sheeezooo
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45 y/o m ..c/orecurrent kidney stones..serum ca is elevated..serum phosphorus is low and the PTH returns elevated..what is next step?
1.observation with repeat chemistries in 6 months
2.neck exploration
3.MRI of neck
4.repeat PTH levels.
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| saadtazjam
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2???????????
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| study_ing
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we'll need neck exploration for sure. but the q asks for next step. can we go for exploration directly without prior investigation?
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| robin082006
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2
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| tolito
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3.
what does neck exploration mean??? to my mind, the neck is not a place for murking around like the abdomen so you will always need guidance from ct or mri.
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| saadtazjam
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I think that is surgical exploration of the neck.
Here are the indicztions when you chose surgical exploration of the neck as answer
1)young Age <50
2)Serum Ca 1mg above the upper limit of Normal with urinary excretion >50 mg /24 hr
3)Ur Ca exc >400 mg/24 hr
4)Bone mineral density lower than T 2.5 at site
5)Difficulty in following up the patient
Source USMLE world
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| sheena2005
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kool explanation. i will go with exploration too
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| sheeezooo
Forum Guru
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hmm nice..yes right answer is 2..neck exploration..pt with primary hyperparathyroidism and kidney stones require surgical excision of the PTH secreting adenoma.in the abscence of previous head surgery there is no need to visualize the adenoma before surgery.
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if u hold up your head with a smile on your face and are truely thankful,u are blessed because the majority can, but most do not..
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| tolito
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thanks guys
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| study_ing
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thanx a lot ppl, i had remembered this q, yet did not know that u cud operate without imaging 
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