Vitamin D & Calcium

Question 1

99% of bony calcium is stored in _____

Answer 1

bone

Question 2

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

Answer 2

liver

calcitriol

Question 3

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

Answer 3

4

PTH

Question 4

What is the function of PTH?

Answer 4

Regulates calcium

by osteoblasts/clasts and works on kidney

Question 5

A solitary parathyroid adenoma causes …

Answer 5

Primary hyperthyroidism

Question 6

What is the presentation of hypercalcaemia?

Answer 6

Bones stones groans moans

Question 7

What is the commonest management of primary hyperparathyroidism?

Answer 7

Surgery

otherwise conservative Mx

Question 8

What is the aetiology of tertiary hyperparathyroidism?

Answer 8

Secondary to to years of chronic kidney disease

Question 9

What are the indications for conservative management in primary hyperparathyroidism?

Answer 9

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

Question 10

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

Answer 10

Elderly female

Question 11

What effect does hypercalcaemia and hypocalcaemia have on QT interval?

Answer 11

Hypercalcaemia short QT interval

Hypocalcaemia long QT interval

Question 12

What causes a pepperpot skull on x-ray?

Answer 12

Hypercalcaemia in hyperparathyroidism

Question 13

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

Answer 13

Hi PTH, low calcium, phosphate

Question 14

What causes secondary hyperparathyroidism?

Answer 14

Almost always due to chronic kidney disease/ vit d deficiency

Question 15

Do you thiazide diuretics cause hyper or hypocalcaemia?

Answer 15

Hypercalcaemia

Question 16

Does lithium cause hyper or hypocalcaemia?

Answer 16

Hypercalcaemia

Question 17

What investigation is done to differentiate the type of hyperparathyroidism?

Answer 17

Nuclear medicine technetium MIBI uptake scan

Question 18

A parathyroid carcinoma can cause primary hyperparathyroidism - true or false

Answer 18

True

less than 1% of primary hyperparathyroidism

Question 19

What is the commonest cause of hypoparathyroidism?

Answer 19

Thyroid surgery damage/removal of parathyroid glands

Question 20

Does hypoparathyroidism cause hyper or hypocalcaemia?

Answer 20

Hypocalcaemia

Question 21

Twitching on BP cuff inflation is what sign/

Answer 21

Trousseau’s sign

Question 22

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

Answer 22

Hypocalcaemia

Question 23

Is perioral paraesthesia caused by hypo or hypercalcaemia?

Answer 23

Hypocalcaemia

Question 24

What is the management of hypoparathyroidism?

Answer 24

Alfacalcidol

Question 25

Benign familial hypocalciuric hypercalcaemia FHH - hypo or hypercalcaemia? - what inheritance pattern? - low or high urine calcium?

Answer 25

Hypercalcaemia Autosomal dominant Low urine calcium

Question 26

How is hyperparathyroidism distinguished from benign familial hypocalciuric hypercalcaemia?

Answer 26

Urine calcium creatinine ratio <0.01

Question 27

Is primary hyperparathyroidism associated with MEN 1 or 2?

Answer 27

Either

Question 28

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

Answer 28

Pseudohypoparathyroidism

Question 29

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

Answer 29

Just kept it for the bants

Question 30

What effects does osteoporosis have on: - Calcium levels - Vitamin D levels - Phosphate levels - PTH levels - ALP

Answer 30

All normal

Question 31

What effects does primary hyperparathyroidism have on: - Calcium levels - Phosphate levels - PTH levels - ALP

Answer 31

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

Question 32

What effects does tertiary hyperparathyroidism have on: - Calcium levels - Phosphate levels - PTH levels - ALP

Answer 32

High calcium Low phosphate High PTH High ALP

Question 33

What effects does osteopetrosis have on: - Calcium levels - Vitamin D levels - Phosphate levels - PTH levels - ALP

Answer 33

All normal

Question 34

What effects does padget's disease of bone have on: - Calcium levels - Vitamin D levels - Phosphate levels - PTH levels - ALP

Answer 34

All normal except very high ALP

Question 35

Define osteoporosis

Answer 35

Low bone mineral density with normal mineralisation | imbalance of production and resorption – progressive bone loss

Question 36

How many bones are there in the human body?

Answer 36

206

Question 37

What is hydroxyapatite?

Answer 37

Calcium in bones

Question 38

What is the action of vitamin d?

Answer 38

Increase calcium and phosphate absorption in the gut

Question 39

``` Cholecalciferol in ____ -> 25OH-D in _____ -> 1,25OH-D in _____ ```

Answer 39

``` Cholecalciferol in SKIN -> 25OH-D in LIVER -> 1,25OH-D in KIDNEY ```

Question 40

``` 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?

Answer 40

``` Cholecalciferol in skin -> 25OH-D in liver = measured -> 1,25OH-D in kidney = active ```

Question 41

"Localised increase in bone turnover with net gain in bone mass" describes what

Answer 41

Paget's disease of bone

Question 42

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

Answer 42

Stimulated by low serum calcium to increase calcium and decrease phosphate

Question 43

What effect does PTH have on bone resorption?

Answer 43

Increases it

Question 44

What is osteomalacia?

Answer 44

Severe vit d deficiency – inadequate mineralisation

Question 45

What effects does osteomalacia have on: - Calcium levels - Vitamin D levels - Phosphate levels - PTH levels - ALP

Answer 45

``` Low calcium Low vitamin d Low phosphate High PTH High ALP ```

Question 46

What is osteomalacia known as in children?

Answer 46

Rickets

Question 47

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

Answer 47

Both true

Question 48

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

Answer 48

Both true

Question 49

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

Answer 49

True

Question 50

What is Dowager’s hump a sign of?

Answer 50

Osteoporosis

Question 51

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

Answer 51

True

Question 52

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

Answer 52

True

Question 53

How is osteoporosis diagnosed?

Answer 53

DEXA bone density scan T score <2.5

Question 54

What bloods should be done when investigating query osteoporosis?

Answer 54

Routine bloods, TSH, myeloma screen, IgA TTG

Question 55

What is a FRAX score?

Answer 55

Ten-year possibility of osteoporosis fracture

Question 56

What is the first line treatment of osteoporosis?

Answer 56

Oral bisphosphonate + ca + vit d supplement

Question 57

Do bisphosphonates inhibit osteoclasts or osteoblasts?

Answer 57

Inhibit osteoclasts

Question 58

Bisphosphonates take 6 months to have effect – true or false

Answer 58

True

Question 59

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

Answer 59

Upper GI problems eg dyspepsia

Question 60

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

Answer 60

Jaw osteonecrosis

Question 61

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

Answer 61

Denosumab monoclonal antibody

Question 62

What is the management of acute hypercalcaemia?

Answer 62

IV saline NaCl