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endoII exam2 > Pales, bone Ca > Flashcards

Pales, bone Ca Flashcards

1
Q

if Ca is too high what is released from thyroid

A

calcitonin to increase Ca deposition

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2
Q

if Ca is too low what does PTgland release

A

PTH to increase Ca release from bone

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3
Q

how does PTH increase Ca release

A

activates the osteoblasts which activates osteoclasts

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4
Q

how does low Mg change PTH secretion

A

decreases it

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5
Q

how does PTH change phosphate leves

A

decreases them because increases renal secretion

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6
Q

effects of active Vit D3 on Ca and PO4

A

increases Ca and PO4 absorption in gut

decreases PTH

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7
Q

What meds can cause hyperCa

A

Vit D
thiazide diuretics
lithium
tamoxifen

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8
Q

what granulomatous disorders can lead to hyper Ca

A

sarcoidosis
TB
wegeners
fungal

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9
Q

what endocrine disorders can lead to hyperCa

A

hyperthyroidism, adrenal insufficiency pheochromocytoma

VIP-oma

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10
Q

what are the malignancy associated causes hyper Ca

A 
local osteolytic
multiplem myeloma
primary bone turnover
metastatic to bones
PTH-RP
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11
Q

how does primary hyperPTH present

A

asymptomatic hyperCa or with renal stones

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12
Q

what type of acid base status will a patient be in primary hyperPTH

A

non anion gap metabolic acidosis

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13
Q

what type of bone loss do you have in hyperPTH

A

cortical bone loss leasing to osteoporosis

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14
Q

tertiary hyperPTH

A

reduced activation Vit D from chronic renal disease leading to elevated PTH

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15
Q

what part of dialysis can cause increase in PTH

A

aluminum containing PO4 binders that increases PTH and leads to osteomalacia

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16
Q

inheritance of familial benign hypocalciuric hypercalcemia

A

autosomal dominant loss of function mutation in CaSR on PTH cells and renal tubules

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17
Q

PTH and Mg levels in familial benign hypocalciuric hypercalcemia

A

mildly elevated PTH and Mg

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18
Q

Signs and Sx hypercalcemia

A

fatigue, polyuria, weakness, anorexia, nausea, vomiting, constipation, abdominal pain, lethargy, mental status change

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19
Q

how does hyper Ca affect pancreas

A

can lead to pancreatitis which will eventually produce hypocalcemia

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20
Q

band keratopathy

A

Ca deposits in cornea

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21
Q

what is osteitis fibrosa caystica

A

chronic bone resorption, demineralization, cystic bone lesions
from excessive PTH

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22
Q

what is an abnormal PTH value if detect hyperCa

A

normal or high because should be low

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23
Q

hyper Ca and have normal or high PTH

next test?

A

24 hr urinary Ca to rule out the benign familial (low urinary Ca)
if high urinary Ca then probably primary hyperPTH

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24
Q

Tx for hyperCa

A 
IV fluids, loop diuretics, IV bisphosphonates
Calcitonin
glcocorticoids
cinacalcet
hemodialysis
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25
Q

what msut you do if put patient on loop diuretic for hyperCa

A

replace fluids

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26
Q

why give glucocorticoids in hyperCa

A

help counter effects of too much vit D in blood from hyperCa

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27
Q

when do you use dialysis to Tx hyperCa

A

hemodialysis

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28
Q

what can cause acquired hypoPTH

A

post surgical
autoimmune: PGA APECED, SLE
Heavy Metals: copper wilson, iron hemochromatosis
Mg deficiency(dec PTH production and Resistance to PTH)
other: infection, tumor, granuloma, reidel thyroiditis

29
Q

what can cause MG deficiency

A

malabsorption

alcoholism

30
Q

PGA type I

A

autoimmune polyendocrinopathy

presents in childhood: candidiasis, hypoPTH, addison

31
Q

what congenital syndrome can cause congenital hypoPTH

A

digeorge

CATCH22

32
Q

what causes pseudohypoPTH

A

end organ R to PTH
tubular R to PTH so have hypercalciuria with hypocalcemia
hyperPO4

33
Q

pseudopseudohypoPTH

A

phenotypic abnormalities without hypocalcemia

34
Q

Albright hereditary osteodystrophy

A 
short stature
obese
bradydactyly, round faces
dermal ossifications
mental retardation
35
Q

