A 65 year old male presents with recurrent calcium kidney stones. He is found to have a calcium level of 11.8 mg/dl. PTH level is mildly elevated. Serum creatinine is 1.4 mg/dl. 24 hour urine calcium excretion is elevated. Parathyroid Sestamibi scan is performed but does not reveal any abnormality. The most likely cause of the primary hyperparathyroidism is:

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Question 1 of 5

A 65 year old male presents with recurrent calcium kidney stones. He is found to have a calcium level of 11.8 mg/dl. PTH level is mildly elevated. Serum creatinine is 1.4 mg/dl. 24 hour urine calcium excretion is elevated. Parathyroid Sestamibi scan is performed but does not reveal any abnormality. The most likely cause of the primary hyperparathyroidism is:

Correct Answer: D

Rationale: The correct answer is D based on the typical presentation of primary hyperparathyroidism. Solitary adenoma accounts for 80-85% of cases, though multiple adenomas can also occur.

Question 2 of 5

A 60-year-old male with a history of coronary artery disease presents with recurrent angina. Coronary angiography shows a 90% stenosis in the left anterior descending artery. What is the most appropriate next step?

Correct Answer: B

Rationale: A significant stenosis in the left anterior descending artery warrants revascularization. PCI is preferred for single-vessel disease.

Question 3 of 5

50 yo female with a 25-year history of migraine headaches with visual auras presents for her clinic visit and has been having them more frequently(once a week). What would you suggest next?

Correct Answer: B

Rationale: An increase in frequency of migraines with aura should prompt further investigation such as an MRI to rule out underlying structural abnormalities.

Question 4 of 5

In thrombosis and hemostasis, all the following are true except:

Correct Answer: D

Rationale: Young age at thrombosis (D) warrants a hypercoagulable work-up, unlike myocardial infarction/stroke (E), which may have other causes. Factor VIII inhibitors are rare (A is false), warfarin starts with heparin overlap (C is false).

Question 5 of 5

Which serologic test is the main method for diagnosis of acute infection by hantaviruses?

Correct Answer: A

Rationale: Anti-hantavirus IgM is the primary serologic test for diagnosing acute hantavirus infection because it indicates recent exposure and active infection.

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