Parathyroid conditions and calcium imbalance: Clinical (To be retired)


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Parathyroid conditions and calcium imbalance: Clinical (To be retired)

Medical and surgical emergencies

Cardiology, cardiac surgery and vascular surgery

Advanced cardiac life support (ACLS): Clinical (To be retired)

Supraventricular arrhythmias: Pathology review

Ventricular arrhythmias: Pathology review

Heart blocks: Pathology review

Coronary artery disease: Clinical (To be retired)

Heart failure: Clinical (To be retired)

Syncope: Clinical (To be retired)

Pericardial disease: Clinical (To be retired)

Valvular heart disease: Clinical (To be retired)

Chest trauma: Clinical (To be retired)

Shock: Clinical (To be retired)

Peripheral vascular disease: Clinical (To be retired)

Leg ulcers: Clinical (To be retired)

Aortic aneurysms and dissections: Clinical (To be retired)

Cholinomimetics: Direct agonists

Cholinomimetics: Indirect agonists (anticholinesterases)

Muscarinic antagonists

Sympathomimetics: Direct agonists

Sympatholytics: Alpha-2 agonists

Adrenergic antagonists: Presynaptic

Adrenergic antagonists: Alpha blockers

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

Loop diuretics

Thiazide and thiazide-like diuretics

Calcium channel blockers

cGMP mediated smooth muscle vasodilators

Class I antiarrhythmics: Sodium channel blockers

Class II antiarrhythmics: Beta blockers

Class III antiarrhythmics: Potassium channel blockers

Class IV antiarrhythmics: Calcium channel blockers and others

Positive inotropic medications

Antiplatelet medications

Dermatology and plastic surgery

Blistering skin disorders: Clinical (To be retired)

Bites and stings: Clinical (To be retired)

Burns: Clinical (To be retired)

Endocrinology and ENT (Otolaryngology)

Diabetes mellitus: Clinical (To be retired)

Hyperthyroidism: Clinical (To be retired)

Hypothyroidism and thyroiditis: Clinical (To be retired)

Parathyroid conditions and calcium imbalance: Clinical (To be retired)

Adrenal insufficiency: Clinical (To be retired)

Neck trauma: Clinical (To be retired)


Mineralocorticoids and mineralocorticoid antagonists


Gastroenterology and general surgery

Abdominal pain: Clinical (To be retired)

Appendicitis: Clinical (To be retired)

Gastrointestinal bleeding: Clinical (To be retired)

Peptic ulcers and stomach cancer: Clinical (To be retired)

Inflammatory bowel disease: Clinical (To be retired)

Diverticular disease: Clinical (To be retired)

Gallbladder disorders: Clinical (To be retired)

Pancreatitis: Clinical (To be retired)

Cirrhosis: Clinical (To be retired)

Hernias: Clinical (To be retired)

Bowel obstruction: Clinical (To be retired)

Abdominal trauma: Clinical (To be retired)

Laxatives and cathartics


Acid reducing medications

Hematology and oncology

Blood products and transfusion: Clinical (To be retired)

Venous thromboembolism: Clinical (To be retired)

Anticoagulants: Heparin

Anticoagulants: Warfarin

Anticoagulants: Direct factor inhibitors

Antiplatelet medications


Infectious diseases

Fever of unknown origin: Clinical (To be retired)

Infective endocarditis: Clinical (To be retired)

Pneumonia: Clinical (To be retired)

Tuberculosis: Pathology review

Diarrhea: Clinical (To be retired)

Urinary tract infections: Clinical (To be retired)

Meningitis, encephalitis and brain abscesses: Clinical (To be retired)

Bites and stings: Clinical (To be retired)

Skin and soft tissue infections: Clinical (To be retired)

Protein synthesis inhibitors: Aminoglycosides

Antimetabolites: Sulfonamides and trimethoprim

Antituberculosis medications

Miscellaneous cell wall synthesis inhibitors

Protein synthesis inhibitors: Tetracyclines

Cell wall synthesis inhibitors: Penicillins

Miscellaneous protein synthesis inhibitors

Cell wall synthesis inhibitors: Cephalosporins

DNA synthesis inhibitors: Metronidazole

DNA synthesis inhibitors: Fluoroquinolones

Herpesvirus medications



Miscellaneous antifungal medications

Anthelmintic medications


Anti-mite and louse medications

Nephrology and urology

Hypernatremia: Clinical (To be retired)

Hyponatremia: Clinical (To be retired)

Hyperkalemia: Clinical (To be retired)

Hypokalemia: Clinical (To be retired)

Metabolic and respiratory acidosis: Clinical (To be retired)

Metabolic and respiratory alkalosis: Clinical (To be retired)

Toxidromes: Clinical (To be retired)

Medication overdoses and toxicities: Pathology review

Environmental and chemical toxicities: Pathology review

Acute kidney injury: Clinical (To be retired)

Kidney stones: Clinical (To be retired)

Adrenergic antagonists: Alpha blockers

Neurology and neurosurgery

Stroke: Clinical (To be retired)

Seizures: Clinical (To be retired)

