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to pacemaker,
can you explain why choise of D is correct for this following qustion,please.
tnx in advance.
A 64-year-old woman comes
#273637
pacemaker - 02/24/08 20:34
A 64-year-old woman comes for a follow-up visit after an episode of kidney stones 2 weeks ago. During the episode, she went to the emergency department and was treated with nonsteroidal anti-inflammatory drugs and fluids. Spiral abdominal CT performed at that time revealed a 3-mm nonobstructing calculus in the midleft ureter. She also has osteoporosis.
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sorry Guys,i thot i clicked on b(refer for parathyroidectomy)
I APOLOGISE !
I messed it up while posting the choices.
following r the choices.
Which of the following is the most appropriate management for this patient's kidney stones?
A Decrease dietary calcium to <1 g/d
B Refer for parathyroidectomy
C Refer for stone removal
D Initiate potassium citrate therapy
E Observe
Answer and Critique (Correct Answer = B)
Key Points
* Asymptomatic hypercalcemia in a patient with a history of calcium stones warrants evaluation for primary hyperparathyroidism.
* Parathyroidectomy should be considered for patients with calcium-containing stones secondary to primary hyperparathyroidism.
The most appropriate management for this patient is referral for parathyroidectomy. Approximately 20% of patients with primary hyperparathyroidism have calcium-containing stones due to hypercalciuria and hyperphosphaturia. Her clinical signs and symptoms of hyperparathyroidism include hypercalcemia, renal insufficiency, and underlying osteoporosis and warrant referral for parathyroidectomy rather than bisphosphonate or estrogen therapy or observation.
Decreasing dietary intake of calcium may temporarily affect the hypercalcemia but is contraindicated in the long term because of her osteoporosis. Stone removal is not indicated because there is no evidence of obstruction, and stones <5 mm in diameter typically can pass without surgical intervention. Alkalization of the urine with citrate therapy is recommended to decrease the solubility of uric acid or to correct hypocitraturia that predisposes patients to calcium-forming stones. However, this therapy does not prevent recurrent stone disease in primary hyperparathyroidism.
