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  #1  
Old 08-18-2012
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Question Most appropriate.. Most effective.. Most likely???

Q-1 :

A 50-year-old woman is admitted for urinary tract infection, complicated by profound weakness, abdominal pain, vomiting, and diarrhea. Her temperature is 40.0 C (104 F), blood pressure is 90/60 mm Hg, pulse is 1I0/min, and respirations are I8/min. Examination reveals signs of dehydration and skin hyperpigmentation over the elbows and knees. Urinalysis shows pyuria. Laboratory studies show hyponatremia, hyperkalemia, and hypoglycemia. Complete blood count is remarkable for eosinophilia. While waiting for the results of urine and blood cultures, intravenous corticosteroids, broadspectrum antibiotics, and volume replacement therapy is instituted. In addition to such treatment, which of the following is the most appropriate next step?

(A) Cortisol level
(B) Cosyntropin stimulation test
( C) IV mineralocorticoids
(D) Oral corticosteroids
(E) Renal ultrasonography

Q-2 :

A 55-year-old alcoholic man is brought to the emergency department by the police after being found wandering and mumbling to himself. The man is unable to give a coherent history. The initial impression is of an emaciated, jaundiced, and confused man who appears older than his stated age. Vital signs are stable and within normal limits. The breath has a musty, sweet odor. Abdominal examination shows ascites and marked nodularity of the liver edge. A "caput medusa" is seen near the umbilicus. Neurologic examination is notable for asterixis. A toxicology screen is negative. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and blood ammonia are all moderately increased. The man is admitted to the hospital and given an extremely low protein diet with oral carbohydrate supplementation. The bowels are cleared with an enema. Which of the following is the most appropriate pharmacotherapy?

(A) Ampicillin, oral
(B) Benzathine penicillin, intramuscular
(C) Ceftriaxone, oral
(D) Neomycin, oral
(E) Penicillin G, N

Q-3:

A 58-year-old man with a I2-year history of type 2 diabetes mellitus comes to the physician because of an ulcer in his right foot. Physical examination reveals a 1- cm irregular ulceration over the right metatarsal head, surrounded by an area of black gangrenous skin. The patient is admitted to the hospital and undergoes amputation of the right forefoot. Which of the following measures would have been most effective in preventing this complication?

(A) Appropriate instructions on self-care of the feet
(B) Doppler examination of the lower extremities
(C) Neurophysiologic and electromyographic studies
(D) Local application of platelet-derived growth factor
(E) Prophylactic treatment with cholesterol-lowering
Agents

Q-4:

A 25-year-old man with acute myelogenous leukemia is undergoing chemotherapy. One week after his therapy, he presents with a headache, fever, and confusion. On physical examination, he has nuchal rigidity, Kernig sign, and photophobia. Laboratory results are notable for a white count of 1000 mm3, hematocrit of 25%, and a differential of 10% neutrophils and 5% lymphocytes. Lumbar puncture is consistent with meningitis. Which of the following is the most likely pathogen?

(A) Bacteroides fragilis
(B) Haemophilus inJl.uenzae
(C) Pseudomonas aeruginosa
(D) Staphylococcus aureus
(E) Toxoplasma gondii

Q-5:

A recently widowed 35-year-old woman who has an anxiety disorder, for which she has been treated with alprazolam and imipramine, is brought to the emergency department for a multiple drug overdose. Her daughter states that she may have taken 30-40 tablets of SO-mg imipramine and 35-40 tablets of I-mg alprazolam. On route to the hospital, she became apneic and was intubated. Her blood pressure is 130/84 mm Hg, and her pulse is I20/min. The patient is unresponsive to painful stimuli, and her pupils react very sluggishly, but there are no other neurologic findings. The ECG shows a normal sinus rhythm with a widened QRS complex. Which of the following is the most appropriate intervention?

