elevated alkaline phosphatase - psych80

[ArchivalUser]

A 56-year-old man is admitted to the hospital for elective cardiac bypass surgery.

As part of his preoperative evaluation, you note an elevated alkaline phosphatase. The other liver function studies are within normal limits. Serum calcium and phosphate are within normal limits. The patient denies any history of bone pain, and the physical examination is normal. What is the next step in the management of this patient?

(A) Obtain a radiologic bone survey
(B) Order a nuclear bone scan
© Begin risedronate orally
(D) Order a 24-hour urine test for hydroxyproline
(E) Begin intranasal calcitonin

[ArchivalUser]

first urinary hydroxiproline, then nuclear bone scan; D

[ArchivalUser]

try again

[ArchivalUser]

asymptamatic pagets dont need treatment..

here pt planning to go surgery..

so is it CC...risedronate..?

[ArchivalUser]

it's A

[ArchivalUser]

(A) Obtain a radiologic bone survey

Explanation:

The best initial test for the diagnosis of Paget's disease is the radiologic bone survey. Nuclear bone scan and urine for hydroxyproline are more sensitive for active disease but would only be done after a nondiagnostic bone survey. Patients who have an isolated rise in bone-specific alkaline phosphatase and are asymptomatic are likely to have Paget's disease of the bone. The treatment of choice is an oral bisphosphonate, but therapy is only initiated when the patient has symptomatic disease or diffuse cranial involvement. Calcitonin is no longer the first-line therapy for treatment of Paget's disease because it is less effective, difficult to administer, and can cause unpleasant side effects (nasal irritation and epistaxis).