Calcium disorders: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Calcium disorders

Sample item

A patient with squamous cell carcinoma of the lung presents with polyuria, constipation and confusion. Serum calcium is 14.5 mg/dL and PTH is suppressed. Which is the most appropriate initial treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Intravenous normal saline followed by a bisphosphonate

Hypercalcaemia of malignancy is commonly mediated by PTH-related peptide. Initial therapy is aggressive intravenous saline for volume repletion and calciuresis, followed by an intravenous bisphosphonate such as zoledronic acid. Calcitonin gives a rapid but short-lived effect.

Option by option

  • A. Oral calcium restriction alone

    Dietary calcium restriction has minimal effect in a bone resorption driven condition.

  • B. Intravenous normal saline followed by a bisphosphonate (correct)

    Correct. Saline restores volume and a bisphosphonate inhibits osteoclastic bone resorption.

  • C. Thiazide diuretics

    Thiazides reduce urinary calcium excretion and would worsen hypercalcaemia.

  • D. Intravenous calcium gluconate

    Calcium gluconate is for hypocalcaemia and would be harmful here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is B, Intravenous normal saline followed by a bisphosphonate. Hypercalcaemia of malignancy is commonly mediated by PTH-related peptide.

Why is "Oral calcium restriction alone" not the answer?

Dietary calcium restriction has minimal effect in a bone resorption driven condition.

Why is "Thiazide diuretics" not the answer?

Thiazides reduce urinary calcium excretion and would worsen hypercalcaemia.

Why is "Intravenous calcium gluconate" not the answer?

Calcium gluconate is for hypocalcaemia and would be harmful here.

What concept does this question test?

It tests Calcium disorders in General Medicine. Initial therapy is aggressive intravenous saline for volume repletion and calciuresis, followed by an intravenous bisphosphonate such as zoledronic acid. Calcitonin gives a rapid but short-lived effect.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Calcium disorders?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.