Test 42

Question 1

Hyperparathyroidism

Answer 1

Chronic kidney disease is associated with phosphate retention, reduced free serum calcium levels, and decreased 1,25-dihydroxyvitamin D levels. This leads to a compensatory rise in parathyroid hormone (PTH) levels (secondary hyperparathyroidism). Over time, this can lead to autonomous PTH secretion (tertiary hyperparathyroidism). Indications for parathyroidectomy in tertiary hyperparathyroidism include persistent hypercalcemia or hyperphosphatemia, very high PTH levels, soft tissue calcification or calciphylaxis, and intractable bone pain.

Question 2

Treatment adherence

Answer 2

Smoking cessation is difficult if the smoker remains subject to environmental triggers, including having friends and family who continue to smoke. Patients who want their children to stop smoking should be encouraged and given assistance to quit themselves.

Question 3

Adverse drug reaction

Answer 3

Anticholinergic medications such as IV diphenhydramine or benztropine are the drugs of choice for immediate treatment of Metoclopramide -induced acute dystonia.

Question 4

Tremor

Answer 4

Benign essential tremors or familial tremors generally do not cause significant disabilities or neurological problems in patients. Most patients with this disease have a normal life expectancy.

Question 5

Tremor

Answer 5

Beta-blockers are the first-line agents for symptomatic treatment of patients with benign essential or familial tremor.

Question 6

Hyperglycemic hyperosmolar nonketotic syndrome

Answer 6

Aggressive volume resuscitation is necessary in patients with a hyperosmolar hyperglycemic state (HHS), since they are generally severely volume depleted. Intravenous insulin should be started after the patient has been partially resuscitated. Aggressive management of hyperkalemia should be avoided in these patients since these patients generally have a total body potassium deficit.

Question 7

Acute respiratory failure

Answer 7

Critically ill patients who are unstable with significant hypoxemia require rapid-sequence intubation for ventilatory support and/or airway protection. After initial stabilization of the airway, patients may be appropriately assessed for the underlying etiology of acute respiratory failure.

Question 8

Delirium

Answer 8

Neuropsychiatric symptoms (apathy, agitation, delusions, hallucinations) are common with both advanced Alzheimer disease and dementia; however, sudden changes and rapid fluctuations in consciousness are not expected with progressive dementia and require urgent evaluation for delirium, a medical emergency.

Question 9

Chronic kidney disease

Answer 9

Conservative management (nondialytic management) is appropriate in patients with chronic kidney disease who have poor functional status and low quality of life. In these patients, dialysis is unlikely to improve symptoms or prolong survival.

Question 10

Decision making capacity

Answer 10

Involuntary sterilization of patients, particularly those with intellectual disabilities, is unethical due to the violation of reproductive rights and bodily integrity. Patients must freely consent to sterilization, and legal guardians or appointed health care decision-makers cannot consent on a patient’s behalf.