(A) DC cardioversion
(B) Flumazenil
(C) Ipecac
(D) Lidocaine bolus
(E) Maintenance of serum pH at 7.5

Q-6:

Thirty-six hours after surgical removal of a large parathyroid adenoma, a 50-year-old man becomes irritable and develops a tingling sensation around his mouth and in his hands. Facial spasm can be easily triggered by tapping in front of the ear. Laboratory studies show:
Blood, serum:
Albumin 4.0 g/dL
Bicarbonate 25 mEq/L
Calcium 7.1 mg/dL
Phosphorus 7.5 mg/dL
Magnesium 1.8 rnEq/L
Arterial blood (room air):
pH 7.40
P02 90 mm Hg
PC02 42mmHg

Which of the following is the most likely cause of this condition?

(A) Atrophy of the remaining parathyroids
(B) Hungry bone syndrome
(C) Hyperventilation syndrome
(D) Magnesium deficiency
(E) Metastatic parathyroid carcinoma
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The above post was thanked by:
doc s.j (12-20-2012)



  #2  
Old 08-18-2012
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Default

1.b
2.d
3. a
4. dont know
5. A or E -> im E assuming since therapy is supposed to with Sodium Bicarbonate :\
6. A
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  #3  
Old 08-18-2012
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Default my answers

1)....c
2)....d
3)....a
4)....c
5)....b
6)....a
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  #4  
Old 08-18-2012
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Quote:
Originally Posted by heartbeat View Post
Q-1 :

A 50-year-old woman is admitted for urinary tract infection, complicated by profound weakness, abdominal pain, vomiting, and diarrhea. Her temperature is 40.0 C (104 F), blood pressure is 90/60 mm Hg, pulse is 1I0/min, and respirations are I8/min. Examination reveals signs of dehydration and skin hyperpigmentation over the elbows and knees. Urinalysis shows pyuria. Laboratory studies show hyponatremia, hyperkalemia, and hypoglycemia. Complete blood count is remarkable for eosinophilia. While waiting for the results of urine and blood cultures, intravenous corticosteroids, broadspectrum antibiotics, and volume replacement therapy is instituted. In addition to such treatment, which of the following is the most appropriate next step?

(A) Cortisol level
(B) Cosyntropin stimulation test
( C) IV mineralocorticoids
(D) Oral corticosteroids
(E) Renal ultrasonography

Q-2 :

A 55-year-old alcoholic man is brought to the emergency department by the police after being found wandering and mumbling to himself. The man is unable to give a coherent history. The initial impression is of an emaciated, jaundiced, and confused man who appears older than his stated age. Vital signs are stable and within normal limits. The breath has a musty, sweet odor. Abdominal examination shows ascites and marked nodularity of the liver edge. A "caput medusa" is seen near the umbilicus. Neurologic examination is notable for asterixis. A toxicology screen is negative. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and blood ammonia are all moderately increased. The man is admitted to the hospital and given an extremely low protein diet with oral carbohydrate supplementation. The bowels are cleared with an enema. Which of the following is the most appropriate pharmacotherapy?

(A) Ampicillin, oral
(B) Benzathine penicillin, intramuscular
(C) Ceftriaxone, oral
(D) Neomycin, oral
(E) Penicillin G, N

Q-3:

A 58-year-old man with a I2-year history of type 2 diabetes mellitus comes to the physician because of an ulcer in his right foot. Physical examination reveals a 1- cm irregular ulceration over the right metatarsal head, surrounded by an area of black gangrenous skin. The patient is admitted to the hospital and undergoes amputation of the right forefoot. Which of the following measures would have been most effective in preventing this complication?

(A) Appropriate instructions on self-care of the feet
(B) Doppler examination of the lower extremities
(C) Neurophysiologic and electromyographic studies
(D) Local application of platelet-derived growth factor
(E) Prophylactic treatment with cholesterol-lowering
Agents

Q-4:

A 25-year-old man with acute myelogenous leukemia is undergoing chemotherapy. One week after his therapy, he presents with a headache, fever, and confusion. On physical examination, he has nuchal rigidity, Kernig sign, and photophobia. Laboratory results are notable for a white count of 1000 mm3, hematocrit of 25%, and a differential of 10% neutrophils and 5% lymphocytes. Lumbar puncture is consistent with meningitis. Which of the following is the most likely pathogen?

