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30 Cards in this Set
- Front
- Back
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1. 1° Hyperparathyroidism?
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a. Elevated PTH usually due to excessive production or parathyroid glands, leading to hypercalcemia.
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2. 2° hyperparathyroidism?
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a. Condition where parathyroid glands overproduce PTH to respond to low calcium levels.
b. This may occur as a response to low dietary calcium intake or deficiency of vitamin D |
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3. 3° (tertiary) hyperparathyroidism?
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a. Elevated PTH in patients who have renal failure.
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4. Distribution of calcium in the body?
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a. 98% is found in the skeleton
b. 2% in circulation. c. Of this: 1. Half is bound to albumin and other proteins 2. Half is free or “ionized” |
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5. Corrected serum calcium formula?!?!?
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a. “Corrected” serum calcium = [(normal albumin) X (patient’s albumin level)] X [0.8x(serum calcium)].
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6. Physiologic regulatory mechanisms calcium levels increase?
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a. Calcitonin, produced by the thyroid parafollicular cells, tend to lower calcium levels through renal excretion of calcium and by opposing osteoclast activity.
b. When calcium is excreted through this pathway, phosphate is also excreted. |
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7. Physiologic regulatory mechanisms calcium levels are low?
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a. PTH secretion ->
i. Osteoclast activation ii. Calcium resorption and the kidneys iii. PTH also increases calcitriol levels, which acts at the GI tract to promote calcium and phosphate absorption |
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8. How does PTH effect phosphate levels?
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a. While PTH will increases the calcium in the blood, has the opposite effect serum phosphate levels
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9. Note: Both Calcitonin and PTH cause phosphate excretion in the kidneys. However, PTH possibly compensates by causing increased absorption of phosphate in the GI tract.
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9. Note: Both Calcitonin and PTH cause phosphate excretion in the kidneys. However, PTH possibly compensates by causing increased absorption of phosphate in the GI tract.
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10. What is the most common cause of hypercalcemia in the ambulatory patient?
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a. Hyperparathyroidism
b. Cancer ranks as the 2nd leading cause, as hypercalcemia is often an early manifestation of malignancy c. Hyperparathyroidism and cancer combined account for 90% of hypercalcemia cases. |
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11. Normal level and what does this correspond to in ionized levels?
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a. 8-10
b. 4-5.6 ionized (makes sense since ionized is about half). |
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12. Mild hypercalcemia levels?
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a. 10.5-12
b. So frequently asymptomatic at these levels |
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13. Hypercalcemia mnemonic?
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a. Stones, bones, psychic groans, and abdominal moans
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14. Cardiac manifestations of hypercalcemia?
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a. Shortening of QT interval
b. Arrhythmias |
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15. 4 types of hypercalcemia caused by increased bone resorption?
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1. 1° hyperparathyroidism
2. Malignancy 3. Hypervitaminosis A 4. Mobilization |
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16. Specific example(s) of: 1° hyperparathyroidism?
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a. Sporadic or familial
b. MEN I and II |
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17. Specific example(s) of: hypercalcemia induced by malignancy?
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a. Solid tumours of lung
b. Squamous cell carcinoma of head and neck c. Renal carcinoma d. Breast cancer e. Multiple myeloma f. Prostate Cancer |
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18. Pathophysiology of: hypercalcemia induced by malignancy?
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a. Tumor secretion of PTH–rP!!!
b. Direct osteolysis |
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19. Specific example(s) of: Hypervitaminosis A induced hypercalcemia?
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a. Includes both vitamin A and its analogues (used to treat acne)
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20. Pathophysiology of: Hypervitaminosis A induced hypercalcemia?
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a. Increased bone resorption
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21. Specific example(s)/pathophys of: Immobilization caused hypercalcaemia?
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a. Less common above causes
b. Increased risk when underlying disorder of high bone turnover (eg, Paget disease ) |
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22. 3 causes of hypercalcemia due to increased calcium absorption?
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1. Hypervitaminosis D
2. Granulomatous disease 3. Milk-alkali syndrome |
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23. Pathophysiology of: Hypervitaminosis D?
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a. Increased calcitriol level leads to increased GI absorption of calcium and phosphate
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24. Specific example(s) of: granulomatous disease induced increased calcium absorption (3)?
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a. Tuberculosis
b. Sarcoidosis c. Hodgkin disease |
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25. Pathophysiology of: granulomatous disease induced increased calcium absorption?
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a. Increased extra-renal conversion of 25-hydroxy-vitamin D 3 to calcitriol .
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26. Pathophysiology of: Milk-alkali syndrome?
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a. Excessive intake of calcium containing antacids.
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27. Specific example(s) of: medications that cause hypercalcemia? (2)
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a. Thiazide diuretics
b. Lithium |
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28. Pathophysiology of: thiazide diuretic hypercalcemia?
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a. Reduce urinary excretion of calcium
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29. Pathophysiology of: lithium hypercalcemia?
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a. Increased PTH secretion
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30. Pathophysiology of rhabdomyolysis-induced hypercalcemia?
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a. Calcium released from injured muscle
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