A 48-year-old woman underwent a thyroidectomy with central neck dissection due to papillary thyroid carcinoma. On day 2 postoperatively, she developed irritability, dysphagia, difficulty breathing, and spasms in different muscle groups in her upper and lower extremities. The vital signs include blood pressure 102/65 mm Hg, heart rate 93/min, respiratory rate 17/min, and temperature 36.1℃ (97.0℉). Physical examination shows several petechiae on her forearms, muscle twitching in her upper and lower extremities, expiratory wheezes on lung auscultation, decreased S1 and S2 and the presence of an S3 on cardiac auscultation, and positive Trousseau and Chvostek signs. Laboratory studies show: Ca2+ 4.4 mg/dL Mg2+ 1.7 mEq/L Na+ 140 mEq/L K+ 4.3 mEq/L Cl- 107 mEq/L HCO3- 25 mEq/L Administration of which of the following agents could prevent the patient’s condition?
AAnticonvulsants prior to and for 1 week after the operation
BVitamin D and ionic calcium prior to and 2 weeks after the operation
CPotassium supplementation prior to and 2 weeks after the operation
DCalcium gluconate intraoperatively
EMagnesium sulfate intraoperatively
A 50-year-old man is brought in by ambulance to the emergency department with difficulty breathing and speaking. His wife reports that he might have swallowed a fishbone. While taking his history the patient develops a paroxysmal cough. Visualization of his oropharynx and larynx shows a fishbone lodged in the right piriform recess. After successfully removing the fishbone the patient feels comfortable, but he is not able to cough like before. Damage to which of the following nerves is responsible for the impaired cough reflex in this patient?
AInferior laryngeal nerve
BInternal laryngeal nerve
CExternal laryngeal nerve
DSuperior laryngeal nerve
ERecurrent laryngeal nerve
A 4-year-old-female presents with a flattened, reddish 2 cm lump located at the base of the tongue. The patient's mother reports her having trouble swallowing, often leading to feeding difficulties. The mother also reports lethargy, constipation, dry skin, and hypothermia. Which of the following is the most appropriate management of this patient’s presentation?
AWeek-long course of penicillin
BNo treatment is necessary, counsel mother on alternative feeding techniques
CThyroid hormone replacement therapy with levothyroxine
DCombination therapy of methimazole and Beta-blockers
ERadioactive iodine ablation
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