PTH CIS

Question 1

What are symptoms of hypocalcemia

Answer 1

twitching, muscle cramps, tingling and numbness

Question 2

what are symptoms of hypercalcemia

Answer 2

constipation, polyuria, polydipsia, lethargy, coma, death

Question 3

how much calcium is usually bound to albumin

Answer 3

45%

Question 4

What are PTH dependent hypercalcemic disorders

Answer 4

primary hyperparathyroidism
hypercalemia of malignancy
familial hypocalciuric hypercalemia

Question 5

What are PTH independent hypercalcemic disorders

Answer 5

thiazide diuretics
milk-alkali syndrome
immobilization
acture renal failure
granulomatous disease
VIT D or A intoxificiation
adrenal insufficiency
hyperthyroidism

Question 6

What causes the hypercalcemia of malignancy

Answer 6

PTH RP

Question 7

What is the key test in differential Dx of hypercalemia

Answer 7

serum PTH

Question 8

What causes familial hypocalciuric hypercalcemia

Answer 8

heterozygous inactivation mutation in CaSR

increased PTH and serum Ca

Question 9

What are the causes of hypocalcemia

Answer 9

Vit D deficiency
hypoPTH
pseudohypoparathyroidism
hypomagnesemia
renal failure
liver failure
acute pancreatitis
hypoproteinemia

Question 10

What causes hypoparathyroidism

Answer 10

usually autoimmune to parathyroid gland

Question 11

describe pseudohypoparathyroidism

Answer 11

genetic disorder causing resistance to PTH

Question 12

What is the key test in Dx for hypocalcemia

Answer 12

measurement of 25-OH VIT D

Question 13

how does hypoproteinemia cause hypocalcemia

Answer 13

losing albumin, so cannot carry Ca

Question 14

High Ca, low phosphate, extremely high PTH, normal albumin, elevated alkaline phosphatase, elevated urinary Ca excretion and calcium oxalate

Answer 14

hyperparathyroidism, tumor of parathyroid gland

Question 15

What triggers alkaline phosphatase release

Answer 15

increased bone resorption from PTH levels

Question 16

how will the levels of ionized Ca be if have alkalemia

Answer 16

decrease

H+ and Ca+ compete with eachother on albumin

Question 17

On what cell type in bone do PTH R sit on

Answer 17

osteoblasts

Question 18

what happens with PTH on bone resorption

Answer 18

bind R on osteoblasts
soluble mediators(cytokines)
stimulate osteoclasts
more Ca released from bone

Question 19

Why do people with primary PTH have increased alkaline phosphatase

Answer 19

increased bone resorption

triggers bone formation

Question 20

What is alkaline phosphatase a measurement for

Answer 20

bone formation

Question 21

What is the effect of increased PTH on kidney

Answer 21

increased production of 1,25 OH Vit D

Question 22

What are the 4 actions of PTH

Answer 22

increased bone turnover, increased intestinal Ca resorption due to increased 1,25 Vit D
decreased serum phosphate
increased renal Ca absorption

Question 23

What is significant of increased phosphate excretion on serum Ca levels

Answer 23

PTH action

Question 24

Why does someone with hyperparathyroidism have hypercalciuria

Answer 24

increased Ca resorption, kidney stones

Question 25

kidney stones presented with dehydration, what is the mechanism

Answer 25

increase in ADH secretion, concentration of urine

Question 26

pain with pressure applied to tibias is indicative of

Answer 26

Vit D deficiency

Question 27

What are the levels of Vit D deficiency

Answer 27

0-10 severe 10-20 moderate 20-30 mild >30 normal

Question 28

a vit D deficiency leads to what bone disorder

Answer 28

osteomalacia

Question 29

bone problems associated with renal failure can be charcterized by what levels

Answer 29

a decrease in 1 alpha hydroxylase activity

Question 30

why do serum calcium levels not increase in bone problems due to renal failure

Answer 30

increase in phosphate leads to biding with Ca and can cause precipitation

Question 31

bone loss because of renal failure occurs because of what

Answer 31

renal phosphate clearance decreases in renal failure

Question 32

8 year old with muscle cramping of arms and legs and tingling of lips Type I DM, addisons, hypothyroidism low Ca, PTH, normal Vit D and albumin increased phosphorous

Answer 32

hypoparathyroidism, autoimmune

Question 33

56 yr old hypercalcemic, asymptomatic except polyuria increased Ca, low phosphorous, increased PTH, increased alkaline phosphatase and normal albumin increased urinary cAMP elevated urinary cAMP and hydroxyproline short QT T score 2.0

Answer 33

primary hyperparathyroidism overproduction PTH T score shows she has osteoporosis increased bone resorption

Question 34

When PTH is extremely high and Ca is slightly low what can be suspected

Answer 34

kidney failure

Question 35

If Ca is extremly high and PTH low/normal what can be suspected

Answer 35

High Ca of malignancy

Question 36

With very elevated PTH AND Ca what can be suspected

Answer 36

primary hyperparathyroidism