(A) Bacteroides fragilis
(B) Haemophilus inJl.uenzae
(C) Pseudomonas aeruginosa
(D) Staphylococcus aureus
(E) Toxoplasma gondii

Q-5:

A recently widowed 35-year-old woman who has an anxiety disorder, for which she has been treated with alprazolam and imipramine, is brought to the emergency department for a multiple drug overdose. Her daughter states that she may have taken 30-40 tablets of SO-mg imipramine and 35-40 tablets of I-mg alprazolam. On route to the hospital, she became apneic and was intubated. Her blood pressure is 130/84 mm Hg, and her pulse is I20/min. The patient is unresponsive to painful stimuli, and her pupils react very sluggishly, but there are no other neurologic findings. The ECG shows a normal sinus rhythm with a widened QRS complex. Which of the following is the most appropriate intervention?

(A) DC cardioversion
(B) Flumazenil
(C) Ipecac
(D) Lidocaine bolus
(E) Maintenance of serum pH at 7.5

Q-6:

Thirty-six hours after surgical removal of a large parathyroid adenoma, a 50-year-old man becomes irritable and develops a tingling sensation around his mouth and in his hands. Facial spasm can be easily triggered by tapping in front of the ear. Laboratory studies show:
Blood, serum:
Albumin 4.0 g/dL
Bicarbonate 25 mEq/L
Calcium 7.1 mg/dL
Phosphorus 7.5 mg/dL
Magnesium 1.8 rnEq/L
Arterial blood (room air):
pH 7.40
P02 90 mm Hg
PC02 42mmHg

Which of the following is the most likely cause of this condition?

(A) Atrophy of the remaining parathyroids
(B) Hungry bone syndrome
(C) Hyperventilation syndrome
(D) Magnesium deficiency
(E) Metastatic parathyroid carcinoma
1)Cortisol level or IV mineralo..i will go with cortisol levels as iv corticosteroids already do the work of maintaining BP
2)Neomycin
3)Foot care instructions
4)Toxoplasma
5)tough one i think protect the heart.. Ph 7.5
6)hungry bone syndrome
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  #5  
Old 08-18-2012
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Default

1.a
2.d
3.a
4.c
5.e
6.a
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  #6  
Old 08-18-2012
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Quote:
Originally Posted by heartbeat View Post
q-1 :

a 50-year-old woman is admitted for urinary tract infection, complicated by profound weakness, abdominal pain, vomiting, and diarrhea. Her temperature is 40.0 c (104 f), blood pressure is 90/60 mm hg, pulse is 1i0/min, and respirations are i8/min. Examination reveals signs of dehydration and skin hyperpigmentation over the elbows and knees. Urinalysis shows pyuria. Laboratory studies show hyponatremia, hyperkalemia, and hypoglycemia. Complete blood count is remarkable for eosinophilia. While waiting for the results of urine and blood cultures, intravenous corticosteroids, broadspectrum antibiotics, and volume replacement therapy is instituted. In addition to such treatment, which of the following is the most appropriate next step?

(a) cortisol level
(b) cosyntropin stimulation test
( c) iv mineralocorticoids
(d) oral corticosteroids
(e) renal ultrasonography

q-2 :

a 55-year-old alcoholic man is brought to the emergency department by the police after being found wandering and mumbling to himself. The man is unable to give a coherent history. The initial impression is of an emaciated, jaundiced, and confused man who appears older than his stated age. Vital signs are stable and within normal limits. The breath has a musty, sweet odor. Abdominal examination shows ascites and marked nodularity of the liver edge. A "caput medusa" is seen near the umbilicus. Neurologic examination is notable for asterixis. A toxicology screen is negative. Aspartate aminotransferase (ast), alanine aminotransferase (alt), and blood ammonia are all moderately increased. The man is admitted to the hospital and given an extremely low protein diet with oral carbohydrate supplementation. The bowels are cleared with an enema. Which of the following is the most appropriate pharmacotherapy?

(a) ampicillin, oral
(b) benzathine penicillin, intramuscular
(c) ceftriaxone, oral
(d) neomycin, oral
(e) penicillin g, n

q-3:

a 58-year-old man with a i2-year history of type 2 diabetes mellitus comes to the physician because of an ulcer in his right foot. Physical examination reveals a 1- cm irregular ulceration over the right metatarsal head, surrounded by an area of black gangrenous skin. The patient is admitted to the hospital and undergoes amputation of the right forefoot. Which of the following measures would have been most effective in preventing this complication?

