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Leila's Yr 5 Pathology > Chem path 12 - clin chem CPC > Flashcards

Chem path 12 - clin chem CPC Flashcards

1
Q

What are hyper and hypocalcaemia associated with?

A

Hypo –> irritability, fits

Hyper –> depression and tiredness

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2
Q

Mycoardium in hyper and hypokalaemia

A

Hypo –> arrhythmias (unstable myocardium)

Hyper –> asystole (ultimate stable rhythm)

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3
Q

Colles fracture vs smith’s fracture

A

Colles –> dorsal displacement/dinner form deformity, falling on outstretched hand
Smith’s –> Ventral displacement (Towards palm), falling on a flexed wrist (much rare)

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4
Q

What does uraemia cause?

A

Tiredness

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5
Q

What is a Pott’s fracture?

A

Ankle fracture involving the tibia and fibula

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6
Q

How can you differentiate between renal stones and glomerulonephritis?

A

Glomerulonephritis is painless and produces microscopic haematuria whereas stones –> macroscopic

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7
Q

How would you investigate renal stones?

A

CT-KUB/plain abdo X ray

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8
Q

Next step after detecting renal stones on CT-KUB?

A

Measure plasma calcium (always do this before PTH as cannot interpret PTH isolated)

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9
Q

Commonest cause of hypercalcaemia in hospitals

A

Cancer

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10
Q

Commonest cause of hypercalcaemia in the community?

A

Primary hyperparathyroidism

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11
Q

PTH and Ca in sarcoidosis

A

High Ca, low PTH

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12
Q

PTH and Ca in cancer

A

High Ca, high PTH in hypercalcaemia of malignancy due to PTHrp or invading bone cancer

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13
Q

Main cause of hyperparathyroidism

A

Adenoma

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14
Q

What are the actions of PTH

A

Kidney: increases 1a hydroxylation –> vitamin D activation (calcitriol) –> gut to increase calcium and phosphate reabsorption
Directly resorb calcium
Directly excrete phosphate

Bone: increase osteoclast activity

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15
Q

What condition is multiple parathyroid adenomas associated with?

A

MEN 1

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16
Q

Which stones are opaque and which are radiolucent?

A

Calcium stones = opaque

Urate stones = radiolucent

17
Q

What presentation in the eye is associated with hypercalcaemia?

A

Band keratopathy (calcium deposition across teh front of eye, it is a feature of chronic hypercalcaemia so cannot be due to hypercalcaemia of malignancy)

18
Q

Complications of hypercalcaemia

A 
Renal stones
Peptic ulcer disease
Pancreatitis
Skeletal changes
Osteitis fibrosa cystica (peper pot skull)
19
Q

Which bacteria commonly cause of recurrent infection in someone with renal stones?

A

Proteus mirabilis (loves calcium stones)

20
Q

Which stone is most common renal stone?

A

Calcium oxalate (second most common is calcium pyrophosphate)

21
Q

Management options for renal stones

A

Most will pass, use pain killers (PR diclofenac good)
Lithotripsy
Cystoscopy
Lithotomy

22
Q

Which diuretics prevent renal stones and which provoke?

A

Thiazide diuretics prevent calcinuria but increase serum calcium
Loop diuretics –> calciuria

23
Q

When would you perform urgent management of hypercalcaemia?

A

Ca2+ >3.0mmol/L and pt unwell

24
Q

What is the acute management of hypercalcaemia?

A

IV 0.9% Saline (~3-6L in 24 hrs, 1st 1L given in 1 hour)
IV furosemide (Aid calciuresis)
Consider IV zaldendronate (bisphosphonate 30-60mg)

25
Q

What are some considerations with giving IV bisphosphonates to treat hypercalcaemia?

A

Takes about 1 week to take affect

Hold off to begin with as you cannot measure serum calcium and phosphate if you give them

26
Q

When would you definitiely give IV bisphosphonates when treating hypercalcaemia?

A

If it is hypercalcaemia of malignancy as bisphosphonates are v good at treating bone pain

27
Q

Saline is safe in treating most conditions except…

A

LIVER FAILURE, you have salt retention so you would prefer dextrose

28
Q

What is the non urgent management of hypercalcaemia?

A

Well hydrated
Avoid thiazides (reduce calciruia but increase plasma calcium)
Surgery (parathyroidectomy)

29
Q

What investigations are done before parathyroidectomy?

A

Technetium SESTA MIBI and USS
If concordant, whole neck does not need to be opened up
If not concordant, surgeon needs to view all 4 glands and take out largest

30
Q

What is a histological feature of longstanding undiagnosed hyperparathyroidism?

A

Brown tumours

31
Q

What are brown tumours?

A

Multinucleate giant cells, activated osteoclasts in the bone

32
Q

Seasonal hypercalcaemia can only be…

A

SARCOIDOSIS

33
Q

CXR of someone with sarcoidosis

A

Bilateral hilar lymphadenopathy

34
Q

Mechanism of hypercalcaemia in sarcoidosis

A

Lung macrophages express 1a-hydroxylase –> activate vitamin D
Pts more likely to become hypercalcaemic during summer months

35
Q

3 ways to assess fluid status of pt

A

JVP
CVP gold standard if in ITU
Skin turgor, mucous membranes

36
Q

Whcih MEN syndromes can present with hypercalcaemia?

A

MEN 1 and MEN 2

Leila's Yr 5 Pathology (100 decks)

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