Block 13 Tx Of Calcium Metab Defects MCQ's

Calcitriol is the active form of vitamin D, and it plays a crucial role in maintaining calcium homeostasis in the body. Rickets is a condition characterized by impaired mineralization of growing bones, often due to vitamin D deficiency. One of the main therapeutic actions of calcitriol in rickets is to increase intestinal calcium absorption. By promoting the absorption of calcium from the intestines into the bloodstream, calcitriol helps to increase the availability of calcium for bone mineralization, thus improving the symptoms of rickets.

Alendronate is a bisphosphonate medication that is commonly used for the treatment of osteoporosis. It works by inhibiting the activity of osteoclasts, which are cells responsible for breaking down bone tissue. By inhibiting osteoclast activity, alendronate helps to decrease bone resorption and increase bone density, leading to the therapeutic effect in this patient. This medication does not stimulate osteoblast activity, intestinal calcium absorption, or renal calcium excretion. Additionally, it does not inhibit renal synthesis of calcitriol, which is the active form of vitamin D.

Teriparatide is a recombinant form of parathyroid hormone (PTH) that stimulates osteoblast activity. Osteoblasts are responsible for bone formation, so by stimulating their activity, teriparatide helps to increase bone density. This is particularly beneficial for individuals with osteoporosis, as it helps to counteract the excessive bone resorption that occurs in this condition. Therefore, the addition of teriparatide to the patient's current therapy is likely to have a therapeutic effect by stimulating osteoblast activity and promoting bone formation.

The patient's history of mastectomy for breast cancer and severe angioedema suggests that she may have received hormonal therapy or other treatments that can increase the risk of osteoporosis. Alendronate is a bisphosphonate medication that helps to prevent bone loss and is commonly prescribed for osteoporosis. It would be the most appropriate drug choice for this patient to help manage her severe back pain and improve her bone health.

Calcium gluconate is the correct answer because it is a form of calcium that can be given intravenously to rapidly replenish calcium levels in the body. Tetanic muscle spasms and paresthesias are symptoms of hypocalcemia, which can occur after a thyroidectomy due to accidental removal or damage to the parathyroid glands. Calcium gluconate can quickly increase calcium levels and reverse these symptoms. Vitamin D, calcitonin, sodium phosphate, hydrocortisone, and alendronate are not indicated for the treatment of acute hypocalcemia.

Adding alendronate to the patient's current regimen would be an appropriate change in treatment plan. Alendronate is a medication that belongs to a class of drugs called bisphosphonates, which are commonly used to treat osteoporosis. It helps to increase bone mass by slowing down the breakdown of bone and reducing the risk of fractures. Since the patient has been experiencing a significant decrease in bone mass despite the current therapy, adding alendronate can help improve her bone density and reduce the risk of further bone loss.

Calcitonin is the most likely drug included in the therapeutic management of the patient because the patient's laboratory values indicate hypercalcemia, with high levels of calcium and low levels of phosphate. Calcitonin is a hormone that helps regulate calcium levels in the body by inhibiting bone resorption and promoting calcium excretion in the kidneys. It is used as a treatment for hypercalcemia, which can cause symptoms such as muscle weakness, fatigue, constipation, nausea, and polyuria. Therefore, administering calcitonin would help lower the patient's calcium levels and alleviate their symptoms.

Alendronate is a bisphosphonate medication commonly used to treat osteoporosis. One of the common side effects of alendronate is gastrointestinal irritation, which can manifest as heartburn and substernal pain. Therefore, it is likely that alendronate caused the patient's symptoms of frequent heartburn and pain in the substernal region.

Cholecalciferol, also known as vitamin D3, would be an appropriate treatment for this boy. The presentation of rib fractures, demineralized bone, and metaphyseal abnormalities suggests a diagnosis of rickets, which is commonly caused by vitamin D deficiency. Cholecalciferol is a form of vitamin D that can help increase calcium and phosphate levels, improve bone mineralization, and promote proper bone growth. This treatment would address the underlying deficiency and support bone health in the boy.

Paricalcitol should be included in the treatment plan for this patient because the laboratory values and x-ray findings suggest that the patient has renal osteodystrophy, which is a common complication of chronic kidney disease. Paricalcitol is a synthetic vitamin D analog that is used to treat secondary hyperparathyroidism associated with chronic kidney disease. It helps to reduce elevated levels of parathyroid hormone, which can contribute to bone mineralization abnormalities. Therefore, paricalcitol would be an appropriate choice to address the bone density changes observed in this patient.

The patient's presentation is consistent with Paget's disease of bone, which is characterized by bone pain, skull enlargement, gait abnormalities, and increased bone density on X-ray. The elevated alkaline phosphatase level further supports this diagnosis. Calcitonin is a medication that can help to reduce bone turnover and pain in patients with Paget's disease, making it the appropriate choice for this patient. Alendronate, calcium carbonate, sodium fluoride, raloxifene, and calcitriol are not indicated for the treatment of Paget's disease.

The patient's physical examination findings, laboratory values, and x-ray results suggest that he is suffering from alcoholic liver disease and hypocalcemia due to vitamin D deficiency. Calcitriol, the active form of vitamin D, is the most appropriate therapy for this patient as it helps in increasing calcium absorption from the gut and promoting bone mineralization. Teriparatide is a recombinant form of parathyroid hormone and is used for osteoporosis, not for hypocalcemia. Cholecalciferol is a form of vitamin D that is used for vitamin D deficiency, but the patient's condition requires the active form of vitamin D. Sodium fluoride is used for the treatment of osteoporosis, not for hypocalcemia. Calcipotriene is a synthetic form of vitamin D that is used for the treatment of psoriasis, not for hypocalcemia.

Fluoride is the correct answer because it has been shown to facilitate new bone formation when calcium supplementation is adequate. Fluoride helps in the formation of hydroxyapatite, which is a key component of bone. It has been used in the treatment of osteoporosis and other bone disorders to increase bone density and strength. Calcium supplementation is important because fluoride works in conjunction with calcium to promote bone growth. Phenytoin, thyroxine, leuprolide, and prednisone do not have the same effect on bone formation as fluoride.

Moving from Toronto to Dominica, where there is more sunlight, will likely result in an increase in the woman's vitamin D profile. Sun exposure is the primary source of vitamin D synthesis in the body, and spending time in the sun in her bikini will allow her skin to produce more vitamin D. Additionally, the increased sunlight exposure in Dominica compared to Toronto will result in higher levels of 25(OH) D and 1,25(OH)2 D, which are the active forms of vitamin D in the body. Therefore, the best description of the likely changes in her vitamin D profile is an increase in all three forms of vitamin D (A, B, and C).

The patient's presentation is consistent with hypercalcemia, as indicated by the elevated calcium level and symptoms such as back pain, drowsiness, and frequent urination. Pamidronate is a bisphosphonate medication that is commonly used to treat hypercalcemia. It works by inhibiting osteoclast activity and reducing bone resorption, thereby lowering calcium levels in the blood. Therefore, the most likely drug infused IV in this case would be pamidronate.

The patient's presentation is consistent with psoriasis, a chronic autoimmune disease characterized by erythematous plaques covered with silvery scales. The involvement of the scalp, extensor surfaces of elbows and knees, buttock, and penis, along with joint swelling and tenderness, suggests an active and severe form of psoriasis. Calcipotriene, a vitamin D analog, is commonly prescribed as a topical treatment for psoriasis due to its ability to inhibit keratinocyte proliferation and promote keratinocyte differentiation, leading to decreased inflammation and scaling. Therefore, calcipotriene is the most likely drug prescribed in this case.