Disorders of calcium balance

Question 1

Hypercalcaemia biochemical threshold

Answer 1

greater than or equal to 2.6 mmol/L

Question 2

Causes of hypercalcaemia

Answer 2

primary hyperparathyroidism
cancer

Question 3

Symptoms of hypercalcaemia

Answer 3

Bones, Stones, Moans, Groans, Thrones, muscle weakness

Question 4

Hypercalcaemia Mx

Answer 4

Treat the cause

Question 5

Hypercalcaemia approach flowchart

Answer 5

Question 6

Hypocalcaemia signs

Answer 6

Neuro - perioral paraesthesia, carpopedal spasm, Chvostek’s (cheek), Trousseau’s,
Psych - anxiety/irritability, impaired orientation
Cardio - long QT
Derm - Dermatitis/impetigo herpetiformis

Question 7

Hypocalcaemia Mx

Answer 7

Severe - IV calcium gluconate
Mild - Oral calcium

Question 8

Hypocalcaemia approach flowchart

Answer 8

Question 9

Risk factors for renal stones

Answer 9

Dehydration
Abnormal pH
Increased stone component excretion
infection
Anatomy

Question 10

Causes of calcium stones

Answer 10

Usually normocalcaemic
Hyperoxaluria
Hypercalciuria

Question 11

Calcium stone prevention

Answer 11

Intake - hydration, reduce oxalate, maintain normal calcium intake
Medical - thiazides, citrate

Question 12

Most common stone constituent

Answer 12

Calcium mixed
Then calcium oxalate

Question 13

Typical radiograph appearance of stones

Answer 13

Radio-opaque

Question 14

Which stones appear as staghorn calculi on radiography

Answer 14

Struvite (triple phosphate) stones

Question 15

Which stones appear as radiolucent on radiography

Answer 15

Uric acid
Xanthine

Question 16

1st line investigations for stones

Answer 16

Adults - low-dose non-contrast CT
children, pregnant women - US

Question 17

Renal stone management

Answer 17

1. IM Diclofenac
2. 0-5mm - conservative
3. 6-20mm - lithotripsy/ureteroscopy
4. larger than 20mm - percutaneous nephrolithotomy

Question 18

Recurrent stone investigations

Answer 18