A 34-year-old male undergoes an uneventful excision of a parathyroid adenoma. The following postoperative day, he complains of numbness around his lips. Which of the following is the most likely cause of this symptom?
Answer(s): C
Hungry bone syndrome refers to hypocalcemia following surgical correction of hyperparathyroidism in patients with severe, prolonged disease, as serum calcium is rapidly taken from the circulation and deposited into the bone. Symptoms usually occur within 2448 hours following parathyroidectomy, when calcium levels reach a nadir. Early symptoms include numbness and tingling in the perioral area, fingers, or toes. Advanced symptoms include nervousness, anxiety, and increased neuromuscular transmission evidenced by positive Chvostek's and Trousseau's signs, carpal pedal spasm, and hyperactive tendon reflexes. In severe cases, one may develop a prolonged QT interval on ECG. Patients who manifest any signs or symptoms of hypocalcemia always require intervention. In severely symptomatic patients, treatment should begin with intravenous calcium gluconate. Mildly symptomatic patients may be given oral calcium in the form of calcium lactate, calcium carbonate, or calcium gluconate. If hypocalcemia remains despite calcium supplementation, additional therapy with vitamin D may be needed. Supplemental calcium and vitamin D therapy should be continued until serum calcium levels return to normal
A 34-year-old male undergoes an uneventful excision of a parathyroid adenoma. The following postoperative day, he complains of numbness around his lips.Which of the following is the most appropriate intervention?
Answer(s): A
A CT scan in a patient with a temperature of 102.1°F and a history of an abdominal aortic graft reveals fluid around the graft. Which of the following is the most appropriate treatment?
Answer(s): D
The triad of fever, abdominal fluid collection, and history of abdominal graft surgery indicates the development of a graft infection. The most common organism isolated is S. aureus. It is a rare, but morbid, complication, with mortality rates as high as 36%. The infection may rapidly result in sepsis, hemorrhagic shock, and septic embolization. The standard treatment is early detection and surgical removal of the infected graft, with primary closure of the aorta and creation of an extra-anatomical reconstruction--most commonly an axillofemoral bypass. Such a bypass carries its own morbidities, including risk of limb loss, aortic stump blowout, and pelvic ischemia.
A newborn male is brought to you in the neonatal intensive care unit (NICU). On physical examination, you notice that the infant has deficient abdominal musculature and undescended testes. Your suspicion is high for a certain condition.You presumptively diagnose the child with which of the following?
Answer(s): E
The constellation of cryptorchidism, posterior urethral valves, and abnormal abdominal musculature is called Eagle-Barrett syndrome. Another name is prune belly syndrome. The greatest morbidity comes from the poor amniotic fluid production, due to bladder outlet obstruction, with a resulting pulmonary hypoplasia. Cushing's triad are hypertension, bradycardia, and widened pulse pressure. This is seen as terminal findings associated with increased intracranial pressure. VATER association has multiple anomalies, none of which are the three mentioned. VATER is a mnemonic which stands for Vertebral anomalies, Anal atresia (imperforate), Tracheo-Esophageal fistula, and Renal anomalies (the R also indicated Radial anomalies). It is sometimes referred to as VACTERL association in which the C indicates Cardiac anomalies with the L indicating Limb anomalies. Potter's syndrome is bilateral renal agenesis. This condition is fatal, due to marked pulmonary hypoplasia. The Jones criteria are used in the diagnosis of ARF.
A newborn male is brought to you in the neonatal intensive care unit (NICU). On physical examination, you notice that the infant has deficient abdominal musculature and undescended testes. Your suspicion is high for a certain condition.Upon further imaging, what associated finding would be expected?
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