Introduction An increase in serum calcium level Mechanisms and pathophysiology dietary causes calcium ingestion (milk-alkali syndrome) hypervitaminosis D hypervitaminosis A pharmacologic causes thiazides causes increased distal tubule reabsorption of calcium used to treat hypercalciuria malignancy-associated causes Paget's disease typically does not result in hypercalcemia can be come hypercalcemic if patient is immobilized squamous cell cancer of the lung ectopic production of PTH (PTH related peptide - PTHrP) multiple myeloma production of IL-1 activates osteoclast-driven bone resorption sarcoidosis granulomatous macrophages produce 1α-hydroxylase which produces high amounts of 1,25 vitamin D hyperparathyroid genetic causes familial hypocalciuric hypercalcemia defect in calcium sensor of parathyroid gland there is a loss of negative feedback on PTH by hypercalcemia PTH levels are normal to high despite high serum calcium levels urine excretion of calcium is low key feature distinguishing primary hyperparathyroidism from FHH other causes hyperthyroid Addison's disease Zollinger-Ellison syndrome Presentation Symptoms CNS confusion stupor weakness gastrointestinal constipation anorexia nausea vomiting kidney polyuria kidney stones polydipsia Physical exam weakness decreased/absent reflexes EKG shortened QTc interval Treatment Conservative hydration saline diuresis Pharmacologic loop diuretics bisphosphonates mithramycin calcitonin galium nitrate Other dialysis
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.EC.14.75) A 28-year-old African American woman presents to her primary care physician with two weeks of nausea, abdominal pain, and increased urination. She states she has had kidney stones in the past and is concerned because her current pain is different in character from what she had experienced then. In addition she reports increasing weakness and fatigue over the past several months as well as mild shortness of breath. Chest radiography shows bilateral hilar adenopathy. Which of the following processes is most likely responsible for her current symptoms? QID: 106742 Type & Select Correct Answer 1 Osteoclast-driven bone resorption 1% (1/93) 2 Increased production of parathyroid hormone 13% (12/93) 3 Ectopic parathyroid hormone release 48% (45/93) 4 Increased intestinal absorption of calcium 26% (24/93) 5 Increased renal calcium reabsorption 12% (11/93) M 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic (M1.EC.14.91) A 60-year-old man presents to the emergency room with a chief complaint of constipation. His history is also significant for weakness, a dry cough, weight loss, recurrent kidney stones, and changes in his mood. He has a 30 pack-year history of smoking. A chest x-ray reveals a lung mass. Labs reveal a calcium of 14. What is the first step in management? QID: 104416 Type & Select Correct Answer 1 Begin alendronate 12% (10/81) 2 Administer calcitonin 20% (16/81) 3 Begin furosemide 16% (13/81) 4 Administer intravenous fluids 47% (38/81) 5 Begin hydrochlorothiazide 2% (2/81) M 3 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
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