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Category: Critical Care Medicine-Endocrine Disorders--->Parathyroid and Calcium
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Question 1# Print Question

A 58-year-old female with history of end-stage renal disease and hyperthyroidism is admitted to the intensive care unit after a complicated total thyroidectomy with reimplantation of parathyroid glands. Intravenous calcium supplementation is initiated. However, the patient continues to fail her spontaneous breathing trials with inadequate tidal volumes and negative inspiratory force (NIF) of −20 mm Hg. Labs on postoperative day 4 showed continued hypocalcemia despite supplementation and normal parathyroid hormone (PTH) levels.

Which of the following statement regarding her condition is NOT correct?

A. The syndrome most often occurs in patients with chronic increase in bone resorption induced by high levels of PTH
B. Patients often present with hypocalcemia, hypophosphatemia, hypomagnesemia, and hypokalemia
C. Sudden withdrawal of PTH causes an imbalance between osteoblast-mediated bone formation and osteoclast-mediated bone resorption
D. It can occur despite normal or even elevated levels of PTH

Question 2# Print Question

Which of the following is NOT a symptom of acute hypoparathyroidism?

A. Focal seizure
B. Laryngospasm
C. PR interval prolongation
D. Anxiety

Question 3# Print Question

Which of the following medications may mimic hyperparathyroidism?

A. Lithium
B. Haloperidol
C. Clozapine
D. Spironolactone

Question 4# Print Question

A previously healthy 62-year-old female is admitted to the intensive care unit for airway watch after sustaining numerous rib fractures in a motor vehicle accident. On additional workup, she is noted to have mild hypercalcemia of 11.5 mg/dL (normal 8.9-10.1 mg/dL) and mildly elevated PTH of 124 pg/mL (normal 10-65 pg/mL). Review of her CT scans demonstrates mild-moderate osteoporosis and bilateral nephrocalcinosis.

Which of the following is the recommended management for this patient’s hyperparathyroidism?

A. Alendronate
B. Vitamin D supplementation
C. Cinacalcet
D. Parathyroidectomy

Question 5# Print Question

A 55-year-old male patient arrives to the emergency department complaining of worsening fatigue, vomiting, and weight loss over the last 2 weeks. A basic metabolic panel demonstrates the following:

  • Sodium 148 mEq/L
  • potassium 3.1 mEq/L
  • chloride 112 mEq/L
  • bicarbonate 18 mEq/L
  • BUN 38 mg/dL
  • creatinine 1.8 mEq/L
  • glucose 98 mg/dL
  • calcium 14 mg/dL

What is the best next step in management?

A. Aggressive fluid bolus of 0.9% NaCl
B. Administration of calcitonin
C. Initiation of furosemide infusion
D. Hemodialysis

Category: Critical Care Medicine-Endocrine Disorders--->Parathyroid and Calcium
Page: 1 of 2