(a) appropriate instructions on self-care of the feet
(b) doppler examination of the lower extremities
(c) neurophysiologic and electromyographic studies
(d) local application of platelet-derived growth factor
(e) prophylactic treatment with cholesterol-lowering
agents

q-4:

a 25-year-old man with acute myelogenous leukemia is undergoing chemotherapy. One week after his therapy, he presents with a headache, fever, and confusion. On physical examination, he has nuchal rigidity, kernig sign, and photophobia. Laboratory results are notable for a white count of 1000 mm3, hematocrit of 25%, and a differential of 10% neutrophils and 5% lymphocytes. Lumbar puncture is consistent with meningitis. Which of the following is the most likely pathogen?

(a) bacteroides fragilis
(b) haemophilus injl.uenzae
(c) pseudomonas aeruginosa
(d) staphylococcus aureus
(e) toxoplasma gondii

q-5:

a recently widowed 35-year-old woman who has an anxiety disorder, for which she has been treated with alprazolam and imipramine, is brought to the emergency department for a multiple drug overdose. Her daughter states that she may have taken 30-40 tablets of so-mg imipramine and 35-40 tablets of i-mg alprazolam. On route to the hospital, she became apneic and was intubated. Her blood pressure is 130/84 mm hg, and her pulse is i20/min. The patient is unresponsive to painful stimuli, and her pupils react very sluggishly, but there are no other neurologic findings. The ecg shows a normal sinus rhythm with a widened qrs complex. Which of the following is the most appropriate intervention?

(a) dc cardioversion
(b) flumazenil
(c) ipecac
(d) lidocaine bolus
(e) maintenance of serum ph at 7.5

q-6:

thirty-six hours after surgical removal of a large parathyroid adenoma, a 50-year-old man becomes irritable and develops a tingling sensation around his mouth and in his hands. Facial spasm can be easily triggered by tapping in front of the ear. Laboratory studies show:
Blood, serum:
Albumin 4.0 g/dl
bicarbonate 25 meq/l
calcium 7.1 mg/dl
phosphorus 7.5 mg/dl
magnesium 1.8 rneq/l
arterial blood (room air):
Ph 7.40
p02 90 mm hg
pc02 42mmhg

which of the following is the most likely cause of this condition?

(a) atrophy of the remaining parathyroids
(b) hungry bone syndrome
(c) hyperventilation syndrome
(d) magnesium deficiency
(e) metastatic parathyroid carcinoma

1.a
2.d
3.a
4.c
5.e
6.a
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  #7  
Old 08-20-2012
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Correct Answer

Quote:
Originally Posted by heartbeat View Post
Q-1 :

A 50-year-old woman is admitted for urinary tract infection, complicated by profound weakness, abdominal pain, vomiting, and diarrhea. Her temperature is 40.0 C (104 F), blood pressure is 90/60 mm Hg, pulse is 1I0/min, and respirations are I8/min. Examination reveals signs of dehydration and skin hyperpigmentation over the elbows and knees. Urinalysis shows pyuria. Laboratory studies show hyponatremia, hyperkalemia, and hypoglycemia. Complete blood count is remarkable for eosinophilia. While waiting for the results of urine and blood cultures, intravenous corticosteroids, broadspectrum antibiotics, and volume replacement therapy is instituted. In addition to such treatment, which of the following is the most appropriate next step?

(A) Cortisol level
(B) Cosyntropin stimulation test
( C) IV mineralocorticoids
(D) Oral corticosteroids
(E) Renal ultrasonography

Q-2 :

A 55-year-old alcoholic man is brought to the emergency department by the police after being found wandering and mumbling to himself. The man is unable to give a coherent history. The initial impression is of an emaciated, jaundiced, and confused man who appears older than his stated age. Vital signs are stable and within normal limits. The breath has a musty, sweet odor. Abdominal examination shows ascites and marked nodularity of the liver edge. A "caput medusa" is seen near the umbilicus. Neurologic examination is notable for asterixis. A toxicology screen is negative. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and blood ammonia are all moderately increased. The man is admitted to the hospital and given an extremely low protein diet with oral carbohydrate supplementation. The bowels are cleared with an enema. Which of the following is the most appropriate pharmacotherapy?

