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Endocrinology > Calcemia > Flashcards

Calcemia Flashcards

1
Q

What is TXT of PT Adenoma?

A

Good hydration and Parathyroidectomy

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2
Q

Furosemide (loop diuretic) is good for?

A

Promoting calciuresis - TXT for hypercalcemia

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3
Q

Reasons for Malabsorption syndromes (Vit-D deficit)?

A

Sprue and Crohns DZ

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4
Q

Labs of Pagets disease?

A

ALP is elevated

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5
Q

Parathyroid Adenoma XR are usually?

A

NL, (low cortical BMD, and distal finger tufts)

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6
Q

Reasons for Defective processing (Vit-D deficit)?

A

Liver/Kidney DZ Meds

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7
Q

Hypocalcemia w/ low PTH is due to

A

Hypomagnesemia Autoimmune/idiopathic hypoparathyroidism Congenital absence of parathyroid glands Surgery damage to neck

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8
Q

Vit-D resistance is due to

A

genetic defects on vit-d metabolism

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9
Q

TXT of PT hyperplasia?

A

Subtotal parathyroidectomy

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10
Q

Should thiazides be used for hypercalcemia?

A

NO

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11
Q

How often are PT Adenoma F/Us?

A

Every 6 months

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12
Q

If FHH is TXT by removing PT glands what will happen?

A

Stops PTH causing hypocalcemia

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13
Q

Common labs for parathyroid adenoma

A

Blood Ca2+ >10.5 Increased 24hr UA calcium/phosphorus Increased PTH

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14
Q

What are FHH labs?

A

Lifelong hypercalcemia and hypocalciuria

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15
Q

Chvosteks sign is

A

Tapping onf acial nerve causes facial spasm

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16
Q

Are PTH bone receptors affected in PHP?

A

NO - bone calcium resorption continues

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17
Q

Isoniazid, Rifampin, Phenytoin are meds involved with?

A

Defective processing of Vit-D resulting in Elevated PTH and hypocalcemia

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18
Q

Trousseau sign is

A

BP cuff inflated above Systolic pressure >3m causes carpal spasms

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19
Q

Bisphosphonates are used w/

A

Hyperparathyroidism Malignancy prolonged immbolization

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20
Q

Observational F/U for Parathyroid Adenoma Annual checks?

A

Urine Calcium Kidney Fx

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21
Q

99 percent of calcium is

A

Sequestered to bones

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22
Q

What condition is caused by PHP’s PTH resistance?

A

Albrights hereditary osteodystrophy (AHO)

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23
Q

Reasons for Defective supply (Vit-D deficit)?

A

Inadequate diet/sunlight

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24
Q

Hormones that regulate serum calcium

A

PTH, Vit D, and Calcitonin

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25
Q

Hypomagnesemia is usually due to

A

Chronic ETOH, or malabsorption

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26
Q

Is FHH malignant?

A

NO

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27
Q

PT hyperplasia is ass/w

A

Multiple endocrine Neoplsias (MEN - 1,2,2a, and 4)

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28
Q

Goal of chronic hypocalcemia TXT is?

A

Keep calcum in the low to NL range

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29
Q

With Vit-D resistance - Vit D is

A

Elevated

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30
Q

PHP causes

A

Increased urine excretion of calcium

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31
Q

Basic TXT for hypercalcemia?

A

Hydration, staying active, and TXT underlying D/Os

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32
Q

High PTH may cause what type of bone changes tho?

A

Cystic lesions Pathologic fractures Diffuse demineralization

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33
Q

AHO may have what other resistances?

A

TSH, FSH, LH

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34
Q

What Sign can be present over affected bones of Pagets disease

A

Warmth over bones (vascularity)

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35
Q

Outpatient maintenace therapy of Hypoparathyroid tetany?

A

Calcium to 8.0-8.6 (low-asymptomatic range)

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36
Q

Rickets cause

A

Poor mineralization/formation at Epiphyseal

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37
Q

What values are truly low with hypocalcemia?

A

Blood calcium and inoized calcium are low

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38
Q

What is the first step to determining hypercalcemia?

A

PTH

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39
Q

Calcitonin is produced by

A

Parafollicular cells

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40
Q

FHH TXT?

A

None

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41
Q

1 percent of calcium is

A

Circulating in blood

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42
Q

Osteomalacia causes?

A

ABNL mineralization

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43
Q

Are (PO) bisphosphonates useful for hypercalcemia?

A

NO (use IV)

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44
Q

Trousseau sign is ass/w

A

Hypocalcemia

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45
Q

Dialysis TXT is good for what type of pt?

A

Hypercalcemia + Renal failure, Hyperkalemia or CHF

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46
Q

Hypocalcemia due to increased loss

A

(CKD, ETOH abuse, Diuretic therapy)

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47
Q

TOC Med used for Pagets?

