spmvj
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A 48-year-old man comes to your office complaining of wrist pain and numbness of the thumbs and index and middle fingers of both of his hands, which has been worsening over the last 6 months. His only chronic medical condition is “slight hypertension,” for which he is being treated with hydrochlorothiazide. On further questioning the patient states that he has noted progressive coarsening of his facial features, as well as an increase in his shoe size, all of which has continuously worsened. His blood pressure is 145/95 mm Hg, pulse is 95/min, respiration rate is 15/min, and he is afebrile. He has a deep, hollow-sounding voice, and you notice slight prognathism. He is alert and oriented to person, place, and time. Chest auscultation is normal, as is heart examination. The rest of his physical exam is unremarkable. Monitoring with which of the following will help prevent one of the major complications of this condition?
A. Bone density
B.Colonoscopy
C.Prostate specific antigen
D.Thyroid stimulating hormone
E.Prolactin levels
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| starcraftbw
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D
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| suv
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E?
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| gordon
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I will bet on the answer A.
This patient had hypertension, progressive coarsening of his facial features, as well as an increase in his shoe size, which means he has Cushing's syndrome. For any Cushing's you need to monitor the Bone density.
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| Justice
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gordon wrote:
which means he has Cushing's syndrome.
To me this all sounds to be the Paget's disease...
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| Justice
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But agree, we should go with A. Bone density as a fragility of bones constitutes one of the major complications
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| gordon
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Thanks justice for reminder me!
actually I also think about acromegly, if he does have acromegly, we should monitor cardiac failure, blood gluccose (DM) or eyesight (visual field defects) and the bone ( osteoporosis) too. I still pick the answer A.
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| Justice
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I agree, this looks very much like acromegaly... And we could monitore E.Prolactin levels as these Pts vrequently have impotence...
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| suv
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acromegaly so E
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| kpmle2
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B.Colonoscopy
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| kpmle2
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B.Colonoscopy ---acromegaly
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| Doc750
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I pick A
S/E of thiazides is hyperGLUC.
edit ... the thiazide causes an increase in the calcium. But then what is a major complication of hypercalcemia? bone thickening? maybe .. but when they say major complication I'm looking at cardio and renal problems. So in that regard I'm going to switch to D
Edited by Doc750 on 09/22/07 - 11:18 AM
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| spmvj
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The answer is B.Colonoscopy.
This Pt has Acromegaly.Acromegaly is associated with increased risk of colonic polyps &colonic malignancy.Polyps are diagnosed in almost 1/3rd of acromegaly patients.So monitoring with regular colonoscopies is advised in patients who are diagnosed with acromegaly.
Bone density monitoring (choice A) is not necessary because these patients will not have a higher incidence of osteoporosis than the population in general.
Patients with acromegaly have no higher risk than the rest of the population of developing prostate cancer, so PSA monitoring (choice C ) is not recommended in these patients
Thyroid-stimulating hormone (choice D) does not have to be monitored in these patients because their incidence of thyroid disorder is no higher than that of the rest of the population.
Monitoring for hyperprolactinemic states is not necessary(choice E).Treating acromegaly will treat this condition.
congrats kpmle2.
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| starcraftbw
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my answer is close but no ciga
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| Ivonne
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Nice question, thanks spmvj
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