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NBME 22 Answers

nbme22/Block 2/Question#19

A 50-year-old man comes to the physician 3 days ...

Calcium

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submitted by hopsalong(3),

This question gets at whether or not you can recognize Trousseau's Sign or Chvostek's Sign in kind of an unusual presentation. Basically you get muscle twitches in the setting of Hypocalcemia. Hypoxemia further exacerbates the sign and can cause twitches randomly throughout the body.

Chvostek's Sign is tapping on the facial nerve of the face that illicits a facial muscle spasm.

Trousseau's Sign is when you put a blood pressure cuff on a patient. This causes cells in the arm to not recieve blood -> No O2 -> No oxidative phosphorylation -> decrease in ATP available -> Na+/K+ pump fails without ATP -> Increased intracellular Na+ -> Increased Ca+ because of increased Na+/Ca2+ exchanger -> decreased SERUM Ca2+ -> Flexion of hand.

Trousseau's Sign is more sensitive for Hypocalcemia, but both are diagnostic. Other tips in this question - Tingling around the mouth, hands, and feet can be another sign of Hypocalcemia. Both generalized tonic-clonic or focal motor seizures can occur with hypocalcemia.