clinical calcium

Question 1

what are 2 intergrated features of bone strength

Answer 1

1. bone density

2. bone quality

Question 2

common locations of osteo breaks

Answer 2

hip, vert., wrist, humerus

Question 3

exceptions to osteo breaks

Answer 3

skull, fingers and toes, ankle, metas

Question 4

what is cutoff for osteo in bone density score (T and z)

Answer 4

under T-score of 2.5 (compared to young adult)

under z-score of 1 (age matched)

Question 5

what are inhibitors of bone resoption

Answer 5

1. biphosohnates (main one)
2. caltitonin
3. estrogen
4. RANKL inhibs

Question 6

what are therapies for osteo ($)

Answer 6

1. inhib. bone resorption (biphosphonates)
2. stim bone formation (PTH)
3. mixed mechanism (Vit D)
4. Ca

Question 7

3 sources of vit D

Answer 7

1. sunlight
2. diet
3. supplements

Question 8

4 Sx of hypercalcemia

Answer 8

1. Moans - altered mental status
2. bones - pain, porosis
3. stones - diuresis, kidney stones
4. groans - GI upset, anorexia, constipation

Question 9

2 main causes of hypercalcemia

Answer 9

1. hyperparathyroidism - outpatient

2. malignancy - inpatient

Question 10

what happens in hyperparathyroidism

Answer 10

parathryoid doesn’t respond to high Ca and keeps producing PTH even when high

Question 11

3 ways to treat hyperpara

Answer 11

1. sugery -curative
2. Ca sensing receptor agonists
3. montior and diet

Question 12

management of acute hypercalcemia

Answer 12

1. hydrate
2. inhibit bone resorption
3. calciuresis - loop diuretics
4. glucocorticoids
5. dialysis

Question 13

3 causes of malignant hypercalcemia and prevalences

Answer 13

1. humoral hypercalcemia (80%)
2. osteolytic metastases (20%)
3. extra-renal production of 1,25D3 (<1%)

Question 14

what mediates hypercalcemia

Answer 14

calcitriol (1,25D3)

Question 15

2 ways that calitriol can be over created

Answer 15

1. extra-renal source

2. over expression of 1-alpha-hydroxylase

Question 16

4 neuromuscular signs of hypocal.

Answer 16

1. tetany
2. numbness and tingling
3. 7th cranial nerve excitability
4. carpopedal spasm

Question 17

4 CNS signs of hypocal.

Answer 17

1. irritable
2. seizures
3. personality change
4. impaired cognition

Question 18

2 common causes of hypocal.

Answer 18

1. hypoparathyroidism

2. organ dysfunction (malabsorbtion or excretion)

Question 19

what helps determine the cause of hypocal.

Answer 19

PTH levels

Question 20

what is 2ndry hyperparathyroidism

Answer 20

normal response of parathyroid to hypocalcemia

Question 21

3 main categories of non-parathyroid dysfunction

Answer 21

1. probs with intesitinal absorb.
2. urinary loss of Ca
3. disorders of Vit D