Block 13 Tx Of Calcium Metab Defects MCQ's

16 Questions | By Chachelly | Last updated: Feb 22, 2013 | Total Attempts: 232

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1.

A 27-year-old woman moves to Dominica from Toronto to go to medical school. Every day at noon, she goes to the beach and lies in the sun for half an hour in her bikini. Which of the following is the best description of the likely changes in her vitamin D profile? Vitamin D 25(OH) D 1,25(OH)₂D A No change Up No change B Up No change down C Up Up No change D No change No change No change E Up Up Up
- A.
  
  A
- B.
  
  B
- C.
  
  C
- D.
  
  D
- E.
  
  E
2.

Which of the following actions most likely mediates the therapeutic efficacy of calcitriol in rickets?
- A.
  
  Stimulation of liver hydroxylation of cholecalciferol
- B.
  
  Stimulation of renal alpha1-hydroxylase
- C.
  
  Decreases intestinal phosphate absorption
- D.
  
  Increased intestinal calcium absorption
- E.
  
  Decreased renal phosphate reabsorption
3.

Which of the following drugs appears to facilitate new bone formation if concomitant calcium supplementation is adequate?
- A.
  
  Phenytoin
- B.
  
  Fluoride
- C.
  
  Thyroxine
- D.
  
  Leuprolide
- E.
  
  Prednisone
4.

A 52-year-old woman was admitted to the hospital because of tetanic muscle spasms and paresthesias following a recent thyroidectomy. Which of the following drugs given IV could rapidly reverse the patient’s symptoms?
- A.
  
  Vitamin D
- B.
  
  Calcitonin
- C.
  
  Sodium phosphate
- D.
  
  Calcium gluconate
- E.
  
  Hydrocortisone
- F.
  
  Alendronate
5.

A 49-year-old woman complained to her physician of occasional, severe back pain. Medical history of the patient was significant for mastectomy for breast cancer four years ago, and for an episode of severe angioedema which occurred six month ago after a prophylactic treatment with hepatitis A immune globulin. An x-ray showed diffuse osteoporosis. Which of the following drugs would be most appropriate for this patient?
- A.
  
  Ethinyl estradiol
- B.
  
  Calcitonin
- C.
  
  Alendronate
- D.
  
  Sodium fluoride
- E.
  
  Cinacalcet
- F.
  
  Sodium phosphate
6.

A 70-year-old woman suffering from osteoporosis and hypertension, has been treated for the last three years with raloxifene and calcium carbonate (1.5 g daily) for osteoporosis and with hydrochlorothiazide for hypertension. In spite of the therapy, a recent bone mineral density showed a significant decrease in bone mass. Which of the following would be an appropriate change in the treatment plan of this patient?
- A.
  
  To substitute hydrochlorothiazide with propranolol
- B.
  
  To substitute raloxifene with ethinyl-estradiol
- C.
  
  To add calcitonin to the present regimen
- D.
  
  To increase the daily dose of calcium carbonate
- E.
  
  To add prednisone to the present regimen
- F.
  
  To add alendronate to the present regimen
7.

A 50-year-old man presented to the hospital because of increasingly severe bone pain, which is accentuated at night, headache, fatigue and decreasing auditory acuity. Pasts history of the patient was significant for gastroesophageal reflux disease presently treated with omeprazole. Physical examination revealed skull enlargement, a hobbing gait and anterolateral bowing of the legs with warmth and periosteal tenderness. A X-ray exam showed increased bone density, cortical thickening and bony enlargement. Laboratory results showed alkaline phosphatase of 230 I.U./L (normal 20-90). Which of the following drugs would be appropriate for this patient?
- A.
  
  Calcitonin
- B.
  
  Alendronate
- C.
  
  Calcium carbonate
- D.
  
  Sodium fluoride
- E.
  
  Raloxifene
- F.
  
  Calcitriol
8.

A 4-year-old black boy was brought to the emergency room after he fell while playing in the yard. Physical examination revealed only minor skin scratches but an x-ray exam showed 2 rib fractures, a clearly demineralized bone and widening and cupping of metaphyses with exaggerated normal concavity and irregular calcification. Pertinent laboratory values were: calcium 8.3 mg/dL, phosphate 3.2 mg/dL, and a two fold increase in alkaline phosphatase. Which of the following would be an appropriate treatment for this boy?
- A.
  
  Cholecalciferol
- B.
  
  Calcitonin
- C.
  
  Fluoride
- D.
  
  Teriparatide
- E.
  
  Alendronate
9.

A 42-year-old man with 25-year history of type 1 diabetes presented for a control visit. His laboratory values were: glucose 190 mg/dL, calcium 11.2 mg/dL, phosphate 5.3 mg/dL, creatinine 4.9 mg/dL. An x-ray exam revealed density changes in the bones that were consistent with renal osteodystrophy. Which of the following drugs should be included in the treatment plan for this patient?
- A.
  
