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Questions and Answers

What is the primary role of parathyroid hormone (PTH) in the body?

  • To promote absorption of vitamin D in the intestines
  • To regulate thyroid hormone production
  • To modulate calcium homeostasis in various organs (correct)
  • To increase phosphate absorption in the kidneys

Which of the following best describes the effect of PTH on plasma phosphate levels?

  • It has no effect on phosphate concentration
  • It increases phosphate concentration in the plasma
  • It decreases phosphate concentration in the plasma (correct)
  • It leads to significant fluctuations in phosphate levels

Which of the following conditions can be a cause of hypocalcemia?

  • Dehydration
  • Excessive vitamin D intake
  • Primary hyperparathyroidism
  • Chronic kidney disease (correct)

What is the typical weight of a parathyroid gland?

<p>30-50 mg (C)</p> Signup and view all the answers

How long is the plasma half-life of PTH 1-84?

<p>2-4 minutes (D)</p> Signup and view all the answers

What is the primary objective of therapy in patients with hypoparathyroidism?

<p>To relieve symptoms and maintain serum calcium in the low-normal range. (A)</p> Signup and view all the answers

Which of the following is a method to confirm the diagnosis of hypocalcemia?

<p>Measuring ionized calcium levels. (C)</p> Signup and view all the answers

If a patient presents with Chvostek's sign, which facial nerve action is being indicated?

<p>Contraction of the ipsilateral facial muscles. (C)</p> Signup and view all the answers

What is the effect of a 1 g/dL reduction in serum albumin concentration on total calcium concentration?

<p>Decreases total calcium concentration by approximately 0.02 mmol/L. (C)</p> Signup and view all the answers

What is the recommended intravenous treatment for acute hypocalcemia?

<p>10% calcium gluconate over 10 minutes. (C)</p> Signup and view all the answers

What is the first step in the diagnostic approach to hypercalcemia?

<p>Check total calcium corrected for albumin or ionized calcium (B)</p> Signup and view all the answers

Which investigation would likely indicate humoral hypercalcemia of malignancy?

<p>Elevated PTHrP (B)</p> Signup and view all the answers

What is the significance of checking 1,25 dihydroxyvitamin D levels in the context of hypercalcemia?

<p>It helps identify granulomatous diseases. (D)</p> Signup and view all the answers

In cases of minimally elevated PTH levels, what is the likely condition associated with hypercalcemia?

<p>Familial hypocalciuric hypercalcemia (A)</p> Signup and view all the answers

What laboratory evaluation is crucial to confirm hypercalcemia?

<p>Albumin-corrected calcium levels (B)</p> Signup and view all the answers

What is the serum calcium level considered to indicate hypocalcemia?

<p>Below 2.12 mmol/L (D)</p> Signup and view all the answers

Which of the following is NOT a cause of hypoparathyroidism?

<p>Vitamin D deficiency (A)</p> Signup and view all the answers

Which acute symptom is commonly associated with hypocalcemia?

<p>Seizures (A)</p> Signup and view all the answers

What is the primary mechanism of action for drugs that can induce hypocalcemia?

<p>Inhibit bone resorption (D)</p> Signup and view all the answers

Trousseau's sign is indicative of which condition?

<p>Hypocalcemia (B)</p> Signup and view all the answers

Which of the following conditions can lead to high parathyroid hormone (PTH) levels?

<p>Chronic kidney disease (D)</p> Signup and view all the answers

Which of the following is a chronic manifestation of hypocalcemia?

<p>Parkinsonism (C)</p> Signup and view all the answers

How does hypomagnesemia relate to parathyroid hormone (PTH) levels?

<p>It can decrease PTH secretion (D)</p> Signup and view all the answers

In which scenario is the risk of symptomatic hypocalcemia higher?

<p>Rapid onset of low calcium levels (A)</p> Signup and view all the answers

What is the relationship between vitamin D deficiency and calcium metabolism?

<p>It decreases calcium absorption and can increase PTH (A)</p> Signup and view all the answers

Which of the following describes a cause of primary hyperparathyroidism?

<p>Multiple endocrine neoplasia syndromes (A)</p> Signup and view all the answers

What is a common neurological manifestation of hypercalcemia?

<p>Confusion (A)</p> Signup and view all the answers

Which treatment is indicated for severe hypercalcemia?