Headaches: Clinical (To be retired)

Traumatic brain injury: Clinical (To be retired)

Neck trauma: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Spinal cord disorders: Pathology review

Anticonvulsants and anxiolytics: Barbiturates

Anticonvulsants and anxiolytics: Benzodiazepines

Nonbenzodiazepine anticonvulsants

Migraine medications

Osmotic diuretics

Antiplatelet medications


Opioid agonists, mixed agonist-antagonists and partial agonists

Opioid antagonists

Pulmonology and thoracic surgery

Asthma: Clinical (To be retired)

Chronic obstructive pulmonary disease (COPD): Clinical (To be retired)

Venous thromboembolism: Clinical (To be retired)

Acute respiratory distress syndrome: Clinical (To be retired)

Pleural effusion: Clinical (To be retired)

Pneumothorax: Clinical (To be retired)

Chest trauma: Clinical (To be retired)

Bronchodilators: Beta 2-agonists and muscarinic antagonists

Pulmonary corticosteroids and mast cell inhibitors

Rheumatology and orthopedic surgery

Joint pain: Clinical (To be retired)

Anatomy clinical correlates: Clavicle and shoulder

Anatomy clinical correlates: Axilla

Anatomy clinical correlates: Arm, elbow and forearm

Anatomy clinical correlates: Wrist and hand

Anatomy clinical correlates: Median, ulnar and radial nerves

Anatomy clinical correlates: Bones, joints and muscles of the back

Anatomy clinical correlates: Hip, gluteal region and thigh

Anatomy clinical correlates: Knee

Anatomy clinical correlates: Leg and ankle

Anatomy clinical correlates: Foot

Acetaminophen (Paracetamol)

Non-steroidal anti-inflammatory drugs


Opioid agonists, mixed agonist-antagonists and partial agonists

Antigout medications


Parathyroid conditions and calcium imbalance: Clinical (To be retired)

USMLE® Step 2 questions

0 / 12 complete


USMLE® Step 2 style questions USMLE

of complete

A 55-year-old female presents to her family physician with pain in the fingers of her right hand. She is mildly confused and is unsure exactly how long she has had this pain. The patient's daughter, who accompanied her mother to the visit, says that the patient has complained about this pain for about a month and has been progressively more confused over the last week. She also says that her mother has been complaining of increased nausea for the last few months. An X-ray of the right hand shows thin bones with brown tumors. Based on the patient's history and symptoms, what is the most likely cause of her condition?


Content Reviewers

Rishi Desai, MD, MPH


Anca-Elena Stefan, MD

There are a number of ways you can measure calcium in the blood.

First, there’s total calcium levels and this is made up of three fractions.

About 40 percent of the calcium is bound to albumin and about 15 percent is bound to minerals and the remaining 45 percent freely circulates the body and it’s called ionized calcium.

Total calcium levels range between 8.5 to 10.5 milligrams per deciliter, while ionized calcium ranges between 4.8 and 5.7 milligrams per deciliter.

When total calcium levels fall below 8.5 milligrams per deciliter, it’s considered hypocalcemia and when total calcium levels rise above 10.5 milligrams per deciliter, it’s considered hypercalcemia.

Okay, let’s start with hypocalcemia.

Individuals with hypocalcemia can be asymptomatic or have symptoms like tetany - which are intermittent muscular spasms - and perioral tingling.

On clinical examination, there may be a positive Chvostek’s sign. That’s when the facial muscles contract in response to tapping the skin over the facial nerve, just 2 centimeters anterior to the ear.

Another sign is the Trousseau sign. That’s where a blood pressure cuff is placed over the individual’s arm and is inflated to a pressure above the systolic blood pressure and is held like that for 3 minutes.

A positive Trousseau sign is when there’s a muscle spasm in the arm and forearm.

Now, the first thing to do in hypocalcemia is redo the lab work to make sure that the reading is accurate.

If hypocalcemia is confirmed, then the next thing is to check albumin levels.

Since most of the total calcium is bound to albumin, any rise or fall in the albumin will affect total calcium levels, leading to pseudohypocalcemia.

Normal albumin levels are 4 milligrams per deciliter and normal total calcium levels are 10 milligrams per deciliter.

For every 1 milligram per deciliter drop in albumin, calcium levels lower by 0.8 milligrams per deciliter. So, based on this, the corrected calcium levels can be calculated.


The parathyroid glands are four small glands in the neck that produce parathyroid hormone (PTH), which plays a major role in regulating calcium in the body. High levels of PTH lead to hyperparathyroidism, whereas low levels can lead to hypoparathyroidism. Hyperparathyroidism leads to an increase in blood calcium levels, resulting in symptoms like fatigue, muscle weakness, bone pain, osteoporosis, and kidney stones.

Hypoparathyroidism leads to a decrease in blood calcium levels. This can cause symptoms like tingling in the fingers and toes, muscle cramps, and seizures. Hyperparathyroidism is treated by surgically removing the overactive parathyroid gland; whereas in hypoparathyroidism, calcium and vitamin D supplementation, and hormone replacement therapy can help manage the symptoms.


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