(A) Ampicillin, oral
(B) Benzathine penicillin, intramuscular
(C) Ceftriaxone, oral
(D) Neomycin, oral
(E) Penicillin G, N

Q-3:

A 58-year-old man with a I2-year history of type 2 diabetes mellitus comes to the physician because of an ulcer in his right foot. Physical examination reveals a 1- cm irregular ulceration over the right metatarsal head, surrounded by an area of black gangrenous skin. The patient is admitted to the hospital and undergoes amputation of the right forefoot. Which of the following measures would have been most effective in preventing this complication?

(A) Appropriate instructions on self-care of the feet
(B) Doppler examination of the lower extremities
(C) Neurophysiologic and electromyographic studies
(D) Local application of platelet-derived growth factor
(E) Prophylactic treatment with cholesterol-lowering
Agents

Q-4:

A 25-year-old man with acute myelogenous leukemia is undergoing chemotherapy. One week after his therapy, he presents with a headache, fever, and confusion. On physical examination, he has nuchal rigidity, Kernig sign, and photophobia. Laboratory results are notable for a white count of 1000 mm3, hematocrit of 25%, and a differential of 10% neutrophils and 5% lymphocytes. Lumbar puncture is consistent with meningitis. Which of the following is the most likely pathogen?

(A) Bacteroides fragilis
(B) Haemophilus inJl.uenzae
(C) Pseudomonas aeruginosa
(D) Staphylococcus aureus
(E) Toxoplasma gondii

Q-5:

A recently widowed 35-year-old woman who has an anxiety disorder, for which she has been treated with alprazolam and imipramine, is brought to the emergency department for a multiple drug overdose. Her daughter states that she may have taken 30-40 tablets of SO-mg imipramine and 35-40 tablets of I-mg alprazolam. On route to the hospital, she became apneic and was intubated. Her blood pressure is 130/84 mm Hg, and her pulse is I20/min. The patient is unresponsive to painful stimuli, and her pupils react very sluggishly, but there are no other neurologic findings. The ECG shows a normal sinus rhythm with a widened QRS complex. Which of the following is the most appropriate intervention?

(A) DC cardioversion
(B) Flumazenil
(C) Ipecac
(D) Lidocaine bolus
(E) Maintenance of serum pH at 7.5

Q-6:

Thirty-six hours after surgical removal of a large parathyroid adenoma, a 50-year-old man becomes irritable and develops a tingling sensation around his mouth and in his hands. Facial spasm can be easily triggered by tapping in front of the ear. Laboratory studies show:
Blood, serum:
Albumin 4.0 g/dL
Bicarbonate 25 mEq/L
Calcium 7.1 mg/dL
Phosphorus 7.5 mg/dL
Magnesium 1.8 rnEq/L
Arterial blood (room air):
pH 7.40
P02 90 mm Hg
PC02 42mmHg

Which of the following is the most likely cause of this condition?

(A) Atrophy of the remaining parathyroids
(B) Hungry bone syndrome
(C) Hyperventilation syndrome
(D) Magnesium deficiency
(E) Metastatic parathyroid carcinoma
ANSWERS
Q-1 :
The correct answer is A. This patient probably has acute adrenal insufficiency, or adrenal crisis. Measurement of serum cortisol will verify the likely diagnosis (cortisol levels would normally be increased following the stress of surgery). Adrenal insufficiency occurs in patients with latent Addison disease who have stress due to events such as surgery, infections, or severe trauma. Other common situations that may precipitate an adrenal crisis include bilateral adrenalectomy, removal of a cortical adenoma that has suppressed the normal gland, and abrupt cessation of exogenous corticosteroid therapy. Withdrawal of corticosteroid treatment should be carried out by gradually tapering the doses. Acute adrenal insufficiency is characterized by signs and symptoms similar to Addison disease, but manifesting with dramatic severity. Indeed, this is a life-threatening condition requmng emergency administration of IV hydrocortisone (100-300 mg), lest the patient develop irreversible shock. Naturally, fluid infusion should be concomitantly administered, and treatment of the underlying cause (in this case, infection) carried out. The cosyntropin stimulation test (choice B) is used to confirm a diagnosis. However, when the clinical picture is so severe, as in this example, hydrocortisone treatment takes precedence over diagnostic confirmation. IV mineralocorticoids (choice C) are not necessary when such large doses of hydrocortisone are administered, as glucocorticoids also have mineralocorticoid activity. Oral corticosteroids (choice D) would not be appropriate
in a medical emergency such as adrenal crisis. They are used once the patient's condition has stabilized. Furthermore, patients in adrenal crisis most often are unable to take anything by mouth because of nausea
and vomiting