<p>Calcitonin 4 iu/kg every 12 hours (B)</p> Signup and view all the answers

Which of the following describes a type of hypercalcemia related to malignancy?

<p>Hypercalcemia of malignancy (D)</p> Signup and view all the answers

Which symptom is more likely to occur in moderate hypercalcemia (calcium levels 12 to 14 mg/dL)?

<p>Fatigue (C)</p> Signup and view all the answers

Which factor is NOT associated with non-parathyroid mediated hypercalcemia?

<p>Nephrogenic diabetes insipidus (B)</p> Signup and view all the answers

What represents the classic renal manifestation of hypercalcemia?

<p>Nephrolithiasis (B)</p> Signup and view all the answers

Which of the following medications is a known cause of hypercalcemia?

<p>Lithium (B)</p> Signup and view all the answers

Which of the following is a constitutional symptom of hypercalcemia?

<p>Weakness (A)</p> Signup and view all the answers

In severe hypercalcemia management, what is the initial fluid treatment recommended?

<p>Isotonic saline (D)</p> Signup and view all the answers

What is the initial management for a patient with mild hypercalcemia?

<p>Adequate hydration and avoidance of contributing factors (D)</p> Signup and view all the answers

Which of the following laboratory findings would indicate primary hyperparathyroidism?

<p>Elevated parathyroid hormone (PTH) levels and high calcium levels (D)</p> Signup and view all the answers

Which treatment is indicated for severe hypercalcemia?

<p>Calcitonin every 12 hours and isotonic saline (A)</p> Signup and view all the answers

In the case of a 55-year-old patient with elevated calcium and specific lab findings, what would be the most appropriate next diagnostic test?

<p>iPTH level (D)</p> Signup and view all the answers

Which condition is characterized by elevated PTH levels and low phosphate levels?

<p>Secondary Hyperparathyroidism (B)</p> Signup and view all the answers

Which is NOT a common factor that aggravates hypercalcemia?

<p>Administration of calcitonin (D)</p> Signup and view all the answers

What is the expected calcium level range for moderate hypercalcemia?

<p>12 to 14 mg/dL (B)</p> Signup and view all the answers

What additional lab findings suggest vitamin D deficiency?

<p>Elevated PTH and low calcium levels (D)</p> Signup and view all the answers

Flashcards

Parathyroid Glands

Four small glands located behind the thyroid gland that produce parathyroid hormone (PTH).

Parathyroid Hormone (PTH)

A hormone that regulates calcium levels in the blood by affecting bone, kidneys, and intestines.

PTH Half-life

Parathyroid hormone has a short half-life of 2-4 minutes in the bloodstream.

Calcium Homeostasis

The process of maintaining a stable level of calcium in the blood, controlled by PTH, vitamin D, and other factors.

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PTH Target Organs

The organs directly affected by parathyroid hormone: kidneys, bones, and intestines.

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PTH Action on Kidneys

PTH increases calcium reabsorption in the kidneys, reducing calcium loss in urine.

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PTH Action on Bones

PTH stimulates bone resorption, releasing calcium into the blood.

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PTH Action on Intestines

PTH indirectly increases calcium absorption from the intestines.

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Hypo/Hypercalcemia

Low/high levels of calcium in the blood, respectively, leading to various symptoms and signs.

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Normal Serum Total Calcium

The range of serum total calcium considered normal is 8.5 to 10.5 mg/dL (2.12 to 2.62 mmol/L).

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Ionized Calcium Range

The normal range for ionized calcium in the blood is 4.65 to 5.25 mg/dL (1.16 to 1.31 mmol/L).

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Hypocalcemia Definition

Hypocalcemia is a condition where serum calcium levels fall below 8.5 mg/dL (2.12 mmol/L).

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Mild Hypocalcemia Range

Mild hypocalcemia is a serum calcium level between 1.9 and 2.12 mmol/l (8.5 and 9.7 mg/dL).

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Severe Hypocalcemia Range

Severe hypocalcemia is a serum calcium level below 1.9 mmol/l (8.5 mg/dl).

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Hypocalcemia Symptoms (Acute)

Acute hypocalcemia presents with neuromuscular irritability, paresthesias, muscle twitching, carpopedal spasm, Trousseau's sign, Chvostek's sign, seizures, and potentially laryngospasm, bronchospasm.