  Alendronate
- B.
  
  Calcitonin
- C.
  
  Paricalcitol
- D.
  
  Sodium fluoride
- E.
  
  Sodium phosphate
10.

A 46-year-old man presented to the hospital with complains of muscle weakness, fatigue, constipation, nausea and polyuria. Past medical history was unremarkable. Pertinent laboratory values on admission were: calcium of 14.5 mg/dL, phosphate 2.1 mg/dL and immunoreactive parathyroid hormone level of 142 pg/mL (normal 11-54). Which of the following drugs was most likely included in the therapeutic management of the patient?
- A.
  
  Calcitriol
- B.
  
  Hydrochlorothiazide
- C.
  
  Sodium fluoride
- D.
  
  Mannitol
- E.
  
  Calcitonin
11.

A 55-year-old woman complained to her physician of a persistent back pain of 3 days duration. A dual-energy x-ray absorptiometry showed diffuse osteoporosis of the spine and hips. The physician ordered calcium and vit D supplementation and alendronate, 10 mg daily. Which of the following actions most likely mediated the therapeutic effect of alendronate in this patient?
- A.
  
  Stimulation of osteoblast activity
- B.
  
  Stimulation of intestinal calcium absorption
- C.
  
  Inhibition of renal calcium excretion
- D.
  
  Inhibition of osteoclast activity
- E.
  
  Inhibition of renal synthesis of calcitriol
12.

A 63-year-old woman, suffering from osteoporosis, had been receiving alendronate, and calcium and vit D supplementation for two years, but a recent dual-energy x-ray absorptiometry showed a significant decrease in bone density. The patient history was significant for a femur fracture 8 months ago and a rib fracture one months ago. The physician decided to add teriparatide to the current therapy. Which of the following actions most likely mediated the therapeutic effect of the drug in this patient?
- A.
  
  Stimulation of osteoblast activity
- B.
  
  Stimulation of renal calcium excretion
- C.
  
  Inhibition of renal phosphate excretion
- D.
  
  Inhibition of osteoclast activity
- E.
  
  Inhibition of renal synthesis of calcitriol
13.

A 47-year-old man presented to his physician complaining of recurring skin lesions most prominent over the scalp, extensor surfaces of elbows and knees, buttock and penis. The man also complained of increasing pain in his left hand and left hip. Physical examination showed oval erythematous plaques covered with thick, silvery, shiny scales. The distal interphalangeal joints of digits two and three of the left hand were swollen and tender. The physician told the patient the diagnosis and ordered a topical drug treatment. Which of the following drugs was most likely prescribed?
- A.
  
  Fludrocortisone
- B.
  
  Calcitonin
- C.
  
  Calcipotriene
- D.
  
  Erythromycin
- E.
  
  Alendronate
14.

A 62-year-old man was admitted to the hospital because of increasing pain in the back and left upper thigh over the past month. The patient also complained that recently he felt drowsy and tired most of the time and urinated very frequently. Past history of the patient was significant for radical prostatectomy for prostate cancer six months ago. Physical examination showed a dehydrated man less alert than normal and slow in his responses. Pertinent laboratory values on admission were: calcium 13.5 mg/L, alkaline phosphatase 204 U/L. An appropriate therapy was started which included an IV infusion of a drug. Which of the following drugs was most likely infused IV?
- A.
  
  Sodium phosphate
- B.
  
  Hydrochlorothiazide
- C.
  
  Pamidronate
- D.
  
  Mannitol
- E.
  
  Calcitriol
- F.
  
  Fludrocortisone
15.

A 52-year-old homeless man with a 15 year history of alcoholism was brought to the hospital by the police who found him laying on the street. Physical examination showed a disheveled, confused and cachectic man with prominent veins on a very tense abdomen. Pertinent laboratory values on admission were: calcium 5.5 mg/L, ALT 300 U/L (normal 8- 35), AST 255 U/L (normal 8-35). An x-ray disclosed diffuse demineralization of bones. An appropriate therapy was ordered. Which of the following drugs was most likely included in the therapeutic management of this patient?
- A.
  
  Teriparatide
- B.
  
  Cholecalciferol
- C.
  
  Sodium fluoride
- D.
  
  Calcitriol
- E.
  
  Calcipotriene
16.

A 56-year-old woman complained to her physician of frequent heartburn and pain in the substernal region. The woman, recently diagnosed with postmenopausal osteoporosis, started an appropriate therapy two weeks previously. Which of the following drugs most likely caused the patient’s symptoms?
- A.
  
  Prednisone
- B.
  
  Calcitonin
- C.
  
  Raloxifene
- D.
  
  Teriparatide
- E.
  
  Alendronate