06-07-2008, 03:58 PM
17. A 67-year-old woman comes for a routine health maintenance examination. She drinks 1 ounce of alcohol daily. Her blood pressure is 138/62 mm Hg, pulse is 76/min and regular, and respirations are 14/min. The lungs are clear to auscultation. The remainder of the examination shows no abnormalities. Laboratory studies show:
Hemoglobin
12.8 g/dL
Serum
Ca2+
11.9 mg/dL
Creatinine
0.8 mg/dL
Phosphorus
2.8 mg/dL
Total protein
6.5 g/dL
Albumin
4.2 g/dL
Ionized calcium
5.8 mg/dL (N=4.5“5.1)
Which of the following is the most appropriate next step in management?
A
) Measurement of serum alkaline phosphatase activity
B
) Measurement of serum parathyroid hormone level
C
) Measurement of serum vitamin D level
D
) Serum and urine protein electrophoresis
E
) X-ray film of the chest
F
) Skeletal survey
G
) Bone scan
Hemoglobin
12.8 g/dL
Serum
Ca2+
11.9 mg/dL
Creatinine
0.8 mg/dL
Phosphorus
2.8 mg/dL
Total protein
6.5 g/dL
Albumin
4.2 g/dL
Ionized calcium
5.8 mg/dL (N=4.5“5.1)
Which of the following is the most appropriate next step in management?
A
) Measurement of serum alkaline phosphatase activity
B
) Measurement of serum parathyroid hormone level
C
) Measurement of serum vitamin D level
D
) Serum and urine protein electrophoresis
E
) X-ray film of the chest
F
) Skeletal survey
G
) Bone scan