EMQs in Clinical Medicine.pdf - Peshawar Medical College

200 Metabolic and endocrine disturbances
82 Hypercalcaemia
A
B
C
D
E
F
G
sarcoidosis
secondary hyperparathyroidism
venesection
hypoparathyroidism
PTH-like hormone secretion
myeloma
tertiary hyperparathyroidism
H
I
J
K
L
vitamin D toxicity
Paget’s disease
benign hypocalciuric hypercalcaemia
bone metastases
thyrotoxicosis
For each clinical scenario below, give the most likely cause for the hypercalcaemia.
Each option may be used only once.
1 An 80-year-old woman presents with weight loss and back pain. Investigations
reveal an elevated erythrocyte sedimentation rate (ESR) and marked excretion of
immunoglobulin light chains in the urine.
2 A 35-year-old man presents with dry cough and shortness of breath. His chest
radiograph shows bilateral hilar lymphadenopathy.
3 A 35-year-old woman with breast cancer complains of pain and tenderness over
the upper lumbar region. Alkaline phosphatase 400 U/l.
4 A 55-year-old smoker has recently been diagnosed with squamous cell lung
cancer. The bone scan is unremarkable.
5 Hypercalcaemia in a 45-year-old man after renal transplantation.
Answers: see page 207.