Hot Boards-like Questions

[Miles Standisch]

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A young woman has had bone pain for a decade, with frequent bulky stools, as well as muscle weakness and distended abdomen. Imaging reveals generalized demineralization of bones, absence of lamina dura, and fracture lines in bones of the feet. Which of the below serum values is most likely?

A) Ca-low, Phosphorus-low, Alkaline phosphatase-hi, PTH-hi

B) C-low, P-hi, AP-hi, PTH-lo

C) C-low, P-hi, AP-hi, PTH-hi

D) C-hi, P-lo, AP-hi, PTH-lo

E) C-hi, P-lo, AP-lo, PTH-hi

 

[md2bny]

A is the answer b/c Vit D is fat soluble therefore its not absorbed...low vit d --> low effectiveness of PTH that is no ca reabsorption from the intestine, low vit d also low phosphorous reabsorption and high pth also makes low reabsorption of phosphorus..and high bone resorption increases alkaline phosphatase

let me know wat u think!

 

[Miles Standisch]

right.

 

[kcrd]

these are great, miles! keep them coming.

 

[GrandMasterB]

yeah and maybe the bone pain is from osteitis fibrocystica or whatever- "brown tumors" of broken down bone from hyper pth- here if it was for ten years she may have secondary hyperpth and even tertiary hyper pth if her glands became hyperplastic- you would have to correct whatever is causing the steaorhea and vit d before knowing this though.

 

[GrandMasterB]

the thing you are supposed to remember about von gerke's disease is that it "turns the liver into a muscle." ie it can break down glycogen but can't dephosphorylate g6p to export glucose. so everytime glucagon hits the liver- glycogen goes to g6p but then it can't go anywhere so the only options are to go through glycolysis, hmp, and remake glycogen- so it probably does all three but the liver is making tons of glycogen because it normally takes up a lot of glucose- and with out the normal option of releasing glucose- it builds up as glycogen in the liver. please correct me if i am wrong- and i hope that helped.

 

[Jaded Soul]

Calcium, phosphate, PTH, and vitamin D ... the bane of my existance. 🙁

 

[Akash]

ya i agree with the g-6-p thing posted above, u cant break down your glycogen since it breaks down via glucose-6-phosphate, so u cant break down the glycogen you have so i get a build up. the other two reactions are also obviously involved, but this is the gist