Challenge yourself on this harder set of questions on hyper and hypocalcaemia
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Approach to calcium disturbance
Stem 1, question 1 of 3
A patient is brought into the emergency department with paraesthesia and seizures. On examination the patient has brittle nails with transverse grooves, dermatitis and hyperpigmentation.
When taking the patient's blood pressure the patient has a carpopedal spasm with the metacarpophalangeal joints flexing the interphalageal joints extending. What causes this to occur?
The restriction of blood flow is deleterious to the function of excitable membranes which leads to skeletal muscle fatigue
In the absence of blood flow, the hypercalcaemic state and subsequent neuromuscular irritability will induce a spasm of the muscles of the hand and forearm
The restriction of blood flow leads to neuromuscular irritability which causes a spasm of the hand and forearm
The restriction of blood flow leads to hypercalcaemia and causes extension of the hand and forearm
In the absence of blood flow, the hypocalacaemic state and subsequent neuromuscular irritability will induce a spasm of the muscles of the hand and forearm
Stem 1, question 2 of 3Urgent electrolyte blood tests are performed and reveal the following results: Low albumin-corrected serum total calcium and high serum phosphate. All other blood test are within normal range. What is the cause of the hypocalcaemia in this patient?
Chronic renal failure
Stem 1, question 3 of 3The patient is successfully treated and is advised to eat a calcium rich diet. Which of the following foods is NOT rich in calcium?
Fortified soya drinks
Stem 2, question 1 of 7
A 78 year old presents to their GP with a 2 week history of lethargy, confusion, fatigue, constipation, polyuria, abdominal pain and nausea. Past medical history includes renal cell carcinoma 2 years previously.
What is most likely to be causing this presentation?
Stem 2, question 2 of 7An ECG is performed. What ECG changes are seen in hypercalcaemia?
Tented T waves
Long QT interval
ST segment elevation
Short QT interval
Stem 2, question 3 of 7If the main presentation was recurrent renal stones, what is the likely cause for hypercalcaemia?
Stem 2, question 4 of 7The patient mentions their friend was recently diagnosed with multiple myeloma. How can multiple myeloma cause hypercalcaemia?
Decreased osteolytic bone activity causing an decreased release of phosphorus from the bone
Decreased osteoblast activity causing an increased release of calcium from the bone
Increased osteolytic bone activity causing an increased release of calcium from the bone
Increased osteoblast activity caused increased release of calcium from the bone
Increased osteolytic activity causing a decreased release of calcium from the bone
Stem 2, question 5 of 7How should you initially manage your patient?
Calcitonin is a second-line therapy and alendronic acid is an oral bisphosphonate used to treat post-menopause osteoporosis. If the patient had presented with signs of cauda equina or spinal cord compression from suspected spinal metastases, she would be confined to a bed until imaging is completed and reviewed.
Stem 2, question 6 of 7The patient is given calcitonin. How does calcitonin reduce calcium levels?
Increase urinary excretion of calcium in the loop of Henle
Inhibits osteoclast activity and enhance urinary excretion of calcium
Dilute calcium levels by increasing plasma volume
Inhibits osteoblast activity and enhance urinary excretion of calcium
Restoration of vitamin D levels
Stem 2, question 7 of 7Pulmonary tuberculosis can result in hypercalcaemia. By which mechanism does this occur?
Secretion of parathyroid hormone related peptide leading to activation osteoclastic bone resorption
Excessive vitamin D intake
Poor absorption of calcium from the gut
Defect in activation of parathyroid hormone receptor
Excessive extra-renal 1-alpha hydroxylase activity