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61 Cards in this Set
- Front
- Back
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What effect does high serum Ca have on sodium permeability and cell excitability?
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What effect does high serum Ca have on sodium permeability and cell excitability? ↑Ca --> ↓Na --> ↓excitability
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What effect does PTH have on Calcium in the bones and the kidneys?
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What effect does PTH have on Calcium and phosphates in the bones and the kidneys? Bones: increased bone resoprtion --> increase plasma Ca and PO4… Kidney-at DCT: increased reabsorption of Ca, increase excretion of PO4
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What are the 3 key factors that regulate gut calcium absorption?
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What are the 3 key factors that regulate gut calcium absorption? Diet, 1,25 vit D, and age
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what are the calcium requirements for these age groups: 11-24, 25-40, >65 y/o
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what are the calcium requirements for these age groups: 11-24=1500 mg/day 25-40=1000 mg/day, >65 y/o=1500 mg/day
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Where do you find CaR receptors?
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on the Parathyroid and in the TAL of the kidneys
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where on the kidney does PTH act?
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where on the kidney does PTH act? The DCT
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: passive diffusion driven by sodium absorption
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: passive diffusion driven by sodium absorption = PCT
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: contains a receptor that when activated, can interfere with ADH --> leading to partial nephrogenic diabetes insipidus and hypercalcemia via passive Ca reabsorption?
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: contains a receptor that when activated, can interfere with ADH --> leading to partial nephrogenic diabetes insipidus and hypercalcemia via passive Ca reabsorption = TAL
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: increased due to compensatory action brought on by dehydration and low GFR.
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: increased due to compensatory action brought on by dehydration and low GFR = PCT
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: Monitors calcium concentration with a CaR?
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: Monitors calcium concentration with a CaR = TAL
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: accounts for only 8% of Ca reabsorption but is hormonally controlled
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: accounts for only 8% of Ca reabsorption but is hormonally controlled = DCT
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: accounts for 70% of Ca absorption
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: accounts for 70% of Ca absorption= PCT
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: accounts for 20% of Ca reabsorption
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: accounts for 20% of Ca reabsorption=TAL
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: can increase the number of open Ca channels in response to PTH
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: can increase the number of open Ca channels in response to PTH=DCT
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: can increase intracellular Ca shuttle calbindin in response to 1,25 OH Vit D
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Which of the following (DCDT, TAL, PCT) matches the describes calcium absorption given here: can increase intracellular Ca shuttle calbindin in response to 1,25 OH Vit D= DCT
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In the PCT, what two condition can increase Ca absorption? dehydration or volume overload, alkalosis or acidosis
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In the PCT, what two condition can increase Ca absorption? Dehydration and alkalosis
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In the PCT, what two condition can decrease Ca absorption? dehydration or volume overload, alkalosis or acidosis
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In the PCT, what two condition can decrease Ca absorption? Fluid overload and acidosis
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What are alkaline phosphate, osteocalcin?
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What are alkaline phosphate, osteocalcin? Markers of bone turnover
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What are urinary N- and/or C-telopeptides used for?
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What are urinary N- and/or C-telopeptides used for? Used to estimate bone resorption rates
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What can increase active (unbound) Ca cations, Alkalosis or acidosis?
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What can increase active (unbound) Ca cations, Alkalosis or acidosis? Acidosis --> which can be excreted… alkalosis --> increases Ca affinity to albumin
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Calcium is autoregulated. How does it accomplish this?
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Calcium is autoregulated. How does it accomplish this? At the parathyroid, via CaR: increase serum Ca --> suppresseses PTH release, while low ionized Ca is permissive of PTH release
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What is the cause of Familial hypocalciuric hypercalcemia? What is used to Rx this?
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What is the cause of Familial hypocalciuric hypercalcemia? CaR don't sense [Ca] --> increased PTH release --> increased release of Ca from bones --> increased Ca reabsorption from bones… Rx: Cinaclet (a CaR agonist)
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Where is the second HO- added to Vit D? and which enzyme makes this possible?
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Where is the second HO- added to Vit D? and which enzyme makes this possible? Kidney: enzyme 1∂ hydroxylase
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match the description to the type of Rickets (VDDR 1 or 2): Vit D nuclear receptor defect
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Describe the two typse of Rickets : Vit D nuclear receptor defect and 1∂ hydroxylase defect.
