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Old 06-12-2012
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Question Asymptomatic Alkaline Phosphatase Elevation!

A 56-year-old man is admitted to the hospital for elective cardiac
bypass surgery.
As part of his preoperative evaluation, you note an elevated
alkaline phosphatase. The other liver function studies are within
normal limits. Serum calcium and phosphate are within normal
limits. The patient denies any history of bone pain, and the
physical examination is normal. What is the next step in the
management of this patient?
(A) Obtain a radiologic bone survey
(B) Order a nuclear bone scan
(C) Begin risedronate orally
(D) Order a 24-hour urine test for hydroxyproline
(E) Begin intranasal calcitonin

dont have gud expln for this.
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Old 06-12-2012
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its B.

⬆ Alkaline phosphatase algorithm from kaplan
since they told us that liver source is ruled out then we have to investigate bone source for Paget/'s disease
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Old 06-13-2012
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Quote:
Originally Posted by neoeinstein View Post
its B.

⬆ Alkaline phosphatase algorithm from kaplan
since they told us that liver source is ruled out then we have to investigate bone source for Paget/'s disease
ans is indeed bone scan.
the image u post, is this from new kaplan notes. i have old and i know its not there.

why bone scan?
qbank says suspect this patient for pagets and so order bone scan.
why not risedronate? because he is asymptomatic. risedronate is given in pagets when patient is symptomatic or have cranial nerve compressions!!! i loved this fact. i picked risedronate.
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Old 06-13-2012
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Quote:
Originally Posted by tyagee View Post
ans is indeed bone scan.
the image u post, is this from new kaplan notes. i have old and i know its not there.

why bone scan?
qbank says suspect this patient for pagets and so order bone scan.
why not risedronate? because he is asymptomatic. risedronate is given in pagets when patient is symptomatic or have cranial nerve compressions!!! i loved this fact. i picked risedronate.
its in kaplan qbank. i noticed its not in mtbck, FACK nor KLN(red one) so i grabbed it.
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Quote:
Originally Posted by tyagee View Post
why not risedronate? because he is asymptomatic. risedronate is given in pagets when patient is symptomatic or have cranial nerve compressions!!! i loved this fact. i picked risedronate.
bisphosphanates are used in hypercalcemia. Here the patients calcium is normal.
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