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Old 10-17-2011
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Sphygmomanometer Wrist pain, increased shoe size, and hypertension

A 48-year-old man comes to your office complaining of wrist pain and numbness of the thumbs and index and middle fingers of both of his hands, which has been worsening over the last 6 months. His only chronic medical condition is “slight hypertension,” for which he is being treated with hydrochlorothiazide. On further questioning the patient states that he has noted progressive coarsening of his facial features, as well as an increase in his shoe size, all of which has continuously worsened. His blood pressure is 145/95 mm Hg, pulse is 95/min, respiration rate is 15/min, and he is afebrile. He has a deep, hollow-sounding voice, and you notice slight prognathism. He is alert and oriented to person, place, and time. Chest auscultation is normal, as is heart examination. The rest of his physical exam is unremarkable. Monitoring with which of the following will help prevent one of the major complications of this condition?

A. Bone density
B. Colonoscopy
C. Prolactin levels
D. Prostate-specific antigen
E. Thyroid-stimulating hormone
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prolactin levels
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Prolactin levels
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its colonoscopy

pt with GH secreating tumours are more prone to collonic cancers than normal population
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Correct Answer

The correct answer is B. Patients with acromegaly are more prone to developing colon cancer than the rest of the population, so monitoring with regular colonoscopies is advised in patients diagnosed with acromegaly.
Bone density monitoring (choice A) is not necessary because these patients will not have a higher incidence of osteoporosis than the population in general.
Prolactin levels (choice C) do not have to be monitored in these patients, even though a patient with a macroadenoma that produces growth hormone and impinges on the pituitary stalk will have a higher level of prolactin than the general population (and can manifest with amenorrhea and galactorrhea in females). Treating acromegaly will treat this condition, however, so monitoring for hyperprolactinemic states is not necessary.
Patients with acromegaly have no higher risk than the rest of the population of developing prostate cancer, so PSA monitoring (choice D) is not recommended in these patients.
Thyroid-stimulating hormone (choice E) does not have to be monitored in these patients because their incidence of thyroid disorder is no higher than that of the rest of the population.
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Endocrinology-, Internal-Medicine-, Step-2-Questions

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