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  #1  
Old 11-28-2012
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Default Bone Mineralization : NBME 2 concept

A 10-year-old boy is brought to the physician
because of
weakness and decreased appetite for 3 months. He
weighs 30 kg (66 lb) and is
142 cm (56 in) tall; he has had a 2.3-kg (5-lb) weight
loss since his
last examination 6 months ago. He appears thin. Deep
tendon reflexes
are brisk. Chvostek's sign is positive. His serum
calcium level is 6.5
mg/dL, and serum intact parathyroid hormone level is
190 pg/mL
(N=965). In addition to calcium supplementation,
which of the following is
the most appropriate next step in management?

A) Oral phosphate supplementation

B) Oral vitamin D supplementation

C) Intranasal calcitonin therapy

D) Parenteral bisphosphate therapy

E) Parenteral parathyroid hormone therapy

Since the question asks most appropriate next step I choose Phosphate supplementation too because only giving Ca is not going to improve Bone demineralization. I dont know how much this rational holds true though
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  #2  
Old 11-29-2012
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Default

B) Oral vitamin D supplementation

Because vitamin D given along with Ca causes better Ca absorption.
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  #3  
Old 11-29-2012
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thats true...Vit. D supplementation is the next best step
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usmle2011 (11-29-2012)



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