A 45 year old woman is referred to a neurologist for a comprehensive evaluation due to concerning signs and symptoms that have been affecting her daily life. She presents with several neurological issues, including muscle cramps, tingling sensations, and episodes of muscle weakness. She denies any pain, fever or weight loss. She has had a recent surgical procedure to her neck, but no other past medical history.

On examination, her observations are all within normal limits. A positive Chvostek sign is observed.

Which of the following best describes the pathophysiology of this patient's condition?

Options:
explanation: This is the correct answer. Given the recent neck surgery, it is possible that accidental damage to or removal of the parathyroid glands during surgery occurred. Damage or removal of the parathyroid glands leads to reduced parathyroid hormone levels which in turn leads to reduced calcium levels. Therefore, symptoms of hypocalcaemia and Chvostek sign (twitching when the course of the facial nerve is tapped) are observed.
name: Decreased parathyroid hormone levels leading to hypocalcaemia
label: a
answer: yes
explanation: Given the recent neck surgery, it is possible that accidental damage to or removal of the parathyroid glands during surgery occurred. Damage or removal of the parathyroid glands leads to reduced parathyroid hormones which causes reduced calcium levels, not increased calcium levels. Therefore, symptoms of hypocalcaemia including Chvostek sign (twitching when the course of the facial nerve is tapped) are observed.
name: Decreased parathyroid hormone levels leading to hypercalcaemia
label: b
answer: no
explanation: The patient's lack of a significant past medical history related to autoimmune disorders makes it less likely that her current symptoms are due to an autoimmune condition. A positive Chvostek sign is more suggestive of neuromuscular irritability, as may be seen in hypocalcaemia. This may occur due to parathyroid gland dysfunction, which can affect calcium regulation and neuromuscular excitability. This aligns with her recent history of neck surgery which could have potentially damaged the parathyroid gland.
name: Autoimmune disorder leading to hypercalcaemia
label: d
answer: no
explanation: The patient's lack of a significant past medical history related to autoimmune disorders makes it less likely that her current symptoms are due to an autoimmune condition. A positive Chvostek sign is more suggestive of neuromuscular irritability, as may be seen in hypocalcaemia. This may occur due to parathyroid gland dysfunction, which can affect calcium regulation and neuromuscular excitability. This aligns with her recent history of neck surgery which could have potentially damaged the parathyroid gland.
name: An autoimmune disorder leading to hypocalcaemia
label: c
answer: no
explanation: Indeed, symptoms of hypocalcaemia such as Chvostek's sign (twitching when the course of the facial nerve is tapped) are observed. Although acute pancreatitis can lead to hypocalcaemia, there are no symptoms that point to pancreatitis. Specifically, the patient is not experiencing any pain. By contrast, pancreatitis is associated with severe pain in the abdomen, nausea and fever.
name: Pancreatitis leading to hypocalcaemia
label: e
answer: no

Correct answer: a