Riddler #4Riddler #4

A 38 y/o homeless male is found A 38 y/o homeless male is found down. In the ED he is inebriated, down. In the ED he is inebriated, blood alcohol level is 200. His blood alcohol level is 200. His serum calcium is 5.5 with an serum calcium is 5.5 with an albumin of 2.7 and his magnesium albumin of 2.7 and his magnesium was 0.7. Exam was consistent with was 0.7. Exam was consistent with hypocalcemia.hypocalcemia.-Explain why hypomagnesemia is -Explain why hypomagnesemia is

associated with hypocalcemia? (be associated with hypocalcemia? (be specific) 2 pts.specific) 2 pts.

Riddler #4 AnswerRiddler #4 Answer

Magnesium depletion causes Magnesium depletion causes hypocalcemia:hypocalcemia:– PTH resistance, which occurs when serum PTH resistance, which occurs when serum

magnesium concentrations fall below 0.8 magnesium concentrations fall below 0.8 meq/L (1 mg/dL or 0.4 mmol/L). meq/L (1 mg/dL or 0.4 mmol/L).

– Decreased PTH secretion, which occurs in Decreased PTH secretion, which occurs in patients with more severe hypomagnesemia. patients with more severe hypomagnesemia.

Note: Severe Note: Severe hypermagnesemiahypermagnesemia, a very , a very rare disorder, also can cause rare disorder, also can cause hypocalcemia, by suppressing the hypocalcemia, by suppressing the secretion of PTH. >6mg/dl. Usually only secretion of PTH. >6mg/dl. Usually only seen with treatment of Eclampsiaseen with treatment of Eclampsia

Riddler #5Riddler #5

20 y/o female in her 120 y/o female in her 1stst trimester, trimester, is referred to you for progressive is referred to you for progressive dyspnea. An echo reveals severe dyspnea. An echo reveals severe pulmonary hypertension. Right pulmonary hypertension. Right Ventricular systolic pressure is 90 Ventricular systolic pressure is 90 with a systemic pressure of 110 with a systemic pressure of 110 mm hg. No PE and no mm hg. No PE and no intracardiac shunt.intracardiac shunt.

Riddler #5Riddler #5

Which of the following is associated with Which of the following is associated with the lowest risk of Maternal Mortality?the lowest risk of Maternal Mortality?

A) Termination of pregnancyA) Termination of pregnancy B) Initiation of prostacyclin therapyB) Initiation of prostacyclin therapy C) Initiation of bosentan therapyC) Initiation of bosentan therapy D) Initiation of anticoagulation therapyD) Initiation of anticoagulation therapy E) Initiation of ACE inhibitor therapyE) Initiation of ACE inhibitor therapy Bonus: Two points:Bonus: Two points: What Super Bowl did What Super Bowl did

Doug Williams win and who received the Doug Williams win and who received the 80 yard bomb pass from him during the 80 yard bomb pass from him during the game?game?