01-14-2010, 03:33 PM
A 78-year-old woman is evaluated for fatigue, irritability, and depression. She is a resident of a nursing home and her ambulation is limited by a residual right-sided hemiparesis following a stroke 3 years ago. She has a history of type 2 diabetes mellitus, hypertension, and hyperlipidemia. Medications include glipizide, simvastatin, aspirin, lisinopril, furosemide, and amlodipine. Physical examination reveals a positive Chvostek's sign on the right side, dry skin, brittle nails, and coarse hair.
Laboratory Studies
Blood urea nitrogen
18 mg/dL (6.43 mmol/L)
Creatinine
1.2 mg/dL (106.1 µmol/L)
Albumin
3.5 g/dL (35 g/L)
Calcium
7.2 mg/dL (1.8 mmol/L)
Alkaline phosphatase
260 U/L
Which of the following is the most appropriate next test in the evaluation of this patient?
A Parathyroid sestamibi scan
B 25-hydroxyvitamin D
C 1,25-dihydroxyvitamin D3
D Calcitonin
Laboratory Studies
Blood urea nitrogen
18 mg/dL (6.43 mmol/L)
Creatinine
1.2 mg/dL (106.1 µmol/L)
Albumin
3.5 g/dL (35 g/L)
Calcium
7.2 mg/dL (1.8 mmol/L)
Alkaline phosphatase
260 U/L
Which of the following is the most appropriate next test in the evaluation of this patient?
A Parathyroid sestamibi scan
B 25-hydroxyvitamin D
C 1,25-dihydroxyvitamin D3
D Calcitonin