A

IV Zoledronate (bisphosphonate) to decrease OC activity

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48
Q

XR of an osteomalacia pt may show

A

Looser lines

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49
Q

VIT D - AKA

A

Calciferol

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50
Q

TXT for Parathyroid Cancer?

A

Tumor resection + affected thyroid lobe

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51
Q

If genetic Vit-D resistance is mild results in?

A

Adulthood osteomalacia

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52
Q

Pagets disease usually DX in

A

40’s

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53
Q

TXT of Chronic hypocalcemia

A

(PO) calcium - Vit-D supplements Sunlight

54
Q

What type of genetic D/O is Familial hypocalciuric hypercalcemia? (Auto-Rec/Dom?)

A

Autodominant

55
Q

MC cause of hypocalcemia is

A

CKD

56
Q

First thing to TXT after AW maintenance in Hypoparathyroid tetany?

A

Hypomagnesium w/ IV magnesium sulfate

57
Q

Hypocalcemia/PTH deficit AKA

A

hypoparathyroidism

58
Q

MOA of Bisphosphonates?

A

Inhibits bone resorption at the OC and causes gradual decline of blood CA2+ lasting Weeks/months

59
Q

Pseudohypoparathyroidism are due to

A

Defects in the renal PTH receptors

60
Q

Most Pagets disease is discovered when?

A

Incidently

61
Q

Milk Alkali syndrome triad?

A

Hypercalcemia Metabolic alkalosis Acute kidney injury

62
Q

What is the result of FHH?

A

defective Calcium receptors on parathyroid cells

63
Q

What other valvues besides Ca2+/Ion Ca2+ should be checked in hypocalcemia?

A

Mg, PTH, Vit-D

64
Q

Chvosteks sign is ass/w

A

Hypocalcemia

65
Q

Will ts with Vit-D resistance benefit from Vit-D supplements?

A

NO

66
Q

F/U tests of asymptomatic Pagets?

A

ALP annually and XR of lytic lesions

67
Q

Osteitis fibrosa cystica is ass/w

A

Hypercalcemia

68
Q

What should be avoided during TXT of hypercalcemia?

A

Thiazides, Vit A&D, Calcium supplements antacids

69
Q

1st S/S of Pagets disease?

A

Bone pain (constant - worse at night)

70
Q

What are PTH/Ca2+ levels of Hypoparathyroid tetany?

A

Both Decreased

71
Q

Parathyroidectomy and Hypercalcemia is reserved for what?

A

PT adenoma & OPT Hyperplasia

72
Q

Involved bone of Pagets disease has increased what?

A

Osteoclast activity causing cystic lesions increasing 1cm/yr

73
Q

What exerts the major regulation of blood calcium concentration?

A

PTH secreted by Parathyroid hormone

74
Q

What type of effect does thyroid hormone have on bone?

A

Resorbing effect

75
Q

What is a subtotal Parathyroidectomy?

A

3.5 glands are removed - half of left over to PVT hypocalcemia

76
Q

Vit D is synthesized by?

A

Sunlight action on the skin

77
Q

What molecule is exposed on the skin surface to sunlight allowing for conversion to Vit-D?

A

7-DHC (7-Dehydrocholesterol)

78
Q

Observational F/U for AS/S Hypercalcemia 6mo checks?

A

Blood Calcium Albumin

79
Q

Mneominc used for hypercalcemia

A

Stones, Bones, Groans, Moans, Overtones

80
Q

If genetic Vit-D resistance is severe results in?

A

Childhood rickets

81
Q

Granulomatous Diseases causing excess Vit-D

A

Sarcoidosis, TB, histoplasmosis, Coccidiomycosis

82
Q

Hypocalcemia w/ High PTH - causes

A

Vit D deficit/resistance Pseudohypoparathyroidism (PTH resistance)

83
Q

Major clinical finding of Osteomalacia?

A

Bone pain

84
Q

Elderly admited w/ hypocalcemia likely to have

A

Vit- D deficit

85
Q

Pagets disease is due to

A

Bone lysis followed by vascular fibrous connective tissue replacement w/ disorganized osteoid formation

86
Q

Albrights hereditary osteodystrophy presents as

A

Short stature, rounded face, and short ring/little fingers

87
Q

Cancers producing PTHrP

A

Squamous cell - Lungs, Esophagus, Head, Neck Renal, Bladder, Ovarian, Breast, Leukemia, Lymphoma, Multiple Myeloma (plasma cell)

88
Q

What type of role does calcitonin have in calcium concentration?

A

Minor role

89
Q

Losser lines are

A

thin radiolucent lines perpendicular to the cortex

90
Q

TXT for severe hypocalcemia?