Mg is cofactor for what

A

PTH secretion

36
Q

hypo Mg common in what disorders

A

chronic GI disease
nutritional deficiency
alcoholism
cis-platinum therapy

37
Q

clinical findings of acute hypoCa

A 
muscle cramps
tetany
irritability
carpopedal spasm
convulsions
perioral tingling
tingling of hands and feet
38
Q

clinical findings chronic hypoCa

A 
lethargy
personality changes
anxiety state
blurred vision from cataracts
parkinsonism
mental retardation
39
Q

chvostek sign

A

facial muscle contraction when tapping facial nerve

40
Q

trousseau phenomenon

A

carpal spasm after BP cuff from tetany

specific and sensitive for hypoCa

41
Q

if detect low Ca what is next test

A

albumin levels

42
Q

if hypoCa and low albumin Dx?

A

hypoproteinemia

confirm with ionized Ca level

43
Q

if hypo Ca and normal albumin next test?

A

measure PTH, creatinine and phosphorus

44
Q

for every decrease (1) of albumin what do you correct Ca

A

add .8 to Ca

45
Q

what levels of PTH creatinine and phosphorus lead you to consider PTH resistance

A

elevated PTH and phosphorus

normal creatinine

46
Q

what levels of PTH creatinine and phosphorus lead you to consider genetic or acquired hypoPTH

A

low PTH
normal creatinine
elevated phosphorus

47
Q

what levels of PTH creatinine and phosphorus lead you to consider Vit D problem

A

elevated PTH
normal creatinine
normal or reduced phosphorus

48
Q

what levels of PTH creatinine and phosphorus lead you to consider seconary hyperPTH from renal failure

A

increased PTH
increased creatinine
increased phosphorus

49
Q

What is Pagets

A

disorder of bone remodeling that increases rates of bone turnover

50
Q

what are signs of pagets

A

enlargement of skull, bowing of long bones
etiology unknown
increased vascularity of bone

51
Q

Sx pagets

A 
HA, bone pain
warmth of skin over involved bone
high output Cardiac failure
entrapment neuropathies (hearing loss)
kyphosis
52
Q

radiogrpahic findings pagets (phases)

A

osteolytic- wedge shaped resorption of long bones
mixed
osteoblastic- cotton wool appearance

53
Q

Tx pagets asymptomatic

A

do not treat

54
Q

Tx Sx pagets

A

bisphosphonates because dec resorption of bone

55
Q

lab findings pagets

A

serum alkaline phosphatase elevated
high serum C telopeptide
high urinary hydroxyproline in active disease
serum Ca usually high

56
Q

what medications increase risk for osteoporosis

A

glucocorticoids, anticonvulsants, heparin

57
Q

when should you measure BMD

A

women age>65
post menopausal women <65 who have 1+ risk factor osteoporosis
postmenopasual woman with fractures
women on hormone replacement therapy for long time
radiographic findings of osteoporosis
someone on corticosteroid therapy for more than 3 mo
primary hyperPTH

58
Q

gold standard test for BMD

59
Q

Dexa scan results

A

T score: standard deviation from mean BMD of young healthy population
Z score: standard deviation from BMD of an age and sex of matched group

60
Q

when do you rely on z score for dexa scan

A

younger men, children and premenopausal women

61
Q

What does a T score of -1 mean

A

10% bone loss

62
Q

T score for osteoporosis

A

T score <-2.5 or osteoporotic fracture

63
Q

T score for osteopenia

A

-1 to -2.5

64
Q

main medication to Tx osteoporosis

A

bisphosphonates: alendronate and risedronate

bind boney surface and inhibit osteoclastic bone resorption

65
Q

side effects bisphosphonates

A

esophagitis- can’t lay down after taking it
cannot eat for an hour because little absorption
black box warning: stop if having dental surgery because can cause dental necrosis

66
Q

how do the replacement estrogen hormones affect BMD

A

decrease vertebral fracture risk

no change on hip fracture risk

67
Q

action teriparatide

A

stimulate osteoblastic bone formation
SQ injection
increases BMD

68
Q

action denosumab

A

monoclonal Ab that inhibits osteoclastic activation

binds RANKL

endoII exam2 (18 decks)

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