This question really boils down to a calcium question and the choices should be broken down into what causes hypocalcemia and what causes hypercalcemia.
WRONG ANSWERS:
Choice (A) lung cancer was put there because of the distractor in the stem, the possibility of squamous cell lung cancer and the paraneoplastic syndrome associated with hypercalcemia and PTHrp (PTHrp is not measured when you get a PTH level. PTH should be suppressed due to the high calcium levels).
Choice (B) primary hyperparathyroidism is another distractor because the patient has a high PTH level. But when does primary hyperparathyroidism ever cause hypocalcemia? Never!
Choice (D) thyroidectomy done by a sloppy surgeon can sometimes cause hypocalcemia due to the inadvertant removal of the parathyroid glands. This would indeed cause hypocalcemia, but, PTH would NEVER be elevated.
Choice (E) plasma cell infiltration of the bone marrow referred to multiple myeloma, which is in the differential diagnosis of HYPERcalcemia. PTH would be suppressed.
ANSWER:
Choice (C) renal failure is the answer because it is the only choice that can cause hyperphosphatemia, hypocalcemia and elevated PTH. The history of diabetes is subltly included but it is not necessary to answer this question. I used to get confused with renal disease until I boiled it down to, "don't give chronic renal failure patients Coca Cola." The main problem with calcium in renal failure is due to the high phosphate levels that the kidneys can't get rid of. The phosphate and the calcium combine in the blood. This lowers the calcium. The parathyroids go into panic mode and try to raise calcium by destroying the bones (osteitis fibrosa cystica).
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Can you please explain exactly what you mean by "dont give patients Coca Cola." thanks.
ReplyDeleteCoca Cola has a high phosphate content, which is trouble for renal failure patients.
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