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What increases 1∂ hydroxylase activity? PTH or Vit D, low PO4 or high PO4
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What increases 1∂ hydroxylase activity? PTH an low PO4
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What decreases 1∂ hydroxylase activity?
PTH or Vit D, low PO4 or high PO4 |
What decreases 1∂ hydroxylase activity? Vit D and high PO4
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Chronic kidney dz results in decreased 1,25 OH(2) Vit D. What is the mechanism by which this happens?
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Chronic kidney dz results in decreased 1,25 OH(2) Vit D. What is the mechanism by which this happens? Low 1∂ hydroxylase and low PO4 clearance.
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Which kidney enzyme deactivates Vit D?
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Which kidney enzyme deactivates Vit D? 24 hydroxylase
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Besides the kidney, where else is 1∂ hydroxylase made?
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Besides the kidney, where else is 1∂ hydroxylase made? Monocytes, skin cells, and placenta cells… also in granulomatous dz and lymphomas there can be unregulated Vit D conversion --> hypercalcemia
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match the description to the type of Rickets (VDDR 1 or 2): Vit D nuclear receptor defect.... and 1∂ hydroxylase defect
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atch the description to the type of Rickets (VDDR 1 or 2): type 1: 1∂ hydroxylase defect =type I and type 2: Vit D nuclear receptor defect
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Which adrenal hormone can inhibit calcium absorption in the gut in inhibiting Vit D activity?
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Which adrenal hormone can inhibit calcium absorption in the gut in inhibiting Vit D activity? GC
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What effect will the binding Calreticulin have on Vit D's inhibition of the PTH promoter when Ca is high and when it is low?
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What effect will the binding Calreticulin have on Vit D's inhibition of the PTH promoter when Ca is high and when it is low? When Ca is low Calreticulin will suppress Vit D's PTH suppressing activities… when Ca is high Calreticulin has no effect on Vit D's activities.
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What specific effect does PTH have on osteoblasts and osteoclasts?
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What specific effect does PTH have on osteoblasts and osteoclasts? PTH --> ↑ osteoblast activity --> ↑ conversion of precursor osteoclast
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What specific effect does Vit D have on osteoblasts and osteoclasts?
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What specific effect does Vit D have on osteoblasts and osteoclasts? (1) Like PTH, Vit D --> ↑ osteoblast activity --> ↑ conversion of precursor osteoclast… (2) Vit D directly promotes precursor osteoclast maturation
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Group these by PTH increased releasing and decreased PTH release: low Ca, high Ca, low vit D, high Vit D, low Mg, very low Mg, high PO4, low PO4
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Group these by PTH increased releasing and decreased PTH release: Increase PTH relase: low Ca, high vit D, low Mg, high PO4… Decrease PTH release: high Ca, low Vit D, very low Mg, low PO4
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What type of of receptor is PTH-®? Steroid, jak/stat, G-protein?
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What type of of receptor is PTH-®? Steroid, jak/stat, G-protein? G protein
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What is Albright's hereditary osteodystrophy caused by? What are it clinical findings?
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What is Albright's hereditary osteodystrophy caused by? Defect in PTH-®… What are it clinical findings? Hypocalcemia with high PTH (pseudohypoparathyroidism)
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What is the mechanism by which PTH causes the urinary excretion of PO4?
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What is the mechanism by which PTH causes the urinary excretion of PO4? PTH suppresses Na/PO4 cotransport --> ↓ reabsorption
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Group the following by primary and secondary hyperparathyroidism: vit D deficiency, adenoma, carcinomas (rare), MEN 1 and 2, chronic renal failure
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Primary: Adenoma, MEN 1 and 2, and carcinomas (rare)… secondary: chronic renal failure and vit D deficiency
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What is the Rx for primary hyperparathyroidism… mild or sever?
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What is the Rx for hyperparathyroidism… mild or sever? Severe= surgery… mild=no rx, f/u
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How do you Rx secondary parathyroid hyperplasia?
