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USMLE Step 2 CK Bits & Pieces High yield short focused points, monographs, charts, illustrations, tables, and other stuff related to the USMLE Step 2 CK Exam.


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  #1  
Old 09-12-2011
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Arrow Hypercalcemia and Hypocalcemia, How to proceed!

Hypercalcemia:

1. check parathormone....
2. if PTH is high, check PO4....
if high... tertiary hyperparathyriodism
if low....check urinary calcium....
if high.....primary hyperparathyriodism
if low......FHH
3. if PTH is low,
vit d toxicity------vit d levels
malignancy-------wt loss or specific signs n symtoms
sarcoidosis--------ACE levels + other features

Hypocalcemia:

1. Get ionized calcium levels
if normal.......hypoalbunimea
if low...........true hypocalcemia, proceed
2. check PO4
if normal.......Alkalosis or massive Blood transfusion
if low...........vit d def or Ac pancreatitis
if high..........get PTH
if low.......hypoparathyriodism
if high......sec hyperparathyriodism/ CRF

Last edited by aasiaafzal; 09-12-2011 at 02:54 PM.
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  #2  
Old 09-12-2011
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hey nice one
is this table given in any books?
thanks
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  #3  
Old 09-13-2011
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Quote:
Originally Posted by iron View Post
hey nice one
is this table given in any books?
thanks
thx...
no its not...
i collected the info from Davidson and Kaplan CK lecture Notes...!! wanted to post it in flow chart format...but that was taking a lot of time...so i hope its still understandable
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Old 09-13-2011
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Question

FHH stands for??
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Old 09-13-2011
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Quote:
Originally Posted by samstar View Post
FHH stands for??
familial hypocalciuric hypercalcemia.........these pts donot excrete ca s have a high calcium, usually not very high....
so when compared to pri hyperparathyriodism, there urinary calcium is low...(though i would like to add that one third pri hyperparathyriod pts may have normal urinary calcium...which would make it difficult to differentiate from FHH but i think they wont test it in exam.)

plz add if u find anything useful...or contradictory
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Old 09-13-2011
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guys want to make sum corrections....im unable to edit the above post...
1. hyperthyriodism is a cause of hypercalcemia (n not hypo) because of increased osteoclast activity....

2. At present im confused about hypercalcemia n glucocorticoids....
Davidson says glucocorticoid def causes hypercalcemia....n even prednisolone can be given as treatment of hypercalcemia....

kaplan lecture notes say, glucocorticoid excess causes osteoporosis n this leads to hypercalcemia..it also says that these pts can have renal stones...

so if both r right, then glucocorticoids excess n def both r causing hypercalcemia....?? plz correct me if im reaching to wrong conclusions...!!
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Old 11-19-2011
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Warning! glucocorticoid excess is related to hypercalciuria

Quote:
Originally Posted by aasiaafzal View Post
guys want to make sum corrections....im unable to edit the above post...
1. hyperthyriodism is a cause of hypercalcemia (n not hypo) because of increased osteoclast activity....

2. At present im confused about hypercalcemia n glucocorticoids....
Davidson says glucocorticoid def causes hypercalcemia....n even prednisolone can be given as treatment of hypercalcemia....

kaplan lecture notes say, glucocorticoid excess causes osteoporosis n this leads to hypercalcemia..it also says that these pts can have renal stones...

so if both r right, then glucocorticoids excess n def both r causing hypercalcemia....?? plz correct me if im reaching to wrong conclusions...!!
This is what I found:
Source:
-UptoDate
-Williams Textbook of Endocrinology, 12th ed.(2011)
-Campbell-Walsh Urology, 10th. ed. (2011)

"Many patients with longstanding Cushing's syndrome have lost height because of osteoporotic vertebral collapse. In addition, osteonecrosis of the femoral and humeral heads is a recognized feature of endogenous Cushing's syndrome. Hypercalciuria may lead to renal calculi, but hypercalcemia is not a feature."

"In one study, stones were found in 50% of patients with active Cushing syndrome, 27% of cured patients, and 6.5% of controls. Compared with controls, patients with active disease had a significantly higher prevalence of hypercalciuria, hypocitraturia, and hyperuricosuria, but these patients were also at greater risk of obesity and diabetes, which have been linked to stone formation"

"calcitonin secretagogues include glucocorticoids...in Sarcoidosis the hypercalcemia and the high levels of calcitriol fall after treatment with glucocorticoids."

So, glucocorticoid excess is related to hypercalciuria (not hypercalcemia)
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Old 06-22-2015
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thank you so much its really helped
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Quote:
Originally Posted by aasiaafzal View Post
Hypercalcemia:

1. check parathormone....
2. if PTH is high, check PO4....
if high... tertiary hyperparathyriodism
if low....check urinary calcium....
if high.....primary hyperparathyriodism
if low......FHH
3. if PTH is low,
vit d toxicity------vit d levels
malignancy-------wt loss or specific signs n symtoms
sarcoidosis--------ACE levels + other features

Hypocalcemia:

1. Get ionized calcium levels
if normal.......hypoalbunimea
if low...........true hypocalcemia, proceed
2. check PO4
if normal.......Alkalosis or massive Blood transfusion
if low...........vit d def or Ac pancreatitis
if high..........get PTH
if low.......hypoparathyriodism
if high......sec hyperparathyriodism/ CRF
Slight modification to the hypercalcemia management.

If Ca is very high >1+ upper limit ... then the first step is hydration
This is followed by Calcitonin
Bisphosphonates are later added.

These patients are usually severely symptomatic.
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