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Year 5 Pathology - week 2 > Hypercalcemia - Meran > Flashcards

Hypercalcemia - Meran Flashcards

1
Q

What does low potassium cause in the heart?

A

VF

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2
Q

What does high potassium cause in the heart?

A

Asystole

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3
Q

Symptoms of hypercalcemia

A

BONES - bony pain
MOANS - depression
GROANS - renal stones, pancreatitis, pain
STONES - renal stones

Band keratopathy
Polyuria and polydipsia

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4
Q

Symptoms of hypocalcemia

A

CATS go numb

tetany
arrhythmia
numbness

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5
Q

Case 1 - a patient comes in with depression, smith’s fracture and haematuria. What’s going on?

A

Hypercalcemia - 2.82 (2.20-2.60)

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6
Q

What is a key investigation for hypercalcemia?

A

Plasma calcium levels
PTH levels

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7
Q

Three key causes of hypercalcemia -

A

Primary hyperparathyroidism (community)
Cancer (hospital)
Sarcoidosis

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8
Q

Smith’s vs Colle’s fracture

A

Colles = FOOSH, distal radius (literally the bit touching the wrist) is displaced posteriorly (DR CPD)
Smith = fall onto back of hand, distal radius has VOLAR displacement aka towards the palm

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9
Q

What does volar mean?

A

Towards the palm

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10
Q

What is another name for the skeletal changes which occur in primary hyperparathyroidism?

A

Osteitis fibrosa et cystica

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11
Q

How do you investigate renal colic?

A

Non contrast CT KUB
or USS if someone is pregnant or a child

+ urinalysis
+ urea and creatinine
+ stone analysis if unclear

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12
Q

Which renal stones show up opaque?

A

Calcium stones

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13
Q

Management of renal colic

A

Lithotripsy
Hydration
Analgesia

cystoscopy? lithotomy?

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14
Q

Which stones are radiolucent?

A

Uric acid - gout

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15
Q

How can you prevent renal colic?

A

Hydration

Thiazide diuretics (if people are stone formers)

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16
Q

Vit D metabolism

A

UV turns cholestrol to 7-dehydroxycholestrol

Liver turns 7-dehydrocholestrol / D3/cholecalciferol into 25-hydroxycholecalciferol using 25 hydroxylase; this is through first pass metabolism.

Kidney converts this into 25-vitamin D3 into 1,25 vitamin D3 through 1 alpha hydroxylase. This is a rate limiting step.

17
Q

Which step is rate limiting in vit D metabolism?

A

1 alpha hydroxylase step - kidney

18
Q

What is another name for calcidiol?

A

25 hydroxyl cholecalciferol / 25-Vit D3

19
Q

What is another name for calcitriol?

A

1,25 hydroxy cholecalciferol

20
Q

Where does PTH act in the metabolism of vitamin D?

A

PTH stimulates the 1 alpha hydroxylase enzyme, produced by the kidneys.

21
Q

What level of calcium is considered really bad hypercalcemia?

A

Above 3.0mmol/L

22
Q

What symptoms might someone with severe hypercalcemia present with?

A

Confusion
Drowsiness
Seizures
Renal failure
Dehydration

23
Q

How do you manage hypercalcemia in an emergency?

A

Get IV access - cannula or central line (through subclavian)

Calciuresis:
0.9% saline 4L
Furosemide

Keep hydrated

Arrange for surgery

24
Q

How long does it take for the emergency treatment of hypercalcemia to work?

A

A few days - gotta be patient

25
Q

What can be used as a last resort? What is the side effect of this?

A

Bisphosphonates - e.g. IV pamidronate 30-60mg.

However then this locks into the bone and causes hypocalcemia when the patient has their parathyroid glands removed.

26
Q

What are Looser’s zones?

A

caused by vit D deficiency; pseudofractures (not to do with primary hyperparathyroidism)

27
Q

What would a hand x-ray show in hypercalcemia?

A

Radial aspect always shows cystic changes.

28
Q

Bilateral hilar lymphadenopathy

A

Sarcoidosis
TB

29
Q

What would the histology show

A

Multinucleate giant cells

30
Q

Why does sarcoidosis cause hypercalcemia?

A

Macrophages in giant cells PRODUCE 1 alpha hydroxylase so they convert 25-OH vitamin D3 into 1,25-OH vitamin D, which then acts on the bone and gut to move more calcium into the blood.

31
Q

What does histology of sarcoidosis show?

A

Giant multinucleated cells

32
Q

How do you treat sarcoidosis?

A

Prednisolone - treats both the lung symptoms and the sarcoidosis

33
Q

What’s the side effect of prednisolone?

A

Hyperglycemia, cushings syndrome, thin skin, easy bruising etc

34
Q

Why does cancer cause hypercalcemia?

A

Some cancers produce PTHrP which makes the cancers invade bone more easily

35
Q

How do you treat cancer hypercalcemia?

A

Fluids + bisphophonate

36
Q

How do bisphosphonates work in cancer hypercalcemia

A

Osteoblasts make bone with bisphosphonate. However bisphosphonate is resistant to osteoclast activity (stimulated by PTHrP from cancer) so it reduces the pain from bony mets.

Year 5 Pathology - week 2 (5 decks)

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