Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 - Endo > Revision > Flashcards

Revision Flashcards

1
Q

2 hormones that increase calcium levels

A

PTH

Calctriol (vit D)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which hormone decreases calcium? Where is this produced?

A

Calcitonin - parafollicular cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Explain how vit D becomes activated

A

Vit D from diet and UV light is hydoxylated by liver to 25-hydroxy vit D.

Rate limiting step - this is then hydroxylated into activated vitamin D (calctriol) by 1alpha hyroxylase, which itself is activated by PTH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the effect of PTH on the bone, kidneys and small intestines? What is the overall effect?

A

Bone - increased resportion
Small intestines - increased absorption of calcium
Kidneys - increased calcium reabsorption and phosphate EXCRETION.

Overall effect - increased calcium, decreased phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the effect of calctriol on the bone, kidneys and small intestines? What is the overall effect?

A

Kidneys - increased calcium reabsorption
Bone - increased formation
Small intestines - increased calcium AND phosphate reabsorption

Overall - INCREASED calcium and phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which hormone is better at increased calcium and dropping phosphate?

A

Vit D - better at increasing calcium than PTH

PTH - better at dropping phosphate (phosphate trashing hormone)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PTH, ALP calcium and phosphate levels in primary hyperparathyroidism

A

High or INAPPROPRIATELY NORMAL PTH
Low phosh
High calcium
Normal ALP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PTH, ALP calcium and phosphate levels in secondary hyperparathyroidism due to Vit D deficiency

A

Vit D low therefore:

Low calcium
Low phosphate
High PTH
High ALP because released by bone (osteomalacia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PTH, ALP calcium and phosphate levels in secondary hyperparathyroidism due to CKD

A

Kidneys not functioning, therefore:

High PTH
Low Calcium
However, high phosphate as kidneys can’t excrete it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PTH, ALP calcium and phosphate levels in tertiary hyperparathyroidism

A

Tertiary hyperparathyroidism is secondary to CKD, therefore:

High PTH 
High calcium (no negative feedback)
High phosphate (because kidneys can't excrete it)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If phosphate is low, what are you thinking?

A

Vit D deficiency or primary PTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If phosphate is high, what are you thinking?

A

CKD

If calcium is high too - tertiary
If calcium low - secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Other causes of hypercalcemia

A

Malignancy

  • Bone mets
  • Haem - multiple -myeloma (CRAB)
  • Paraneoplastic - lung squamous cell cancer

Sarcoidosis
Thiazide diuretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Multiple myeloma acronym

A

Calcium high
Renal failure
Anemia
Bone disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Low PTH causes of low calcium

A

Surgical complications

Autoimmune hypoparathyroidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

High PTH + low calcium

A

Osteomalacia (secondary hyperPTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Low calcium symptoms

A

Convulsions
Arrhythmias - prolonged QT
Tetany (increased nerve conduction)
Paraesthesia - numb hands, mouth, feet, lips

CATS go numb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Signs of hypocalcemia

A

Trousseau’s sign - spasm when tightening BP cuff

Chvostek’s sign - twtiching when touching facial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which is more likely to be found in pancreatitis - hyper or hypocalcaemia?

A

Hypocalcemia due to saponification

High calcium causes pancreatitis but then it gets deposited.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Risk factors for primary hyperparathyroidism

A

MEN 1 or 2

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

MEN 1 complications

A

Pancreatic tumours
Parathyroid hyperplasia
Pituitary adenomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

MEN 2 complications

A

Parathyroid hyperplasia
Phaeo
Medullary thyroid cancer

23
Q

Causes of secondary hyperparathyroidism besides lack of sunlight/dietary intake if vit D

A

Crohns/Coeliac
CKD
Liver disease

24
Q

Symptoms on secondary hyperparathyroidism in adults

A

Fractures/bone pain
Proximal myopathy (weakness)
Fatigue
Hypocalcemia symptoms - convulsions, arrhythmias, tetany, numbness

