doc179
Forum Guru
Topics: 67
Posts: 1,217
|
A 38-year-old man sees his physician because of abdominal pain, nausea, and constipation for the past 3 days. On physical examination he has no palpable abdominal masses and bowel sounds are present. His lungs are clear to auscultation. He has a heart rate of 80 with an irregular rhythm. An electrocardiogram demonstrates a shortened QT(corrected) interval and a prolonged PR interval. He has a stool positive for occult blood. Upper GI endoscopy reveals multiple 1 cm diameter shallow ulcerations of the gastric antrum. Which of the following laboratory test findings is most likely to be present in this man?
A Thyroid peroxidase antibody of 4 IU/mL
B Serum calcium of 12.4 mg/dL
C Blood glucose of 225 mg/dL
D Total serum thyroxine of 21 ng/mL
E Plasma cortisol of 45 microgm/dL at 8 am
F Urine normetanephrine of 692 microgm/gm of creatinine
G Plasma renin activity (upright) of 6.8 ng/mL/hr
|
| new_n_lost
Politically InCorrect
Topics: 650
Posts: 6,063
|
B Serum calcium of 12.4 mg/dL <<< Hypercalcemia due to Hyperparathyroidism ???
Man this is a good question
___________________
FORUM RULES-- Those who believe in telekinesis, raise my hand. I get enough exercise just by pushing my luck --P4U World.." The pure and simple truth is rarely pure and never simple."
|
| po
Forum Elite
Topics: 39
Posts: 356
|
IS IT C?
|
| Luckyall
Forum Guru
Topics: 11
Posts: 593
|
B) Primary Hyper PTH ? classical sympt Gi disturb constip, gastric ulcers, Cardiac manif
|
| po
Forum Elite
Topics: 39
Posts: 356
|
answer please
|
| Mikeland
Forum Senior
Topics: 24
Posts: 109
|
Answer is B (I think) cuz
there is not Na related problem with ulcer deschart C E G
A is in a normar range but that is not this pathology caused
D Thyroxine course with low or hight HR and with diferent GI problems
and think in pheochromocytoma pt must have more symtomathology with this levels.
Let me know if we are wrong. Really a good Q, boddy.
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
sorry, I was not at home and so could not get back on forum. I will just need sometime to find the qns and their explanations.
|
| doc179
Forum Guru
Topics: 67
Posts: 1,217
|
(A) Incorrect. A positive anti-TPO suggests an autoimmune process such as Hashimoto thyroiditis.
(B) CORRECT. He most likely has a parathyroid adenoma secreting excessive parathormone to increase serum calcium and decrease serum phosphorus. The hypercalcemia leads to increased gastrin production and peptic ulcer disease. Hypercalcemia produces cardiac arrhythmias (or asystole).
(C) Incorrect. Elevated glucose can be seen with Cushing syndrome or diabetes mellitus.
(D) Incorrect. Graves disease can be associated with a thyroxine level this high.
(E) Incorrect. Pituitary adenomas secreting ACTH (or an ectopic source of ACTH) to produce adrenal hyperplasia, or adrenal neoplasms, can cause secretion of excessive cortisol.
(F) Incorrect. Increased urinary catecholamines are seen with pheochromocytoma, which can be associated with hypertension but not gastric ulcerations.
(G) Incorrect. Hyperreninemia may be seen with some forms of renovascular hypertension and with hyperaldosteronism with hypokalemia.
|
|
| |
| | | | | | | | |
