nbme 2

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nbme 2

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doc-o8
Forum Elite

Topics: 29
Posts: 375

06/11/07 - 07:53 AM

42. A 10-year-old boy is brought to the physician because of weakness and decreased appetite for 3 months. He weighs 30 kg (66 lb) and is 142 cm (56 in) tall; he has had a 2.3-kg (5-lb) weight loss since his last examination 6 months ago. He appears thin. Deep tendon reflexes are brisk. Chvostek's sign is positive. His serum calcium level is 6.5 mg/dL, and serum intact parathyroid hormone level is 190 pg/mL (N=9–65). In addition to calcium supplementation, which of the following is the most appropriate next step in management?
A ) Oral phosphate supplementation
B ) Oral vitamin D supplementation
C ) Intranasal calcitonin therapy
D ) Parenteral bisphosphate therapy
E ) Parenteral parathyroid hormone therapy

B;

ram3
Forum Guru

Topics: 47
Posts: 512

06/13/07 - 02:24 PM

This patient has hypocalcemia this is probably due to hypoparatyroidism there will be prolonged qt interval on the ecg so treatment with vitamin d is the answer

doc-o8
Forum Elite

Topics: 29
Posts: 375

06/14/07 - 04:50 PM

but his parathyroid harmone is ELEVATED. is it still hypoparathyroidism?

doc-o8
Forum Elite

Topics: 29
Posts: 375

06/14/07 - 04:55 PM

no now i got it. B is teh right answer coz of secondary hyperparathyroidism. he should get vit. d.

Adam
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Topics: 6
Posts: 136

06/15/07 - 02:59 AM

B is teh right answer coz of secondary hyperparathyroidism

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ts97
Forum Senior

Topics: 13
Posts: 128

08/06/07 - 10:05 AM

What is the diagnosis?

My answer was A, because I thought he lost a lot of phosphates because of high PH level. He needs vitamin D, but cannot he get it just from going outside?

liliaeliz
Forum Elite

Topics: 38
Posts: 351

08/21/07 - 06:48 AM

b can be pseudohipoparat.decres Ca increase P increase PTH
               chronic failure renal
               rickettsi
                decrease intake vit d
                anticonvulsivant

elitoki
Forum Guru
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Topics: 54
Posts: 508

08/21/07 - 05:38 PM

Answer is B.

Pte has secondary hyperparathyroidism.

PTH/ CALCIUM /PHOSPH/ DX

INCREASE /DECREASE/ DECREASE /SEC HYPERPARATHY

INCREASE /INCREASE /DECREASE/ PRIMARY HYPERPARTHY

NORMAL /NORMAL/ NORMAL /RULE OUT PAGET DISEASE(IN ADULT)

liliaeliz
Forum Elite

Topics: 38
Posts: 351

08/23/07 - 06:55 AM

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