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Y4 Gen Med > Vitamin D & Calcium > Flashcards

Vitamin D & Calcium Flashcards

1
Q

99% of bony calcium is stored in _____

A

bone

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2
Q

Vitamin D is hydroxylated to its active form in the _____, becomes _____

A

liver

calcitriol

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3
Q

How many parathyroid glands are there? what do they secrete?

A

4

PTH

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4
Q

What is the function of PTH?

A

Regulates calcium

by osteoblasts/clasts and works on kidney

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5
Q

A solitary parathyroid adenoma causes …

A

Primary hyperthyroidism

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6
Q

What is the presentation of hypercalcaemia?

A

Bones stones groans moans

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7
Q

What is the commonest management of primary hyperparathyroidism?

A

Surgery

otherwise conservative Mx

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8
Q

What is the aetiology of tertiary hyperparathyroidism?

A

Secondary to to years of chronic kidney disease

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9
Q

What are the indications for conservative management in primary hyperparathyroidism?

A

If calcium <0.25 above normal + over 50yr old + no end organ damage

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10
Q

What age group and gender are most commonly affected by primary hyperparathyroidism?

A

Elderly female

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11
Q

What effect does hypercalcaemia and hypocalcaemia have on QT interval?

A

Hypercalcaemia short QT interval

Hypocalcaemia long QT interval

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12
Q

What causes a pepperpot skull on x-ray?

A

Hypercalcaemia in hyperparathyroidism

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13
Q

What effect does secondary hyperparathyroidism have on PTH, calcium, phosphate?

A

Hi PTH, low calcium, phosphate

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14
Q

What causes secondary hyperparathyroidism?

A

Almost always due to chronic kidney disease/ vit d deficiency

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15
Q

Do you thiazide diuretics cause hyper or hypocalcaemia?

A

Hypercalcaemia

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16
Q

Does lithium cause hyper or hypocalcaemia?

A

Hypercalcaemia

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17
Q

What investigation is done to differentiate the type of hyperparathyroidism?

A

Nuclear medicine technetium MIBI uptake scan

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18
Q

A parathyroid carcinoma can cause primary hyperparathyroidism - true or false

A

True

less than 1% of primary hyperparathyroidism

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19
Q

What is the commonest cause of hypoparathyroidism?

A

Thyroid surgery damage/removal of parathyroid glands

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20
Q

Does hypoparathyroidism cause hyper or hypocalcaemia?

A

Hypocalcaemia

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21
Q

Twitching on BP cuff inflation is what sign/

A

Trousseau’s sign

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22
Q

Are Trousseau’s sign and Chvostek’s sign caused by hypo or hypercalcaemia?

A

Hypocalcaemia

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23
Q

Is perioral paraesthesia caused by hypo or hypercalcaemia?

A

Hypocalcaemia

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24
Q

What is the management of hypoparathyroidism?

A

Alfacalcidol

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25
Q

Benign familial hypocalciuric hypercalcaemia FHH

  • hypo or hypercalcaemia?
  • what inheritance pattern?
  • low or high urine calcium?
A

Hypercalcaemia
Autosomal dominant
Low urine calcium

26
Q

How is hyperparathyroidism distinguished from benign familial hypocalciuric hypercalcaemia?

A

Urine calcium creatinine ratio <0.01

27
Q

Is primary hyperparathyroidism associated with MEN 1 or 2?

A

Either

28
Q

“Cells insensitive to PTH, low IQ, short stature, shortened 4th/5th metacarpals” describes what

A

Pseudohypoparathyroidism

29
Q

What effect does osteoporosis have on I’m negative I was time to be like - dictation whilst you got your COVID result

A

Just kept it for the bants

30
Q

What effects does osteoporosis have on:

  • Calcium levels
  • Vitamin D levels
  • Phosphate levels
  • PTH levels
  • ALP
A

All normal

31
Q

What effects does primary hyperparathyroidism have on:

  • Calcium levels
  • Phosphate levels
  • PTH levels
  • ALP
A

High calcium
Low phosphate
High or inappropriately normal PTH
High or normal ALP

32
Q

What effects does tertiary hyperparathyroidism have on:

