Quiz 66

Question 1

A 14-year-old female sees you for follow-up after hypercalcemia is found on a chemistry profile obtained during a 5-day episode of vomiting and diarrhea. She is now asymptomatic, but her serum calcium level at this visit is 11.0 mg/dL (N 8.5–10.5). Her aunt underwent unsuccessful parathyroid surgery for hypercalcemia a few years ago.
Which one of the following laboratory findings would suggest a diagnosis other than primary hyperparathyroidism?
(check one)
A. Low 24-hour urine calcium
B. Decreased serum phosphate
C. High-normal to increased serum chloride
D. Elevated alkaline phosphatase
E. Elevated parathyroid hormone

Answer 1

Low 24-hour urine calcium

Low urine 24-hour calcium levels or a low urine calcium to urine creatinine ratio is not characteristic of hyperparathyroidism. This finding should suggest familial hypocalciuric hypercalcemia. The parathyroid hormone level may be mildly elevated.

Parathyroid hormone is elevated in hyperparathyroidism. Serum chloride tends to be high normal or mildly elevated. Alkaline phosphatase may be elevated in more severe cases, while serum phosphate levels tend to be low.

Question 2

semiformed rather than watery stool, fecal leukocytes (not seen in viral gastroenteritis or sprue), and a hospital stay greater than 2 weeks.

Answer 2

Clostridium difficile colitis

The diarrhea of ulcerative colitis usually contains blood and occurs intermittently over a protracted course. Digoxin toxicity is likely to be accompanied by electrocardiographic and laboratory abnormalities,

Question 3

A 63-year-old female with type 2 diabetes mellitus presents to the emergency department with unstable angina. Her blood pressure is 150/90 mm Hg, her pulse rate is 70 beats/min, and her lungs are clear to auscultation.
The patient expresses a preference for conservative (i.e., noninvasive) therapy. In addition to aspirin, which one of the following agents should be administered at this time?

Answer 3

An oral loading dose of clopidogrel should be administered as soon as possible in patients with unstable angina/NSTEMI who are to be treated conservatively. The standard dosage should then be prescribed, to be taken daily for at least 1 month along with aspirin

Question 4

A 25-year-old female has an annular rash on the dorsal surface of both hands. The rash does not respond to initial treatment with an antifungal medication, and a biopsy reveals granuloma annulare.

Granuloma annulare

Answer 4

a self-limited condition. It is not contagious

You should allow the rash to resolve without further treatment

Treatments may include injected or topical corticosteroids, but oral corticosteroids have not been specifically recommended.

Question 5

A 24-year-old female who works at a day-care facility presents to your office to discuss ways to avoid getting “all the infections the kids get.” She plans to enroll her child in the facility. She is specifically concerned about diarrheal illnesses, and a friend has suggested the use of probiotics.

Answer 5

probiotics can lessen the severity and duration of infectious diarrhea

Common side effects include flatulence and abdominal pain. Contraindications include short-gut syndromes and immunocompromised states.

Safe for all ages

Question 6

The 1990 Patient Self-Determination Act requires that:

Answer 6

hospitals ask patients about advance directives

Question 7

Which one of the following would be considered a normal ejection fraction in this patient?
In an echo

Answer 7

65%

The normal predicted value is 55%–75%

Question 8

A 42-year-old asymptomatic female presents for a routine evaluation. On examination her uterus is irregularly enlarged to the size seen at approximately 8 weeks gestation. Pelvic ultrasonography shows several uterine fibroid tumors measuring <5 cm. The patient does not desire future fertility.
Which one of the following would be the most appropriate treatment option?

Answer 8

Observation

Symptoms related to fibroids can include menorrhagia, pelvic pain, obstructive symptoms, infertility, or pregnancy loss.

However, many fibroids are asymptomatic and are discovered incidentally, with expectant management being the treatment of choice in this situation

For women who are symptomatic, the data is insufficient to allow conclusions to be made about the most appropriate therapy.