Clinical Calcium Flashcards

Question

What are MSK Sx

Answer 1

Muscle weakness / myopathy Bone pain Osteoporosis Fractures

Answer 2

``` Decreased concentration Fatigue Low mood Confusion = most common Coma HYporeflexia Seizures ```

Answer 3

``` Short QT Bradycardia Various degree of heart block Hypertension Fatal arrhythmia ```

Answer 4

``` Hx - drugs + FH Bloods - Bone profile - Ca, phosphate, PTH - U+E - Myeloma - ALP - Amylase for pancreatitis - Glucose for polyuria etc. ECG X-ray / USS / CT head for confusion / MRI / isotope bone scan / CXR if suspect effusion ```

Answer 5

Primary hyperparathyroid Familial hypocalciuric hyperclacaemia Tertiary

Answer 6

Malignancy | Drugs

Answer 7

Stop medication contributing - thiazide / vit D Rehydration with normal saline = main stay - 3L over 24 hours Monitor U+E closely as can gt hypo K IV biphosphonates if Ca >3 = main stay or not coming down with saline Can use thiazide diuretic but only if overload as may cause other electrolyte Monitor Ca and phosphates Need to treat cause e.g. steroids If due to sarcoid If >3.5 / coma/. arrhythmia ICU for cardiac monitoring Haemofiltration

Answer 8

Monitor for overload | Consider dialysis if severe renal failure so can't use saline or biphhsophoantes

Answer 9

Glucocorticoid in lymphoma/. granulomatous Calcitonin Parathyroidectomy = 1st line primary Calcimimetic - in primary

Answer 10

``` Destruction of parathyroid gland - surgery / thyroiditis Genetic Autoimmune Post surgery on thyroid Hypomagnesium Infiltration - mets / granulomatous Radiation Hungry bone HIV ```

Answer 11

Required for production of PTH | Drugs e.g. omeprazole can cause

Answer 12

Low ca, phosphate and Mg after parathyroid surgery

Answer 13

``` Chronic renal disease Vit D deficiency (osteomalacia) Pseudohypoparathyroid Rhabdomylosis Tumour lysis Acute pancreatitis Blood transfusion - cause metabolic alkalosis Acute respiratory alkalosis ```

Answer 14

High phosphate and K as releases | Promotes reabsorption in bone

Answer 15

Target organ unresponsive to PTH Leads to hypocalcaemia but hyperphosphataemia PTH rises due to low Ca but organ doesn't respond to increase Rx as per primary hypoparathyroid

Answer 16

``` Pseudohypoparathyroid + Obesity Short stature Low IQ Shortening of metacarpals - 4th and 5th ```

Answer 17

AHO but normal biochemistry

Answer 18

``` Biphosphonates Loop diuretic Phenytoin Fluoride Calcium chelator ```

Answer 19

``` Tetany Paraesthesia Muscle twitching / spasms Trousseau's Chovstek's Seizure Bronchospams Cardiac Papilloedema ```

Answer 20

Prolonged QT Hypotension HF Arrhythmia

Answer 21

Trousseau - tight cuff applied to occlude brachial = wrist flexion, fingers cuff, paraesthesia + bronchospasm Chovstek - touch facial nerve = spasm of muscles

Answer 22

``` Extra-pyramidal Parkinsonism Dementia Depression Cataract Abnormal dentition Dry skin ```

Answer 23

Hx Bloods ECG

Answer 24

``` Ca + vit D intake Autoimmune disease Surgery to neck Drug Hx FH ```

Answer 25

Calcium, albumin, phosphate, vit D, phosphate, Mg, U+E

Answer 26

Check Mg If Mg low = deficiency If normal = hypoparathyroid

Answer 27

Check U+E | If high = renal failure

Answer 28

Check Via D If low = vit D deficiency If normal = pseudo

Answer 29

``` Oral calcium Vit D if defiicent Replace Mg Stop precipitating drugs Advise diet ```

Answer 30

IV calcium gluconate bolus 10-20ml 10% in 50-100ml of 50% dextrose over 10 minutes Continuous ECG Rx cause

Answer 31

``` MENIN Mutation 3P's Primary hyperparathyroid - most common presentation Pancreatic and duodenal insulinoma Pituitary adenoma ``` Other - Adrenal / thyroid

Answer 32

``` RET mutation 2P's Primary hyperparathyroid Phaeochromocytoma Medullary thyroid cancer ```

Answer 33

``` RET mutation 1P Phaeochromocytoma Medullary thyroid Neuroma of skin ```

Answer 34

Symptoms suggestive. + Male and hyperparathyroid <50 2 MEN-1 tumours 1st degree with EMN1

Answer 35

``` Hypercalcaemia and renal calculi Peptic ulcer Unexplained hypoglycaemia Hyperprolactin Acromegaly Hypopituitary ```

Answer 36

Surgical excision | Medical / RT depending on tumour type

Answer 37

Any patient with medullary cancer as usual presentation MEN2 tumour <30 or 2 >30 Neurofibromatosis 1st degree relative with MEN2

Answer 38

``` Gland failure - RT - Surgery Autoimmune Congenital Hypo-Mg ```

Answer 39

Ca supplements + calcitriol