Ca++

Question 1

Where does PTH act?

Answer 1

bone, kidney, and GI system (indirectly via the kidney)

Question 2

PTH causes what in the bone?

Answer 2

increased osteoclast activity –> elevated Ca++ and PO4-

Question 3

PTH causes what in the kidney?

Answer 3

reabsorb Ca++, excrete PO4-

Question 4

What does vitD do in the gut?

Answer 4

causes absorption of Ca++ and PO4-

Question 5

Name an exogenous source of vitD in the body?

Answer 5

granulomas (sarcoid, TB)

Question 6

What is a normal albumin value?

Answer 6

4

Question 7

What is a normal Ca++ value?

Answer 7

10

Question 8

For every 1 point of albumin deficiency, the Ca++ changes by?

Answer 8

0.8

Question 9

As Ca++ goes up, PTH goes ___.

Answer 9

down

Question 10

S/s hypocalcemia?

Answer 10

tetany, perioral tingling, Trosseau sign, Chvostek sign

Question 11

What is Trosseau sign?

Answer 11

hand spasm w BP cuff inflation

Question 12

What is Chvostek sign?

Answer 12

facial nerve spasm with tapping

Question 13

Dx? tetany, perioral tingling, Trosseau sign, Chvostek sign

Answer 13

hypocalcemia

Question 14

If you see low Ca++ on labs, what do you do first?

Answer 14

check albumin- see if the Ca++ corrects (0.8 increase for every 1 unit of albumin deficient)

Question 15

Tx hypocalcemia on labs?

Answer 15

IV calcium

Question 16

Sequelae severe hypocalcemia?

Answer 16

seizures, arrhythmia

Question 17

S/s hypercalcemia?

Answer 17

kidney stones, psychic moans, abd groans, and painful bones

Question 18

Tx hypercalcemia with s/s?

Answer 18

TONS of IV fluids, maybe bisphosphonates, and loop diuretics later

Question 19

Dx? kidney stones, psychic moans, abd groans, and painful bones

Answer 19

hypercalcemia

Question 20

Tx hypercalcemia with no s/s?

Answer 20

recheck Ca++ –> if still elevated, diagnose

Question 21

Tx for super-high calcium?

Answer 21

calcitonin IV

Question 22

Long-term tx for hypercalcemia?

Answer 22

bisphosphonates

Question 23

Dx? hypercalcemia, pathologic fxs, brown tumors, high PTH, high K+, high PO4-

Answer 23

hyperparathyroidism

Question 24

What does insulin do to PO4-?

Answer 24

shifts it into the cell

Question 25

Hypocalcemia EKG finding?

Answer 25

prolonged QT

Question 26

How does CA cause hypercalcemia?

Answer 26

either metastasis to bones (releasing Ca++ and PO4-) or paraneoplastic syndrome (PTHrp from SSC of the lung)

Question 27

Dx? low PTH, increased Ca++, elevated PO4-

Answer 27

cancer mets to the bone

Question 28

Dx? low PTH, increased Ca++, low PO4-

Answer 28

paraneoplastic syndrome (PTHrp from SSC of the lung)-

Question 29

What causes hypervitaminosis D?

Answer 29

granulomas

Question 30

Dx? increased Ca++, increased PO4-, low PTH, high 1-25 vit D

Answer 30

hypervitaminosis D secondary to granulomatous disease

Question 31

Dx? tetany, perioral tingling on post-op day 1 with low PTH and low Ca++, normal PO4-

Answer 31

hypoPTH

Question 32

Tx hypoPTH (iatrogenic)?

Answer 32

IV calcium

Question 33

Dx? high Ca++, low PO4-, normal PTH

Answer 33

benign familial hypocalciuric hypercalcemia

Question 34

Dx? high Ca++, PO4- high, PTH low, high urine Ca++

Answer 34

hypercalcemia of immobilization

Question 35

What does Cinecalcet do?

Answer 35

suppresses PTH

Question 36

What does pancreatitis do to Ca++?

Answer 36

sequesters it

Question 37

Name a drug that suppresses PTH.

Answer 37

Cinecalcet