopy
Lithotomy

27
Q

Surgery for hyperparathyroidism

A

Minimally invasive parathyroidectomy

Technetium sestamibi can show a hyperactive parathyroid gland

Year 5 path SW (106 decks)

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