input: The following are multiple choice questions (with answers) about medical knowledge.   **Question:** A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-Y gastric bypass to treat obesity. He underwent a total thyroidectomy to treat a Hurthle cell lesion 4 days ago. His mother died of lung cancer at age 68. He has smoked 1 pack of cigarettes daily for 22 years. His only current medication is a multivitamin supplement. He appears fatigued. His temperature is 36°C (96.8°F), pulse is 72/min, respirations are 20/min, and blood pressure is 130/70 mm Hg. While measuring the patient's blood pressure, the nurse observes spasm of the patient's hand. Physical examination shows a well-healing surgical wound on the neck. The abdomen is mildly tender to palpation with well-healed laparoscopic incisional sites. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 138 mEq/L K+ 4.2 mEq/L Cl- 102 mEq/L HCO3- 25 mEq/L Mg2+ 1.7 mEq/L Phosphorus 4.3 mg/dL 25-hydroxyvitamin D 20 ng/mL (N: 20-100 ng/mL) Parathyroid hormone 115 pg/mL Total bilirubin, serum 0.7 mg/dL Alanine aminotransferase, serum 14 U/L Aspartate aminotransferase, serum 15 U/L Alkaline phosphatase, serum 42 U/L Which of the following is the most appropriate initial step in the management of this patient?"   (A) Obtain abdominal CT   (B) Begin rehydration therapy   (C) Administer calcium gluconate   (D) Supplementation with vitamin D
output: ['(C) Administer calcium gluconate <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Obtain abdominal CT  (B) Begin rehydration therapy  (C) Administer calcium gluconate  (D) Supplementation with vitamin D <> possible answers', '  A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-Y gastric bypass to treat obesity. He underwent a total thyroidectomy to treat a Hurthle cell lesion 4 days ago. His mother died of lung cancer at age 68. He has smoked 1 pack of cigarettes daily for 22 years. His only current medication is a multivitamin supplement. He appears fatigued. His temperature is 36°C (96.8°F), pulse is 72/min, respirations are 20/min, and blood pressure is 130/70 mm Hg. While measuring the patient\'s blood pressure, the nurse observes spasm of the patient\'s hand. Physical examination shows a well-healing surgical wound on the neck. The abdomen is mildly tender to palpation with well-healed laparoscopic incisional sites. The remainder of the examination shows no abnormalities. Serum studies show:\nNa+ 138 mEq/L\nK+ 4.2 mEq/L\nCl- 102 mEq/L\nHCO3- 25 mEq/L\nMg2+ 1.7 mEq/L\nPhosphorus 4.3 mg/dL\n25-hydroxyvitamin D 20 ng/mL (N: 20-100 ng/mL)\nParathyroid hormone 115 pg/mL\nTotal bilirubin, serum 0.7 mg/dL\nAlanine aminotransferase, serum 14 U/L\nAspartate aminotransferase, serum 15 U/L\nAlkaline phosphatase, serum 42 U/L\nWhich of the following is the most appropriate initial step in the management of this patient?" <> context']