Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 2 > Diseases of the parathyroid glands > Flashcards

Diseases of the parathyroid glands Flashcards

1
Q

What is the primary cause of hyperparathyroidism

A

Parathyroid adenoma - hypersecretion of PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the secondary cause of hyperparathyroidism

A

Physioloical compensation of all parathyroid hormones - hypertrophy due to hypocalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a tertiary cause of hyperparathyroidism

A

Adenomas arising from patients with secondary hyperparathyroidism - These hyper secrete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of primary hyperparathyroidism

A
  1. Renal stones
  2. Muscle weakness
  3. Tiredness
  4. Thirst
  5. Anorexia and constipation
  6. Peptic ulcers as gastric secretion ins enhanced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why are renal stones common in primary hyperparathyroidism

A

Due to hypercalciurea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are four causes of hypercalcaemia

A
  1. Malignancy in bones
  2. Hyperparathyroidism
  3. Vitamin D intoxication
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Two actions of vitamin D

A

Intestines - Increases Ca absorption

Bone - With PTH, releases Ca into circulation (needed for mineralisation of osteoids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What three things do we look out for in patients when hypercalcaemia points towards hyperparathyroidism as a cause

A
  1. Raised plasma calcium conc. and LOW phosphate conc.
  2. Mild metabolic acidosis
  3. Raised PTH levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are 80% of primary hyperparathyroidism caused by

A

Secretory adenoma of one of the parathyroid glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is 20% of primary hyperparathyroidism caused by

A

Hyperplasia of all parathyroid glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is hyperparathyroidism managed

A
  1. Inspection of all parathyroid glands + removal of suspected adenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

5 Clinical features of hypoparathyroidism

A

(same as clinical features of hypocalcaemia)

  1. tetany (look at larynx, hands and feet or premature labour)
  2. Convulsion
  3. Psychiatric disturbances
  4. Cataracts
  5. Paraesthesiae
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is Tetany

A

Skeletal muscle spasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Paraesthasiae

A

Abnormal dermal sensations (itching, burning) with no physical stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is hypoparathyroidism diagnosed

A
  1. Hyperphosphataemia
  2. Rickets due to vitamin D deficiency
  3. Excessive loss during lactation

AND mainly due to low PTH levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are three main causes of hypoparathyroidism

A
  1. Removal of parathyroid glands during surgery
  2. Idiopathic hypoparathyroidism
  3. DiGeorge syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is idiopathic hypoparathyroidism and when does it occur

A

Childhood

Hypoparathyroidism that occurs suddenly with no reason (idiopathic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is idiopathic hypoparathyroidism caused

A

Destruction of parathyroid cells by an autoantibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How many parathyroid glands do adenomas effect

A

Only one usually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to calculate corrected calcium levels

A

Total serum calcium + 0.02*(40-serum albumin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why do we need to correct calcium levels in measurements

A

Because we could have a low serum calcium level but a high ionised calcium ion level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are two tests we can do as doctors to check for hypocalcaemia

A
  1. Chvostek’s sign (Tap over facial nerve and see if facial muscles spasm)
  2. Trousseau’s Sign (Inflate blood pressure cuff to 20mm Hg above systolic for 5 minutes)
REMEMBER:
SPASMODIC
S - Spasms
P - Perioral paraesthesia
A - Anxious
S - Seizures
M - Muscle tones increases - wheeze
O - Orientation impaired
D - Dermatitis
I - Impetigo Herpetiformis (reduced Ca and pustules in pregnancy)
C - Chvostek's Sign, Cataract and Cardiomyopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe how the Trosseau’s Sign help’s detect for hypocalcaemia

A
  1. Occludes brachial artery
  2. In absence of blood flow, neuromuscular irritability will cause spasm of hand
  3. Wrist and metacarpophalangeal joins flex
  4. DIP and PIP joints extend

Looks like a camp hand

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Role of Vit D in immunity

A

Induces differentiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is DiGeorge Syndrome

A

Deletion of chromosome 22 - causes abnormality in 3rd and 4th branchial pouches

  1. Cleft Palate
  2. Hypoparathyroidism
  3. Immunodeficiency
  4. Kidney problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What autoimmunity causes hypoparathyroidism

A

Polyglandular type I

  • Recessive disorder located on chromosome 21
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is hypoparathyroidism caused by magnesium

A

Because a low, constant level is needed for parathyroid secretion of calcium. If it gets too low, then secretion is inhibited

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

role of magnesium in the body

A
  1. Magnesium is needed to relax muscles whilst calcium is needed to contract them.
  2. Provides elasticity and flex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Effect of decreased PTH production in hypoparathyroidism

A
  1. Decreased renal absorption of Ca
  2. Increased renal absorption of phosphates
  3. Decreased bone resorption
  4. Decreased formation of 1,25(OH)2D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is pseudohypoparathyroidism

A

Resistance to PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is Albright hereditary osteodystrophy

A

Mutation with deficient G-alpha subunit (pseudohypoparathyroidism type 1)

32
Q

Signs of pseudohypoparathyroidism type 1a

A
  1. Short stature
  2. Obesity
  3. Learning difficulties
  4. Short fourth metacarpal
  5. Subcutaneaous ossification

Albright

33
Q

Sign of pseudohypoparathyroidism type 1b

A

Mild brachydactyly

34
Q

How is type 1b pseudohypoparathyroidism caused

A

Methylation defect

35
Q

Is type 1b similar to 1a

A

Biochemically but not physically when seen in an individual

36
Q

In what way is type 2 different to type 1a and 1b

A

Genetic defect is further down the signalling pathway than in type 1 so cAMP response to PTH works here