Q-2 :
The correct answer is D. This patient has hepatic encephalopathy (hepatic coma, portal-systemic encephalopathy), which is a neuropsychiatric syndrome caused by liver disease. It is usually associated with portal- systemic shunting of venous blood, which can cause esophageal varices and dilation of veins near the umbilicus ("caput medusa"). The diagnosis is usually made on clinical, rather than laboratory, grounds, since liver function tests correlate poorly. Serum ammonia level is usually elevated, but specific values correlate poorly with clinical status. Therapy is based on removing sources of nitrogen (e.g., protein) in the gut by enema, restriction of dietary protein, and reduction of bacterial load (since some bacteria produce ammonia). Two different strategies are commonly used for reducing the bacterial load: orallactulose, which acts as an osmotic cathartic to "wash the bacteria out," and oral neomycin (a poorly absorbed aminoglycoside), which can be used to kill most of the bacteria while minimizing significant systemic side effects. (Oral neomycin is also sometimes used as part of bowel preparation prior to abdominal surgery.) Other types and routes of administration of

Q-3 :
The correct answer is A. Diabetic patients are particularly prone to gangrene of the feet. Sensory loss due to peripheral neuropathy, small vessel disease leading to ischemia, and secondary infections are the pathogenetic factors underlying this pathology. In addition to strict glycemic control to prevent vascular and neurologic complications, the most effective method of prevention is self-care. The patient should receive instructions on daily foot self-examination (to look for abrasions and blisters), wearing appropriate shoes, cutting toenails straight across, and avoiding barefoot walking.

Q-4 :
The correct answer is C. The patient is neutropenic with an absolute neutrophil count (ANe) of 100 (1000 x 10%). He has symptoms of meningitis. By definition, a patient with an ANC less than 500 is neutropenic. Such patients are susceptible to gram-negative bacteria, such as Pseudomonas, and would be treated with IV ceftazidime.

Q-5:
The correct answer is E. Any unknown overdose with QT prolongation on ECG should raise the suspicion of tricyclic antidepressant (TCA) overdose. We know that the patient ingested both TCAs and benzodiazepines in overdose amounts. The ECG changes (QRS widening) are signs of TCA intoxication. The treatment is to maintain an alkalemic state, by hyperventilation if the patient is intubated or with IV bicarbonate. Gastric aspiration and lavage should be performed to eliminate unabsorbed drug if more than 750 mg ofTCA has been taken. Seizures may occur in TCA overdose, but this patient also took an overdose of a benzodiazepine, which is likely suppressing the seizures.

Q-6 :
The correct answer is A. Low calcium and high phosphorus levels, combined with the characteristic manifestations of hypocalcemia (muscle spasms and perioralparesthesias), are characteristic of hypoparathyroidism.This often occurs as a transient postoperative manifestation following removal of a large parathyroid adenoma, which had previously caused atrophy of the remaining normal glands. Hypocalcemia must be treated with calcium gluconate soon after surgery,followed by oral calcium and vitamin D administration.Hungry bone syndrome (choice B) develops days or weeks following resection of a parathyroid adenoma because of avid calcium uptake by a previously demineralized bone. However, since PTH returns to normal levels as the normal glands become functional again, hypocalcemia is not associated with hyperphosphatemia, as in this case. Hungry bone syndrome is the main reason patients require calcium and vitamin D supplementation for months after surgery.
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  #8  
Old 08-20-2012
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why not answer B for 5 question????

the patient is apneic and intubated due to respiratory depressant effects of alprazolam so why not flumazenil to reverse its effects?????

also patients BP and PR seems ok for me with a normal sinus rhythm with just wide QRS interval....

any1 who can help me with this????
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