05-14-2011, 09:41 AM
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
the answer is D.
but i can't figure out the diagnosis... it is not primary hypoparathyroidism, PTH here is even elevated... what is diagnosis?
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
the answer is D.
but i can't figure out the diagnosis... it is not primary hypoparathyroidism, PTH here is even elevated... what is diagnosis?