Забыла привести обьяснение к первой задаче:
Explanation:
The correct answer is A. This patient has symptomatic hypercalcemia. The most likely etiology in this patient is hyperparathyroidism. This diagnosis is made by checking PTH levels. Since her calcium is elevated, a normal or high PTH level is inappropriate and therefore would help confirm the diagnosis.
Vitamin D (choice B) intoxication is typically secondary to patients taking large amounts of vitamin D (often for treatment of hypoparathyroidism). The treatment is to discontinue vitamin supplementation and recheck levels. This patient denied taking over-the-counter medications or vitamins.
Ordering a TSH (choice C) is never a bad idea in a patient with a variety of vague complaints since thyroid disease is very common and because it can explain these symptoms. In this patient, you would expect to find hypothyroidism based on her symptoms but an elevated serum calcium is more likely explained by hyperthyroidism secondary to increased bone turnover. Therefore, a PTH level would more likely lead to the correct diagnosis.
CT scanning of the neck (choice D) is very sensitive for parathyroid disease but it is not meant to be used as a screening test for hyperparathyroidism. Rather, the diagnosis is made by checking serum calcium and PTH levels.
Multiple myeloma is a common disease and can cause hypercalcemia as well. A serum protein electrophoresis (choice E) is helpful in making this diagnosis by demonstrating a monoclonal spike in the beta or gamma globulin region. Our patient lacks anemia, renal disease, or significant back pain which makes multiple myeloma less likely.
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