nbme 2/32 - diabolic

[ArchivalUser]

32. 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

???

y not calcitonin

[ArchivalUser]

is it.....B ??

[ArchivalUser]

nop, calcitonin can decrease ca level, now ca is already low.

The picture is...weakness and decreased appetite for 3 months...that cause vit D def...low ca absorption from GI.. low serum ca...activate parathyroid....so PTH increase.

So, main defect is low vit D, give B, oral vit D.
This is Secondary hyperparathyroidism...Hope you got it,

[ArchivalUser]

nop, calcitonin can decrease ca level, now ca is already low.

The picture is...weakness and decreased appetite for 3 months...that cause vit D def...low ca absorption from GI.. low serum ca...activate parathyroid....so PTH increase.

So, main defect is low vit D, give B, oral vit D.
This is Secondary hyperparathyroidism...Hope you got it,

[ArchivalUser]

1.his weight and height is less for his age ..has growth retartdation ,any chronic process causing this.
2.calcium is definitely low ,PTH high =secondary hyperparathyroidism
to reduce bone resorption ,BISPHOSPHONATE IS NOT A BAD OPTION ,IN addition to Ca supplementation ..