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Hypoparathyroidism Etiology (Post-Surgical)

Surgical removal of the parathyroid glands is the most common cause of hypoparathyroidism, accounting for a significant portion of cases.

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Hypocalcemia Etiology (Drugs)

Certain medications like bisphosphonates, calcitonin, and denosumab can contribute to hypocalcemia, especially if combined with Vitamin D deficiency.

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Hungry Bone Syndrome

A post-parathyroidectomy complication causing severe hypocalcemia, hypophosphatemia, and hypomagnesemia.

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Trousseau's Sign

A sign of hypocalcemia; carpal spasm induced by blood pressure cuff inflation.

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Chvostek's sign

Facial muscle contraction when the facial nerve is tapped anterior to the ear.

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Trousseau's sign

Carpal spasm induced by blood pressure cuff inflation.

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Hypocalcemia

Low calcium levels in the blood.

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Hypocalcemia Cardiovascular effects

Hypotension, heart failure, prolonged QT interval.

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Hypocalcemia Diagnosis

Confirm low calcium by measuring ionized calcium and albumin. Albumin drop lowers total calcium.

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Hypocalcemia Cause Finding

Identify cause by measuring magnesium, phosphorus, parathyroid hormone (PTH), and vitamin D.

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Hypocalcemia Treatment- Magnesium

If low, correct magnesium intravenously (IV) or orally.

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Hypocalcemia Treatment- Calcium

Administer calcium intravenously (IV) slowly or orally.

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Hypocalcemia Treatment- Vitamin D

Vitamin D supplements are needed for vitamin D deficiency or hypoparathyroidism.

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Hypoparathyroidism Treatment Goals

Relieve symptoms and maintain calcium in the low-normal range.

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Recombinant PTH

An alternative treatment option for managing resistant hypoparathyroidism.

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Hypercalcemia

High calcium levels in the blood, potentially causing various symptoms.

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Primary hyperparathyroidism

Overactive parathyroid glands producing excessive parathyroid hormone (PTH).

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Hypercalcemia of malignancy

Cancer-related high calcium levels, often from tumor factors.

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PTHrP

Parathyroid hormone-related peptide; a protein that mimics PTH's effects.

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Vitamin D intoxication

High levels of vitamin D, leading to hypercalcemia.

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Thiazide diuretics

Medications that can cause hypercalcemia as a side effect.

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Mild Hypercalcemia

Blood calcium levels slightly elevated (<12 mg/dL).

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Renal manifestations of hypercalcemia

Kidney problems like kidney stones, excessive urination, and kidney failure.

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Severe Hypercalcemia

High blood calcium levels (>14 mg/dL).

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Treatment of severe hypercalcemia

Managing severe hypercalcemia involves volume expansion, calcitonin and bisphosphonates.

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Mild Hypercalcemia Range

Serum calcium level below 12 mg/dL (3 mmol/L).

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Moderate Hypercalcemia

Serum calcium between 12-14 mg/dL (3-3.5 mmol/L).

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Severe Hypercalcemia

Serum calcium above 14 mg/dL (3.5 mmol/L).

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Hyperparathyroidism (types)

Three types: 1° (primary), 2° (secondary), and 3° (tertiary).

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iPTH Level

A diagnostic blood test for parathyroid hormone.

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Case 1 - Lab Findings

Low Hemoglobin, High Calcium, Low Phosphate, High Alkaline Phosphatase, Low Albumin

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Case 1 - Next Diagnostic

Determine possible hyperparathyroidism or other potential cause by checking iPTH level

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Hypercalcemia

High calcium levels in the blood.

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Band Keratopathy

A calcium phosphate deposit in the eye's cornea.

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Confirm Hypercalcemia

Repeat calcium measurements (corrected for albumin).

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Etiology of Hypercalcemia

The cause of high blood calcium.

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Laboratory Evaluation

Analyze blood tests (calcium, phosphate, albumin, PTH, vitamin D, renal function).

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PTH

Parathyroid hormone, regulates calcium.

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Non-PTH mediated Hypercalcemia

High calcium levels not caused by parathyroid hormone.

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PTHrp

Parathyroid hormone-related protein, a factor associated with cancer and increased calcium.

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1,25-dihydroxyvitamin D

Active form of vitamin D, affecting calcium absorption.

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25-hydroxyvitamin D

Precursor form of vitamin D in the body.

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