Endocrinology and diabetes: hypercalcaemia of malignancy treatment: 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.

Try it

General Medicine · Endocrinology and diabetes: hypercalcaemia of malignancy treatment

Sample item

A 62-year-old man with squamous cell lung cancer has confusion, polyuria and dehydration. Serum calcium is 14.2 mg/dL, PTH is suppressed and PTHrP is raised. After starting intravenous isotonic saline, which drug gives the most durable reduction in calcium?

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

The answer and the reasoning

D. Zoledronic acid

Hypercalcaemia of malignancy is mainly caused by PTHrP-driven bone resorption. After rehydration, an intravenous bisphosphonate inhibits osteoclasts and lowers calcium over days for weeks. Calcitonin acts quickly but loses effect within a couple of days.

Option by option

  • A. Cinacalcet

    Cinacalcet acts on the parathyroid calcium sensor, but PTH is already suppressed.

  • B. Salmon calcitonin

    Calcitonin acts rapidly but its effect fades from tachyphylaxis.

  • C. Hydrochlorothiazide

    Thiazides reduce urinary calcium excretion and would raise calcium further.

  • D. Zoledronic acid (correct)

    Correct. Bisphosphonates give a sustained fall in calcium by inhibiting bone resorption.

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.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Zoledronic acid. Hypercalcaemia of malignancy is mainly caused by PTHrP-driven bone resorption.

Why is "Cinacalcet" not the answer?

Cinacalcet acts on the parathyroid calcium sensor, but PTH is already suppressed.

Why is "Salmon calcitonin" not the answer?

Calcitonin acts rapidly but its effect fades from tachyphylaxis.

Why is "Hydrochlorothiazide" not the answer?

Thiazides reduce urinary calcium excretion and would raise calcium further.

What concept does this question test?

It tests Endocrinology and diabetes: hypercalcaemia of malignancy treatment in General Medicine. After rehydration, an intravenous bisphosphonate inhibits osteoclasts and lowers calcium over days for weeks. Calcitonin acts quickly but loses effect within a couple of days.

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 Endocrinology and diabetes: hypercalcaemia of malignancy treatment?

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.