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endo II exam1 > phys III > Flashcards

phys III Flashcards

1
Q

what is considered hypocalcemia? hyper?

A

hypo 10.5 mg/dL

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2
Q

Sx hypocalcemia

A

twitching, muscle cramps, tingling, numbness

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3
Q

Sx hypercalcemia

A

constipation, polydipsia, polyuria, lethargy, coma, death

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4
Q

majority of phosphate in plasma is in what form

A

ionized

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5
Q

majority of Ca in plasma is in what form

A

50% ionized 45% protein bound

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6
Q

what binds Ca

A

albumin

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7
Q

What does albumin bind in acidemia

A

more H than Ca so more ionized Ca

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8
Q

what does albumin bind in alkalemia

A

more Ca than H so less ionized Ca

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9
Q

what hormones regulate Ca

A

PTH, 1,25-dihydroxyvitamin D

calcitonin

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10
Q

what organs regulate Ca

A

skeleton, kidney, intestines

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11
Q

what is the Ca sensor R

A

7 membrane GPCR
senses extracell Ca- ionized Ca
R found on parathyroid cells, parafollicular c-cells and renal tubular cells

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12
Q

what sitmualtes bone resorption? what inhibits it

A

stimulated by PTH and 1,25 dihydrovit D

inhibited by calcitonin

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13
Q

functions PTH

A
  • Ca and phospate resorption from bone
  • promotes Ca resorption from kidney
  • promotes phosphate excretion from kidney
  • signals 1alpha hydroxylation of 25-hydroxycholecalciferol in kidney
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14
Q

functions of 1,25(OH)2 vit D

A

bone remodeling promotes mineralization
Ca absorption from gut
renal resorption of Ca and phosphate
negatively feedbacks on its own conversion

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15
Q

What suppresses PTH secretion

A

high levels extracell Ca

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16
Q

how does PTH increase bone resoprtion

A

acts on R on osteoblasts which stimulate osteoclasts

17
Q

severe deficiencies Vit D can cause what

A

osteomalacia and rickets

18
Q

what is osteopetrosis and what can cause it

A

increase in bone density, loss of RANKL

19
Q

what is Osteoprotegerin OPG

A

soluble R for RANKL and shuts down resorption by osteoclases

20
Q

if you lose OPG what results, and why

A

decrease in bone density, osteoporosis because unregulated RANKL is activation osteoclasts

21
Q

what is needed to activate the conversion of 25 OH to 1,25 OH in kidney

A

decrease Ca [ ]
increase PTH
decrease PO4 [ ]

22
Q

what levels classify severe, moderate, mild and normal Vit D deficiency

A

normal is >30ng/ml
mild 20-30
moderate 10-20
severe 0-10

23
Q

if PTH is super super high and blood Ca is low what will you suspect?

A

kidney failure

24
Q

if PTH is super high and Ca is normal-high what do you suspect

A

primary hyperparathyroidism

25
Q

if PTH is elevated and Ca low what do you suspect

A

Vit D deficiency

26
Q

what id PTH is super low, almost 0 and Ca super high

A

High Ca of malignancy

27
Q

What are the hyperCa disorders

A 
primary hyperPTH
hyperCa of malignancy
granulomatous disease
Vit D intoxication
Vit A intoxication
hyperthyroidism
thiazide diuretics
milk-alkali syndrome
immobilization
adrenal insufficiency
acute renal failure
familial hypocalciuric hyperCa
28
Q

what can cause familial hypocalciuric hypercalcemia

A

heterozygous inactivation mutation in CaSR

increase PTH and serum Ca

29
Q

what is key test in Dx hypercalcemia cause

A

serum PTH

30
Q

causes of hypoCa

A 
Vit D def
hypoPTH
pseudohypoPTH
hypoMg
Renal failure
liver failures
acute pancreatitis
hypoproteinemia
31
Q

what are key tests in Dx hypocalcemia

A

25-OH vit D measurement and PTH

32
Q

if PTH levels are low and patient is hypcalcemic what is Dx

A

hypoPTH because all other causes hypoCa have high PTH or normal

33
Q

how do renal and liver disease contribute to hypocalcemia

A

interfere with Vit D synthesis

34
Q

how does acute pancreatitis lead to hypo Ca

A

precipitation of Ca from release of lipid products

35
Q

what is the key abnormal blood level in pagets disease

A

increased alkaline phosphatase

have bone pain as cc

endo II exam1 (14 decks)

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