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Flashcards in Pales, bone Ca cases Deck (14):
1

39 y.o F on birth control and MVI
Ca shows high Ca
otherwise normal CBC and CMP
next step

check PTH

2

39 y.o F on birth control and MVI
Ca shows high Ca
otherwise normal CBC and CMP
high PTH
next step

24 hour urinary Ca

3

39 y.o F on birth control and MVI
Ca shows high Ca
otherwise normal CBC and CMP
high PTH
urine Ca is high

primary hyperPTH

4

53 y.o F with cc weakness, malaise, constipation and back pain
becomes somewhat lethargic
normal CXR, low albumin, high Ca
normal phosphorus
high chloride, high BUN
high creatinine
next step

Tx Ca
check PTH

5

53 y.o F with cc weakness, malaise, constipation and back pain
becomes somewhat lethargic
normal CXR, low albumin, high Ca
normal phosphorus
high chloride, high BUN
high creatinine
how Tx the hyper Ca?

loop diuretics- furosemide
IV bisphosphonates-- alendronate

6

53 y.o F with cc weakness, malaise, constipation and back pain
becomes somewhat lethargic
normal CXR, low albumin, high Ca
normal phosphorus
high chloride, high BUN
high creatinine
low PTH
next step?

check for malignancy
Vit D lab
PTHrP
bone scan
TSH and freeT4 T3
multiple myeloma (SPEP/UPEP)
ACE level for sarcoidosis

7

SPEP UPEP

serum and urine protein electrophoresis

8

71 y.o F poor appetite weight loss, cramps and weakness
PMH crohns
+ trousseaus sign
Ca low low
next step

albumin

9

71 y.o F poor appetite weight loss, cramps and weakness
PMH crohns
+ trousseaus sign
Ca low low
low albumin so corrected Ca still a little low
next step

PTH
PO4
Cr
alkaline phosphatase

10

71 y.o F poor appetite weight loss, cramps and weakness
PMH crohns
+ trousseaus sign
Ca low low
low albumin so corrected Ca still a little low
low PO4
normal Cr
high alkaline phosphatase
high PTH
differential?

Vit D problem

11

71 y.o F poor appetite weight loss, cramps and weakness
PMH crohns
+ trousseaus sign
Ca low low
low albumin so corrected Ca still a little low
low PO4
normal Cr
high alkaline phosphatase
high PTH
low 25 hydroxy vit D
Dx?

Vit D deficiency

12

what you expect to see on XR and DEXA of a patient with Vit D deficiency

decreased bone density- osteoporosis

13

35 y.o F with thyroid cancer
had total thyroidectomy
3 days after surgery had facial cramps

hypoCa

14

best osteoporosis Tx for women with previous Hx breast cancer

estrogen modulator drugs