Northerncardinal

2+ Year Member
May 25, 2016
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Medical Student
A 57 year old man comes to ER due to cramping in his hands and feet and numbness and tingling around his lips and in his fingers; these symptoms occurred intermittently for 6 months but have been progressively severe during the past 2 weeks. He also has had a 13 kg wt loss and bulky, foul smelling stools that do not flush easily. He has a 10 year history of drinking 8 to 10 beers daily. He has been hospitalized twice for severe abdo pain 4 and 6 years ago. His pulse is 80/min, and BP is 105/65. He appears cachectic and chronically I'll. The abdomen is nontender. Deep tendon reflexes are 4+ bilaterally. Chvostek and trosseau signs are present. His serum calcium concentration is 6.5 mg/dl. What's the most likely diagnosis?
A. Hypomagnesemia
B. Hypoparathyroidism
C. Osteomalacia
D. Vitamin D deficiency

How to differentiate betweenC and D?
 

Reperfused

5+ Year Member
Aug 24, 2015
379
91
Status
Medical Student
Is the answer D?

He’s an alcoholic. Foul smelling, bulky stools point towards pancreatic insufficiency. Weight loss. I’m guessing this is pancreatic carcinoma. In any case, vitamin D is a fat soluble vitamin. If he has pancreatic insufficiency, that must be causing vitamin D deficiency. This is the reason he’s getting all the signs and symptoms of hypocalcemia because vitamin D facilitates absorption of calcium in the gut.

Let me know if my theory is right.
 
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Northerncardinal

2+ Year Member
May 25, 2016
148
46
Status
Medical Student
Is the answer D?

He’s an alcoholic. Foul smelling, bulky stools point towards pancreatic insufficiency. Weight loss. I’m guessing this is pancreatic carcinoma. In any case, vitamin D is a fat soluble vitamin. If he has pancreatic insufficiency, that must be causing vitamin D deficiency. This is the reason he’s getting all the signs and symptoms of hypocalcemia because vitamin D facilitates absorption of calcium in the gut.

Let me know if my theory is right.
Yes ans is D. Thx for breaking it down. I was considering osteomalacia equivalent to vitamin D deficiency so got confused.
 
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Reperfused

5+ Year Member
Aug 24, 2015
379
91
Status
Medical Student
Osteomalacia can be caused by vitamin D deficiency, yes.

But I think the reason why in this particular qs, osteomalacia wouldn’t be the most likely diagnosis is because it’s a disease of bones and this guy doesn’t have any bone related symptoms.
 
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