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Flashcards in Pales, bone Ca Deck (68):
1

if Ca is too high what is released from thyroid

calcitonin to increase Ca deposition

2

if Ca is too low what does PTgland release

PTH to increase Ca release from bone

3

how does PTH increase Ca release

activates the osteoblasts which activates osteoclasts

4

how does low Mg change PTH secretion

decreases it

5

how does PTH change phosphate leves

decreases them because increases renal secretion

6

effects of active Vit D3 on Ca and PO4

increases Ca and PO4 absorption in gut
decreases PTH

7

What meds can cause hyperCa

Vit D
thiazide diuretics
lithium
tamoxifen

8

what granulomatous disorders can lead to hyper Ca

sarcoidosis
TB
wegeners
fungal

9

what endocrine disorders can lead to hyperCa

hyperthyroidism, adrenal insufficiency pheochromocytoma
VIP-oma

10

what are the malignancy associated causes hyper Ca

local osteolytic
multiplem myeloma
primary bone turnover
metastatic to bones
PTH-RP

11

how does primary hyperPTH present

asymptomatic hyperCa or with renal stones

12

what type of acid base status will a patient be in primary hyperPTH

non anion gap metabolic acidosis

13

what type of bone loss do you have in hyperPTH

cortical bone loss leasing to osteoporosis

14

tertiary hyperPTH

reduced activation Vit D from chronic renal disease leading to elevated PTH

15

what part of dialysis can cause increase in PTH

aluminum containing PO4 binders that increases PTH and leads to osteomalacia

16

inheritance of familial benign hypocalciuric hypercalcemia

autosomal dominant loss of function mutation in CaSR on PTH cells and renal tubules

17

PTH and Mg levels in familial benign hypocalciuric hypercalcemia

mildly elevated PTH and Mg

18

Signs and Sx hypercalcemia

fatigue, polyuria, weakness, anorexia, nausea, vomiting, constipation, abdominal pain, lethargy, mental status change

19

how does hyper Ca affect pancreas

can lead to pancreatitis which will eventually produce hypocalcemia

20

band keratopathy

Ca deposits in cornea

21

what is osteitis fibrosa caystica

chronic bone resorption, demineralization, cystic bone lesions
from excessive PTH

22

what is an abnormal PTH value if detect hyperCa

normal or high because should be low

23

hyper Ca and have normal or high PTH
next test?

24 hr urinary Ca to rule out the benign familial (low urinary Ca)
if high urinary Ca then probably primary hyperPTH

24

Tx for hyperCa

IV fluids, loop diuretics, IV bisphosphonates
Calcitonin
glcocorticoids
cinacalcet
hemodialysis

25

what msut you do if put patient on loop diuretic for hyperCa

replace fluids

26

why give glucocorticoids in hyperCa

help counter effects of too much vit D in blood from hyperCa

27

when do you use dialysis to Tx hyperCa

hemodialysis

28

what can cause acquired hypoPTH

post surgical
autoimmune: PGA APECED, SLE
Heavy Metals: copper wilson, iron hemochromatosis
Mg deficiency(dec PTH production and Resistance to PTH)
other: infection, tumor, granuloma, reidel thyroiditis

29

what can cause MG deficiency

malabsorption
alcoholism

30

PGA type I

autoimmune polyendocrinopathy
presents in childhood: candidiasis, hypoPTH, addison

31

what congenital syndrome can cause congenital hypoPTH

digeorge
CATCH22

32

what causes pseudohypoPTH

end organ R to PTH
tubular R to PTH so have hypercalciuria with hypocalcemia
hyperPO4

33

pseudopseudohypoPTH

phenotypic abnormalities without hypocalcemia

34

Albright hereditary osteodystrophy

short stature
obese
bradydactyly, round faces
dermal ossifications
mental retardation

35

Mg is cofactor for what

PTH secretion

36

hypo Mg common in what disorders

chronic GI disease
nutritional deficiency
alcoholism
cis-platinum therapy

37

clinical findings of acute hypoCa

muscle cramps
tetany
irritability
carpopedal spasm
convulsions
perioral tingling
tingling of hands and feet

38

clinical findings chronic hypoCa

lethargy
personality changes
anxiety state
blurred vision from cataracts
parkinsonism
mental retardation

39

chvostek sign

facial muscle contraction when tapping facial nerve

40

trousseau phenomenon

carpal spasm after BP cuff from tetany
specific and sensitive for hypoCa

41

if detect low Ca what is next test

albumin levels

42

if hypoCa and low albumin Dx?

hypoproteinemia
confirm with ionized Ca level

43

if hypo Ca and normal albumin next test?

measure PTH, creatinine and phosphorus

44

for every decrease (1) of albumin what do you correct Ca

add .8 to Ca

45

what levels of PTH creatinine and phosphorus lead you to consider PTH resistance

elevated PTH and phosphorus
normal creatinine

46

what levels of PTH creatinine and phosphorus lead you to consider genetic or acquired hypoPTH

low PTH
normal creatinine
elevated phosphorus

47

what levels of PTH creatinine and phosphorus lead you to consider Vit D problem

elevated PTH
normal creatinine
normal or reduced phosphorus

48

what levels of PTH creatinine and phosphorus lead you to consider seconary hyperPTH from renal failure

increased PTH
increased creatinine
increased phosphorus

49

What is Pagets

disorder of bone remodeling that increases rates of bone turnover

50

what are signs of pagets

enlargement of skull, bowing of long bones
etiology unknown
increased vascularity of bone

51

Sx pagets

HA, bone pain
warmth of skin over involved bone
high output Cardiac failure
entrapment neuropathies (hearing loss)
kyphosis

52

radiogrpahic findings pagets (phases)

osteolytic- wedge shaped resorption of long bones
mixed
osteoblastic- cotton wool appearance

53

Tx pagets asymptomatic

do not treat

54

Tx Sx pagets

bisphosphonates because dec resorption of bone

55

lab findings pagets

serum alkaline phosphatase elevated
high serum C telopeptide
high urinary hydroxyproline in active disease
serum Ca usually high

56

what medications increase risk for osteoporosis

glucocorticoids, anticonvulsants, heparin

57

when should you measure BMD

women age>65
post menopausal women <65 who have 1+ risk factor osteoporosis
postmenopasual woman with fractures
women on hormone replacement therapy for long time
radiographic findings of osteoporosis
someone on corticosteroid therapy for more than 3 mo
primary hyperPTH

58

gold standard test for BMD

dexa scan

59

Dexa scan results

T score: standard deviation from mean BMD of young healthy population
Z score: standard deviation from BMD of an age and sex of matched group

60

when do you rely on z score for dexa scan

younger men, children and premenopausal women

61

What does a T score of -1 mean

10% bone loss

62

T score for osteoporosis

T score <-2.5 or osteoporotic fracture

63

T score for osteopenia

-1 to -2.5

64

main medication to Tx osteoporosis

bisphosphonates: alendronate and risedronate
bind boney surface and inhibit osteoclastic bone resorption

65

side effects bisphosphonates

esophagitis- can't lay down after taking it
cannot eat for an hour because little absorption
black box warning: stop if having dental surgery because can cause dental necrosis

66

how do the replacement estrogen hormones affect BMD

decrease vertebral fracture risk
no change on hip fracture risk

67

action teriparatide

stimulate osteoblastic bone formation
SQ injection
increases BMD

68

action denosumab

monoclonal Ab that inhibits osteoclastic activation
binds RANKL