37
Q

3 ways pseudohypoparathyroidism effects the body

A
  1. reduced Bone resorption

2. reduced Ca absorption

38
Q

What is pseudopseudohypoparathyrodiism

A

Where an individual has the phenotype of pseudohypoparathyroidism type 1a but normal levels of Ca and PTH in the blood

39
Q

Two circumstances when calcium levels are high in the blood but there do not have hypercalcaemia

A
  1. Torniquet on for too long

2. Sample is old and has haemolysed

40
Q

Hypocalcaemia vs hypercalcaemia in ECGs

A

Hypo - Long QT interval

Hyper - Short QT

41
Q

What is sarcoidosis

A

Abnormal collections of inflammatory cells that form granulomas

42
Q

What is osteitis fibrous cystica and in which condition is this seen in

A
  1. Loss of bone mass and weakening of calcified supporting structures
  2. Primary hyperparathyroidism
43
Q

Why would a patient with primary hyperparathyroidism have abdominal moans

A
  1. Constipation

2. Acute pancreatitis

44
Q

In what sex are thyroid problems more common in

A

Females

45
Q

Why is the thyroid highly vascularised

A

As it secretes hormones directly into the blood

46
Q

Lab results for primary hyperparathyroidism

A

High PTH
High Ca
Low Phosphate
High Alkaline Phosphatase

47
Q

Symptoms of secondary hyperparathyroidism

A

Joint pain and osteomalacia (low mineral content of bone)

48
Q

Lab results for secondary hyperparathyroidism

REMEMBER: Secondary is usually seen in Chronic Kidney Disease and Chrohn’s Disease

A

High PTH
Low Ca
High Phosphate (renal disease)
High Alkaline Phosphate

49
Q

Can symptoms for secondary hyperparathyroidism be seen

A

No - asymptomatic

50
Q

Lab results for tertiary hyperparathyroidism

A

High PTH
High CA
High Phosphate
High Alkaline Phosphatase

51
Q

How is malignant hyperparathyroidism caused

A

Parathyoroid-related protein is produced by squamous cell lung cancers and breast cancers which mimic PTH (PTH levels are low in labs)

Bone infiltration

Production of osteoclastic factors by tumours

52
Q

What drugs would be given to treat malignant hyperparathyroidism

A
  1. Thiazide diuretic
  2. Vit D analogies
  3. Lithium administration

And long-term immobility

53
Q

What is the first presenting symptom of malignant hyperparathyroidism

A

Hypercalcaemia

54
Q

What is the patient suffering from if they are overall very healthy but have hypercalcaemia

A

Primary hyperparathyroidism NOT malignant

55
Q

How do we go from primary to tertiary hyperparathyroidism

A

Long-standing pathology

56
Q

What blood component would exclude hyperpaarthyroidism in lab results

A

LOW PTH levels - Malignant

57
Q

Lab results for Malignant hyperparathyroidism

A
  1. Low albumin
  2. Low PTH
  3. Raised alkaline phosphatase
58
Q

What do we do if the following was found:

  1. Low albumin
  2. Low PTH
  3. Raised alkaline phosphatase
A

Protein electrophoresis t look for myeloma

59
Q

What is myeloma

A

Cancer of plasma cells in the bone marrow

60
Q

What would we see in electrophoresis if myeloma is positive

A

B2-microglobulin will be present

61
Q

What would low renal function indicate

A

Secondary or tertiary hyperparathyroidism

62
Q

What would we detect to exclude all type of hyperparathyroidism in the patient

A

Measure TSH levels

DXA bone density scan - could diagnose osteoporosis instead

63
Q

How do we detect a patient for parathyroid tumours

A

Radioisotope scanning (90% sensitive)

64
Q

What might be a more effective replacement for radioisotope scanning

A

High res CT or MRI is more sensitive

65
Q

How is acute severe hypercalcaemia treated

A
  1. Rehydrate with IV 0.9% saline - prevents stones
  2. Bisphosphates (prevents bone resorption by inhibiting osteoclasts) after rehydration (IV Pamidronate)
  3. Measure serum and U+Es daily and serum Ca 48 hours after treatment
  4. Give glucocorticoids steroids (ORAL PREDNISOLONE)
66
Q

How do we treat [rimary hyperparathyroidism

A

Surgically remove adenoma

OR

Surgically remove all four glands if its parathyroid hyperplasia

67
Q

What is the complication of post-op primary hyperthyroidism surgery

A

Hypocalcaemia

68
Q

What would we give to treat post-op hypocalcaemia in patients with primary hyperparathyroidism that just had surgery

A

Oral Cinacalcet - Calcimimetic that increases sensitivity of parathyroid glands to Ca

69
Q

Would we give Thiazide diuretic to patients with primary hyperparathyroidism

A

No, we avoid them and high Ca and Vit D intake

70
Q

How is pseudopseudohypoparathyroidsm inherited

A

Father

71
Q

Drugs to treat hypocalcaemia

A
  1. Calcitonin
  2. Bisphosphates

Reduces Ca plasma conc

72
Q

How is acute hypoparathyroidism treated

A

IV CALCIUM GLUCONATE for 30 mins with ECG monitoring

73
Q

How to treat Vit D deficiency

A
  1. Give Oral Colecalciferol (Vid D3) OR Oral Adcal (calcium and vit D3)
74
Q

How is non-acute hypoparathyroidism treated

A

Calcium supplements and Calcitriol

75
Q

What is Calcitriol

A

Activated Vit D

Year 2 (155 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions