Calcium drugs: hypercalcaemia of malignancy: practice question

A Pharmacology 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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Pharmacology · Calcium drugs: hypercalcaemia of malignancy

Sample item

A 60-year-old man with metastatic squamous cell carcinoma of the lung is confused, polyuric and dehydrated. His corrected calcium is 14.2 mg/dL. What is the first step in management?

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

The answer and the reasoning

B. Aggressive intravenous 0.9% saline rehydration

Hypercalcaemia causes nephrogenic diabetes insipidus and volume depletion, which reduce renal calcium excretion. Restoring volume with isotonic saline is the first step, with a bisphosphonate such as zoledronic acid added because its effect takes two to four days. Calcitonin gives a rapid but short-lived reduction, and loop diuretics are used only after volume repletion.

Option by option

  • A. Intravenous furosemide before fluids

    A loop diuretic given before volume repletion worsens dehydration and kidney injury.

  • B. Aggressive intravenous 0.9% saline rehydration (correct)

    Saline restores volume and promotes calciuresis, and is the immediate first step.

  • C. Oral calcium restriction only

    Dietary calcium restriction has a negligible effect on malignancy-related hypercalcaemia.

  • D. Zoledronic acid alone as the first measure

    Zoledronic acid takes days to act and is given after, or alongside, fluids.

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 Pharmacology question

What is the answer to this Pharmacology question?

The best answer is B, Aggressive intravenous 0.9% saline rehydration. Hypercalcaemia causes nephrogenic diabetes insipidus and volume depletion, which reduce renal calcium excretion.

Why is "Intravenous furosemide before fluids" not the answer?

A loop diuretic given before volume repletion worsens dehydration and kidney injury.

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

Dietary calcium restriction has a negligible effect on malignancy-related hypercalcaemia.

Why is "Zoledronic acid alone as the first measure" not the answer?

Zoledronic acid takes days to act and is given after, or alongside, fluids.

What concept does this question test?

It tests Calcium drugs: hypercalcaemia of malignancy in Pharmacology. Restoring volume with isotonic saline is the first step, with a bisphosphonate such as zoledronic acid added because its effect takes two to four days. Calcitonin gives a rapid but short-lived reduction, and loop diuretics are used only after volume repletion.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 drugs: hypercalcaemia of malignancy?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology 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.