Clinical Chemistry CPC

Question 1

What part of the body is affected in a Colles’ fracture

Answer 1

Wrist

Question 2

What part of the body is affected in a Pott’s fracture

Answer 2

Ankle fracture - involved tibia and fibula

Question 3

What is the normal range for calcium

Answer 3

2.2-2.6

Question 4

What are the causes of hypercalcaemia (3)

Answer 4

Cancer
Primary hyperPTH
Sarcoidosis

Question 5

How can you determine the cause of high calcium

Answer 5

Measure PTH

Question 6

What causes the majority of primary hyperPTH

Answer 6

Parathyroid adenomas

Question 7

What are the consequences of primary hyperPTH (3)

Answer 7

Efflux of calcium from bone
Decreased loss of calcium in urine
Enhanced absorption of calcium from intestines

Question 8

What indicates primary hyperPTH (2)

Answer 8

Raised/inappropriately normal PTH in the presence of hypercalcaemia

Question 9

Raised calcium 
Low phosphate 
Raised/normal PTH
Raised/normal ALP
Normal Vitamin D

Answer 9

HyperPTH

Question 10

Clinical features of hypercalcaemia (6)

Answer 10

Moans/Bones/Groans/Stones
Asymtpomatic
Polydypsia/polyuria (nephrogenic DI)

Question 11

Signs of hypercalcaemia

Answer 11

Band keratopathy

Question 12

Complications of hypercalcaemia (5)

Answer 12

Renal stones 
Pancreatitis 
Peptic ulcer disease 
Skeletal changes 
Ostetitis fibrosa et cystica

Question 13

What are the types of renal stones (3)

Answer 13

Calcium oxalate-monohydrate
Calcium phosphate
Uric acid

Question 14

Uric acid renal stones

Answer 14

Radiolucent

Question 15

Calcium renal stones

Answer 15

Radio opaque

Question 16

Risk factors for calcium renal stones (5)

Answer 16

Family history 
Dewhydration 
Hypercalciuria (>6mmol Ca/day) 
Hypercalcaemia 
HyperPTH

Question 17

How do calcium renal stones present (4)

Answer 17

Pain (colic)
Haematuria
Recurrent infection
Renal failure

Question 18

Investigations for renal stones (3)

Answer 18

KUB
Stone analysis
Urine and serum biochemistry

Question 19

Natural history of calcium renal stones

Answer 19

Most stones pass

Question 20

How are calcium renal stones treated if they do not pass (3)

Answer 20

Lithotrypsy
Cystoscopy
Lithotomy

Question 21

How can calcium renal stones be prevented (2)

Answer 21

Drink more water 
Treat hypercalciuria (e.g. thizides) and/or hypercalcaemia as necessary

Question 22

What warrants emergency management of hypercalcaemia

Answer 22

Calcium > 3mmol/L and/or unwell - dehydrated, confusion, drowsy, coma, seizures, renal failure

Question 23

Emergency management of hypercalcaemia (5)

Answer 23

IV access (venflon/central line)
Catheter
Rehydrate 0.9% saline (FLUIDS FLUIDS FLUIDS)
Initiate calciuresis: ).9% saline, frusemide
IV pamidronate 30-60mg (hold off)

Question 24

Non emergency treatment of hypercalcaemia (3)

Answer 24

Keep well hydrated
Avoid thiazides
Surgery (parathyroidectomy)

Question 25

What can present with depression

Answer 25

Hypercalcaemia

Question 26

Mechanism of sarcoidosis

Answer 26

Systemic disease where macrophages express 1-alpha hydroxylase

Question 27

CXR sarcoidosis

Answer 27

Bilateral hilar lymphadenopathy

Question 28

PTH in sarcoidosis

Answer 28

Suppressed to undetectable levels

Question 29

Sarcoidosis treatment

Answer 29

Steroids will normalise both the calcium and treat the lung problem