Page Contents
OVERVIEW
This page is dedicated to organizing various examples of standardized exam questions whose topic is hypoparathyroidism. While this may seem a odd practice, it is useful to see multiple examples of how hypoparathyroidism will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a traditional question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a topic is quite valuable.
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for hypoparathyroidism.
The vignette can be very similar to that of hypocalcemia because of the potential overlap in pathology between these conditions.
Chief Complaints:
- Numbness/tingling (parasthesia) can be felt by the patient
- Muscle cramps
Patient History:
- Recent thyroidectomy: this can cause damage to the parathyroid glands leading to hypocalcemia
Clinical Workup:
- Trousseau sign: forceful flexion of her wrist with abduction of the thumb when her blood pressure cuff was tightened
- Chvotsek’s sign: tapping of the region anterior to the ears causes twitching of the perioral muscles
- Hyperreflexia can be detected on the neurological workup.
- Hypocalcemia can be detected on labs.
- QTc Prolongation can be seen on the EKG as a result of this electorate abnormality
QUESTION EXAMPLES
Question # 1
A 50 year old male comes to the clinic because he has been noticing that his voice is hoarse for the past week. A physical exam is notable for a large and nodular goiter. A biopsy is performed and he is diagnosed with a papillary thyroid cancer. He is admitted for a thyroidectomy. After the procedure he begins to develop muscle cramps in his lower extremities and also begins to notice numbness around his mouth. His muscles strength and reflexes are unremarkable. What is likely the cause of this patient’s current symptoms?
Explanation # 1
Recent thyroidectomy + muscle cramps + parasthesias (numbness around mouth) = hypocalcemia
Question # 2
A 45 year old woman with Graves is scheduled to have her thyroid gland removed. Her goiter has been resistant to medical treatments. Her past medical history is otherwise unremarkable. Before her operation all of her electrolyte lab values are within normal limits. After undergoing the total thlryodiectomy she is recovering well. Labs are collected and shown below.
- Sodium: 140 mEq/L
- Potassium: 4.3 mEq/L
- Creatinine: 0.7 mg/dL
- Calcium: 7.3 mg/dL ***
What is the likely diagnosis in this patient?
Explanation # 2
Recent thyroidectomy + hypocalcemia on labs = hypocalcemia
Question # 3
A 60 year old male undergoes a total thyroidectomy for thyroid cancer. The next day after the procedure he notices numbness along his hands and feet. His vital signs are stable, however he exhibits a carpal spasm when the cuff on the blood pressure cuff is inflated. What is the likely diagnosis in this patient?
Explanation # 3
Recent thyroidectomy + Trousseau sign = hypocalcemia
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Pathophysiology:
- Damage of parathyroid tissue leads to a drop in parathyroid hormone. This leads to decreased calcium and phosphate resorption from bone, and decreases calcium reabsorption from the kidneys (overall lower serum levels of calcium).
Treatment:
- Oral calcium: to raise serum levels of calcium
- Calcitriol (active form of vitamin D): should be chose over calcidiol because conversion of this to calcitriol depends on the parathyroid hormone (which patients with this condition don’t have!)
Page Updated: 06.11.2018