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For the second zone (zone 2), we want to train as close as we can to our anaerobic threshold. A measure to find this point is the highest constant heart rate you can sustain for 15-20 min. The goal of zone 2 is to train your aerobic metabolism to burn energy as fast as it can. Your metabolism then adapts and you burn more energy 24 hours a day. Zone two is the workout that I see that every exerciser skips. Most people either spend all their time in the easy zone 1 or do high intensity training all the time which we are going to talk about next. Working out at the moderately high intensity in zone 2 is essential to training our aerobic metabolism which is our major source of energy all day.

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A nutritarian diet is where you eat more food that is high in nutrients and less food that is lower in nutrients. Dr. Joel Fuhrman, after many years of research, coined the term nutritarian when he came up with the equation H=NC, or health equals nutrients divided by calories in food. Healthier food options are high in nutrients and low in calories so you get a bigger nutritional punch with every calorie you put into your body. It makes the most out of every calorie you eat.


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USMLE - Hypercalcemia | Step 1, Step 2 CK and Step 3
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USMLE – Hypercalcemia

Pathophysiology
1. Abnormally high serum calcium
2. Malignancy related
3. Parathyroid related
4. Vitamin D
5. High bone turnover related
6. Renal failure related

Signs and Symptoms
1. Weakness and fatigue
2. Headaches
3. Constipation
4. Anorexia
5. Vomiting
6. Abdominal pain
7. Depression
8. Confusion and coma
9. Pruritus
10. Polyuria and polydipsia
11. Metastatic soft tissue calcification
12. Bone pain

Characteristic Test Findings
1. Decreased serum phosphorus
2. Increased serum gastrin
3. Abnormal levels of PTH (can be high or low, depending on cause)
4. Presence of parathormone-like substance (if caused by squamous cell carcinoma of lung)
5. Calciuria
6. Calcification of heart valves, lungs, and blood levels on plain films
7. EKG – shortened QT interval

Histology/Gross Pathology
Calcium deposition in renal tubules, blood vessels, and alveolar septa of lung

Associated Conditions
1. Pancreatitis
2. Peptic ulcer disease
3. Nephrolithiasis (kidney stones)
4. Nephrocalcinosis
5. Hypertension

Biochemistry
Malignancy-related hypercalcemia caused by – 1) bone metastases 2) osteoclast activating factors 3) paraneoplastic release of parathormone-like substance

Treatment
1. Hydration
2. Forced diuresis (furosemide)
3. Bisphosphonates such as pamidronate or zoledronate
4. Calcium (blocks bone resorption and increases urinary calcium excretion)
5. Mithramycin (largely replaced by biphosphonates)
6. Dialysis (in renal failure)
7. Glucocorticoids (especially in bone metastases and vitamin D intoxication)
8. Correction of underlying condition (stopping antacids or vitamin D intake)

Tips for the USMLE
1. Think moans, bones, stones, and groans (confusion, bone pain, kidney stones, abdominal pain) – this also applies to hyperparathyroidism
2. If question mentions a high serum calcium and a high serum PTH, think hyperparathyroidism

Lillian Thompson By Lillian Thompson

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