A 68-Year-Old Man Comes to the Office for Follow-Up

question 181

Multiple Choice

A 68-year-old man comes to the office for follow-up.  The patient has a 10-year history of end-stage renal disease due to diabetic and hypertensive nephropathy and receives intermittent hemodialysis.  Current medications are losartan, metoprolol, amlodipine, short- and long-acting insulins, and epoetin alpha.  His calcium acetate and calcitriol therapy were stopped 3 months ago due to an elevated serum calcium level.  The patient is adherent with medications and dietary restrictions.  Laboratory results are as follows: Which of the following is the most likely underlying cause of this patient's elevated serum calcium level?

• A)Decreased clearance of parathyroid hormone
• B)Ectopic production of parathyroid hormone
• C)Hyperplasia of parathyroid glands
• D)Increased activation of vitamin D
• E)Plasma protein-mediated pseudohypercalcemia

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Definitions:

Evolutionary Psychology

is a theoretical approach in psychology that examines human thoughts, feelings, and behaviors through the lens of evolutionary biology, proposing that many aspects of human nature can be understood as adaptations to ancestral environments.

Adapt Reactively

To modify or change behavior after an event.

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Patterns and practices associated with how one prepares for exams or learns new information, significantly impacting academic performance.

Socially Decenter

The ability to step outside one's own experience or viewpoint to understand the social context and perspectives of others, promoting more effective communication.