  • Calcium levels
  • Phosphate levels
  • PTH levels
  • ALP
A

High calcium
Low phosphate
High PTH
High ALP

33
Q

What effects does osteopetrosis have on:

  • Calcium levels
  • Vitamin D levels
  • Phosphate levels
  • PTH levels
  • ALP
A

All normal

34
Q

What effects does padget’s disease of bone have on:

  • Calcium levels
  • Vitamin D levels
  • Phosphate levels
  • PTH levels
  • ALP
A

All normal except very high ALP

35
Q

Define osteoporosis

A

Low bone mineral density with normal mineralisation

imbalance of production and resorption – progressive bone loss

36
Q

How many bones are there in the human body?

A

206

37
Q

What is hydroxyapatite?

A

Calcium in bones

38
Q

What is the action of vitamin d?

A

Increase calcium and phosphate absorption in the gut

39
Q 
Cholecalciferol in \_\_\_\_ 
-> 
25OH-D in \_\_\_\_\_ 
-> 
1,25OH-D in \_\_\_\_\_
A 
Cholecalciferol in SKIN 
-> 
25OH-D in LIVER 
-> 
1,25OH-D in KIDNEY
40
Q 
Cholecalciferol in skin 
-> 
25OH-D in liver 
-> 
1,25OH-D in kidney

Which one is the one we measure? Which one is the active version?

A 
Cholecalciferol in skin 
-> 
25OH-D in liver = measured
-> 
1,25OH-D in kidney = active
41
Q

“Localised increase in bone turnover with net gain in bone mass” describes what

A

Paget’s disease of bone

42
Q

What is the action of PTH? When is it stimulated?

A

Stimulated by low serum calcium to increase calcium and decrease phosphate

43
Q

What effect does PTH have on bone resorption?

A

Increases it

44
Q

What is osteomalacia?

A

Severe vit d deficiency – inadequate mineralisation

45
Q

What effects does osteomalacia have on:

  • Calcium levels
  • Vitamin D levels
  • Phosphate levels
  • PTH levels
  • ALP
A 
Low calcium
Low vitamin d
Low phosphate
High PTH
High ALP
46
Q

What is osteomalacia known as in children?

A

Rickets

47
Q

Hyperthyroidism and Cushing’s are associated with osteoporosis - true or false

A

Both true

48
Q

Chronic pancreatitis and IBD are risk factors for osteoporosis - true or false

A

Both true

49
Q

Fracture from falling from a standing height is a fragility fracture - true or false

A

True

50
Q

What is Dowager’s hump a sign of?

A

Osteoporosis

51
Q

There is a loss of height in osteoporosis - true or false

A

True

52
Q

Smoking, alcohol, mobility and inactivity are all risk factors for osteoporosis – true or false

A

True

53
Q

How is osteoporosis diagnosed?

A

DEXA bone density scan T score <2.5

54
Q

What bloods should be done when investigating query osteoporosis?

A

Routine bloods, TSH, myeloma screen, IgA TTG

55
Q

What is a FRAX score?

A

Ten-year possibility of osteoporosis fracture

56
Q

What is the first line treatment of osteoporosis?

A

Oral bisphosphonate + ca + vit d supplement

57
Q

Do bisphosphonates inhibit osteoclasts or osteoblasts?

A

Inhibit osteoclasts

58
Q

Bisphosphonates take 6 months to have effect – true or false

A

True

59
Q

If oral bisphosphonates are not tolerated, IJ can be given, for what reason are oral bisphosphonate’s not tolerated?

A

Upper GI problems eg dyspepsia

60
Q

Before starting bisphosphonates, patients need assessment by a dentist – why is this?

A

Jaw osteonecrosis

61
Q

If bisphosphonate’s are contra indicated what is the next line management of osteoporosis?

A

Denosumab monoclonal antibody

62
Q

What is the management of acute hypercalcaemia?

A

IV saline NaCl

Y4 Gen Med (9 decks)

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