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How do you Rx secondary parathyroid hyperplasia? Vit D or analogs, phosphate binders, CaR antagonists
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What are C-cells of the parathyroid derived from?
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What are C-cells of the parathyroid derived from? Neural crest
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What role does calcitonin play?
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Stimulated by ↑ Ca, calcitonin acutely shuts down osteoclast activity
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What is calcitonin used as a marker for?
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What is calcitonin used as a marker for? Medullary thyroid carcinoma, MEN 2/3
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What is the role of FGF-23 hormone?
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What is the role of FGF-23 hormone? Controls PO4 secretion
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What effect does hypercalcemia have on cellular excitabilty?
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What effect does hypercalcemia have on cellular excitabilty? Decreased
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A patient presents with nausea, vomiting, pancreatitis and a peptic ulcer. What would you expect their Calcium levels to be? What is the diagnosis?
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A patient presents with nausea, vomiting, pancreatitis and a peptic ulcer. What would you expect their Calcium levels to be? high What is the diagnosis? Hypercalcemia
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A patient presents with numbness, chvostek signs, Trousseau's, long QT, and CHF… what do you think their Ca levles will be? Diagnosis?
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A patient presents with numbness, chvostek signs, Trousseau's, long QT, and CHF… what do you think their Ca levles will be? LOW Ca Diagnosis? Hypocalcemia
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A patient presents with spasms, what do you think their Ca levels will be? Diagnosis?
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A patient presents with spasms, what do you think their Ca levels will be? Low Ca... Diagnosis? Hypocalcemia
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A patient presents with renal symptoms: polyuria, polydipsia, dehydration… what do you expect their Ca levels to be? What is the diagnosis?
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A patient presents with renal symptoms: polyuria, polydipsia, dehydration… what do you expect their Ca levels to be? High What is the diagnosis? Hypercalcemia
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A patient presents with palpatations, arrhythmia, bradycardia, short QT, and AV block… what do you think their Ca will be? Diagnosis?
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A patient presents with palpatations, arrhythmia, bradycardia, short QT, and AV block… what do you think their Ca will be? High… Diagnosis? Hypercalcemia
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What can milk-alkali syndrome cause?
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What can milk-alkali syndrome cause? Primary hypercalcemia
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What is the Rx for hypercalcemia? (7 items)
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What is the Rx for hypercalcemia? Increase GFR --> IV fluids, Loop diruetics, Calcitonin, bisphosphates (↓ bone resporption), hemodialysis if severe, GC, determine etiology
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What do bisphosphates do?
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BLOCKS BONE RESPORPTION
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What effect does low serum calcium have on cellular excitabiltiy?
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What effect does low serum calcium have on cellular excitabiltiy? Increased excitability
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What determines the signs and symptoms of both hyper and hypocalcemia?
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What determines the signs and symptoms of both hyper and hypocalcemia? Rate and amount of Ca change
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Would hungry bone syndrome cause hyper or hypocalcemia?
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hypocalcemia
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how do you Rx hypocalcemia?
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how do you Rx hypocalcemia? Ca replacement… if chronic: Vit D and thiazide diuretics, rhPTH
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match the following: [osteoclast, osteoblasts] [monocytes/macrophage, fibroblast-like mesenchymal cells]
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osteoclasts = monocytes/macrophage… osteoblasts=mesenchymal cells
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which is defined here, osteoporosis or osteomalacia? Decreased bone mineralization and change in architecture due to decrease bone formation.
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which is defined here, osteoporosis or osteomalacia? Decreased bone mineralization and change in architecture due to decrease bone formation = OSTEOPOROSIS
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1. What would you expect the PTH levels to be in renal osteodystrophy-related (ERD)secondary hyperparathyroidism and osteoitis fibrosa? what effect will that have on bone turnover?
2. What would you expect PTH levels to be in long term Ca and Vit D? What would happen to bone turnover? What would result from this? |
What would you expect the PTH levels to be in renal osteodystrophy-related (ERD)secondary hyperparathyroidism and osteoitis fibrosa? PTH level increase 20x --> high bone turnover.
2. What would you expect PTH levels to be in long term Ca and Vit D? LOW PTH... What would happen to bone turnover? DECREASED... What would result from this? Adynamic bone disese and osteomalacia |