25
Q

Invx

A

USS of parathyroid
XR/CT
Bn

26
Q

XR findings in primary hyperparathyroidism

A

Subperiosteal bone resorption
Acro-osteolysis (erosions of finger tips)

Pepper pot skull

27
Q

XR findings in secondary hyperparathyroidism

A

Swelling of constrochondral junctions - rachitic rosary

Looser’s pseudofractures - doesn’t go all teh way

28
Q

Treatment of acute hypercalcemia in primary hyperPTH

A

IV fluids

Bisphosphonates if calcium remains high

29
Q

Treatment of hypercalcemia in primary hyperPTH once pt is stable

A

Total parathyroidectomy

SE: risk of recurrent laryngeal nerve -> hoarseness

30
Q

What do you give if a a patient with primary hyperPTH is unsuitable for surgery?

A

Cinacalcet, calcimimetic i.e. tries to do negative feedback against PTH like calcium

31
Q

Secondary hyperPTH management in acute hypocalcemia

A

IV calcium infusion - calcium gluconate

32
Q

What else is calcium gluconate used for?

A

Hyperkalemia

33
Q

What would you give to a pt with secondary hyperPTH once they are stable?

A

Calcium

Vit D - ergocalciferol (inactive form)

34
Q

How do you manage a pt with secondary hyperPTH with CKD once they are stable?

A

Calcium
Vit D - alfacalcidol (active)
Treat CKD

35
Q

Three phases of paget’s disease

A 
Lytic phase (hyperactive osteoclasts causing resorttion)
Mixed phase
Sclerotic phase (hyperactive osteoblasts - woven bone, not lamellar)
36
Q

Symptoms of Pagets

A

Often asymptomatic
Fragility fractuers
Bone pain - skull, femur, pelvis
Nerve compression due to osteoblasts reforming the bone in areas where there used to be foramina - sensorineural hearing loss, sciatica

37
Q

Signs of Paget’s

A

Warm skin over painful area (high metabolism)

Bone enlargement

38
Q

Blood findings in Paget’s

A

High ALP, everything else normal

39
Q

Name a bone resorption marker used in Pagets

A

Serum CTX

40
Q

Name a bone formation marker used in Pagets

A

Serum P1NP

41
Q

Imaging for pagets

A

XR

Tec99 scan - hot spots seen in high functioning areas of bone

42
Q

PE scan if pregnant

A

V/Q scans

43
Q

Osteoporosis primary causes

A

Menopause

Elderly

44
Q

Osteoporosis secondary causes

A 
Drugs: 
- Steroid use
- Thyroxine
- Alcohol
Endo causes:
- Cushing's
- Hyperparathyroidism
- Hyperthyroidism
GI causes
- Coeliac disease
- IBD
45
Q

Signs and symptoms in osteoporosis

A

Often asymptomatic Fragility fractures

Back pain

46
Q

Osteoporosis fractures (four)

A

NOF
Colles wrist fracutre
Lumbar spine wedge fracture
Neck of humerus

47
Q

Imaging for osteoporosis

A

DEXA scan

XR

48
Q

Blood results for osteoporosis

A

Everything normal

49
Q

What are the two types of scores used in DEXA? Which of these is most important?

A

T score - patient’s BMD compared to young, healthy adults - most important

Z score - patient’s BMD compared to age matched BMD

50
Q

What numbers are key in diagnosing osteoporosis and also the stage before that, using DEXA scans?

A
  • 1 to -2.5 -> osteopenia

- 2.5 or above - osteoporosis

51
Q

What is the DEXA score used to calculate?

A

The FRAX score aka 10 year risk of developing fragility fractures; decides management

52
Q

Looser’s pseudofracture

A

low vit D and calcium

53
Q

Osteoporosis mx

A

Bisphosphonates

Recombinant PTH - teriparatide

Year 3 - Endo (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions