A 52-year-old patient has just passed a kidney stone and has high ...

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A 52-year-old patient has just passed a kidney stone and has high levels of calcium in her urine. Blood tests show high levels of calcium in her blood as well.
 
  What subsequent lab results would be most likely to distinguish between primary hyperparathyroidism and hypercalcemia of malignancy?
  A)
  Parathyroid hormone level
  B)
  Bone scan
  C)
  Plasma phosphate levels
  D)
  Serum magnesium level

Question 2

Chronic anxiety and stress contribute to ulcers. Which of the following effects of the sympathetic nervous system is most responsible for this effect?
 
  A)
  Inhibition of the actions of Brunner glands
  B)
  Overstimulation of the oxyntic glands
  C)
  Suppression of cholecystokinin
  D)
  Inflammation of the parotid glands

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Answer to Question 1

Ans:
A

Feedback:

Hyperparathyroidism, in which parathyroid hormone is secreted in excess, may be caused by a parathyroid adenoma. Since parathyroid hormone mobilizes calcium from bone and promotes its transfer to the extracellular fluid, excess calcium is excreted in the urine (promoting the development of kidney stones) and is evident in the plasma. In primary hyperparathyroidism, antibody binding assays of intact PTH would reveal either normal or elevated parathyroid hormone in the face of hypercalcemia, whereas in hypercalcemia of malignancy, levels of intact PTH are suppressed.

Answer to Question 2

Ans:
A

Feedback:

Brunner glands, which produce large amounts of alkaline mucus that protects the duodenum from acid and digestive enzymes, are strongly affected by sympathetic stimulation, which causes a marked decrease in mucus production. Where the stomach contents and secretions from the liver and pancreas enter the duodenum, deficiency of mucus can cause irritation and, potentially, ulcers. Overstimulation of the oxyntic glands is not produced by the SNS. The hormone cholecystokinin, which is thought in part to control gastric emptying, is released in response to the pH, osmolality, and fatty acid composition of the chyme. The two largest salivary glands are called parotid glands. One is located in each cheek over the jaw in front of the ears. Inflammation of one or more of these glands is called parotitis.