A

IV calcium gluconate - infusion usually req

91
Q

Bone deformities of Pagets disease?

A

Bowed tibias, kyphosis, chalk stick fracture

92
Q

2nd (MC) cause of primary parathyroidism?

A

Parathyroid Hyperplasia

93
Q

Observational F/U for Parathyroid Adenoma Every 2yr checks?

A

BMD

94
Q

What should be prescribed for outpatient hypoparathyroid tetany?

A

HCTZ w/ potassium supplement for hypercalciuria

95
Q

TXT Hypoparathyroid tetany hypocalcemia w/

A

Slow IV calcium gluconate

96
Q

Observational F/U for AS/S Hypercalcemia Annual checks?

A

UA calcium Renal Fx

97
Q

Childhood Vit-D deficit AKA?

A

Rickets

98
Q

Severe calcemia is

A

.>14 and concerning for malignancy

99
Q

What is the rate of bone resoprtion in comparison to bone deposition of calcium in pagets disease?

A

The exact same

100
Q

What condition is the exact same S/S for PT adenoma?

A

PT Hyperplasia

101
Q

Outpatient monitoring of hypoparathyroid tetany?

A

Calcium Q3mo (Spot urine)

102
Q

Hypercalcemia due to High bone turn over

A

Thyrotoxicosis or Exogenous thyroid hormone

103
Q

Is FHH symptomatic?

A

NO

104
Q

When should (PO) TXT start w/ hypoparathyroid tetany?

A

(PO) Calcium and Vit-D ASAP (1-3g/D w/ meals)

105
Q

PTHrP causes what?

A

Bone resorption and Hypercalcemia (like PTH)

106
Q

Calcium is bounded to what molecules?

A

40 percent proteins (Alb/globulin) 10 percent bicarb, citrate, phosphate

107
Q

What increases Calcium/phosphate absorption in the intestines?

A

Vit-D

108
Q

In postmenopausal women w/ hypercalcemia what should be considered?

A

Estrogen replacement

109
Q

Picture frame vertebrae is ass/w

A

Pagets

110
Q

What should be asked every visit w/ parathyroid adenomas?

A

S/S of hypercalcemia

111
Q

Hypocalcemia w/ Low PTH - causes

A

Hypoparathyroidsm (PTH deficit)

112
Q

Rising ionized calcium causes PTH to

A

become suppressed

113
Q

Milk Alkali syndrome is ass/w

A

Increased calcium intake

114
Q

TOC for malignant associated hypercalcemia?

A

IV bisphosphonates

115
Q

Circulating calcium is compsed of

A

50 percent free(ionized) calcium 50 bound

116
Q

What medical ER can occur after parathyroidectomy?

A

Hypoparathyroid Tetany (Acute hypocalcemia)

117
Q

Observational F/U for AS/S Hypercalcemia 1-2yr checks?

A

BMD

118
Q

MC cause of primary hyperparathyroidism

A

Benign parathyroid adenoma

119
Q

Falling ionized calcium causes PTH to?

A

Stimulated gland - Secreted

120
Q

Parathyroid Cancer Ca2+ and PTH levels are?

A

Severe HYPERcalcemia and Very high PTH levels

121
Q

10-20 percent of cancer patients will have what?

A

Hypercalcemia

122
Q

PTHrp (PTH-related protein) is related to?

A

Tumors

123
Q

What is cryopreserved parathyroid transplant?

A

After parathyroidectomy and hypoparathyroid tetany begins the tissue can be transplanted to correct the calcemia (25 percent works)

124
Q

What causes Calcitonin to be produced?

A

Elecvated Calcium levels

125
Q

Primary organs regulatorting calcium?

A

Parathyroid gland and kidney

126
Q

Adult Vit-D deficit AKA?

A

Osteomalacia

127
Q

Observational F/U for Parathyroid Adenoma 6mo checks?

A

BP Serum Calcium

128
Q

Complications of Pagets

A

OA, High CO Cardiac failure (skeletal vascularity) Renal stones - immbolized pt w/ Pagets Osteosarcoma Freq fractures Spinal cord compression Deafness (auditory bones)

129
Q

Surpressed PTH labs?

A

> 15 Ca2+ Severe HYPERcalcemia Low PTH High PTHrP

130
Q

Is imaging necessary for PT Adenoma Hyperparathyroidism?

A

NO (but most pts will receive prior to surgery) U/S, CT, MRI, XR

131
Q

Serum calcium, Phosphours and PTH levels are usually what with pagets disease?

A

Normal

132
Q

What would a radionuclide bone scan find in a pagets pt?

A

Diffuse uptake in skull, pelvis, and long bones

Endocrinology (5 decks)

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