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A 52-Year-Old Woman Comes to the Office to Discuss an Elevated

question 231

Multiple Choice

A 52-year-old woman comes to the office to discuss an elevated calcium level. Mild hypercalcemia was recently noted on a serum chemistry panel performed to manage her chronic antihypertensive therapy. The patient has no musculoskeletal symptoms other than occasional low back pain, and she walks 2-3 miles every day. She experienced menopause 2 years ago but has minimal vaginal dryness and no hot flashes. Current medications include lisinopril and a daily over-the-counter calcium and vitamin D supplement. Her mother suffered a hip fracture at age 60, and her father died of prostate cancer. The patient does not use tobacco, alcohol, or illicit drugs.
Blood pressure is 144/91 mm Hg and pulse is 68/min. BMI is 25 kg/m². Physical examination is unremarkable.
Laboratory results are as follows:
$A 52-year-old woman comes to the office to discuss an elevated calcium level. Mild hypercalcemia was recently noted on a serum chemistry panel performed to manage her chronic antihypertensive therapy. The patient has no musculoskeletal symptoms other than occasional low back pain, and she walks 2-3 miles every day. She experienced menopause 2 years ago but has minimal vaginal dryness and no hot flashes. Current medications include lisinopril and a daily over-the-counter calcium and vitamin D supplement. Her mother suffered a hip fracture at age 60, and her father died of prostate cancer. The patient does not use tobacco, alcohol, or illicit drugs. Blood pressure is 144/91 mm Hg and pulse is 68/min. BMI is 25 kg/m<sup>2</sup>. Physical examination is unremarkable. Laboratory results are as follows: Repeat serum calcium is 10.9 mg/dL and parathyroid hormone level is 89 pg/mL (normal: 10-65) . X-rays of the thoracic and lumbar spine reveal no fractures. DXA reveals T-scores as follows: Which of the following is the most appropriate next step in management of this patient? A) 24-hour urinary calcium measurement B) Bisphosphonate therapy C) Follow-up in 6-12 months D) Referral for parathyroid surgery E) Ultrasound of the neck$ Repeat serum calcium is 10.9 mg/dL and parathyroid hormone level is 89 pg/mL (normal: 10-65) . X-rays of the thoracic and lumbar spine reveal no fractures. DXA reveals T-scores as follows:
$A 52-year-old woman comes to the office to discuss an elevated calcium level. Mild hypercalcemia was recently noted on a serum chemistry panel performed to manage her chronic antihypertensive therapy. The patient has no musculoskeletal symptoms other than occasional low back pain, and she walks 2-3 miles every day. She experienced menopause 2 years ago but has minimal vaginal dryness and no hot flashes. Current medications include lisinopril and a daily over-the-counter calcium and vitamin D supplement. Her mother suffered a hip fracture at age 60, and her father died of prostate cancer. The patient does not use tobacco, alcohol, or illicit drugs. Blood pressure is 144/91 mm Hg and pulse is 68/min. BMI is 25 kg/m<sup>2</sup>. Physical examination is unremarkable. Laboratory results are as follows: Repeat serum calcium is 10.9 mg/dL and parathyroid hormone level is 89 pg/mL (normal: 10-65) . X-rays of the thoracic and lumbar spine reveal no fractures. DXA reveals T-scores as follows: Which of the following is the most appropriate next step in management of this patient? A) 24-hour urinary calcium measurement B) Bisphosphonate therapy C) Follow-up in 6-12 months D) Referral for parathyroid surgery E) Ultrasound of the neck$ Which of the following is the most appropriate next step in management of this patient?

Definitions:

Apex

The top or highest part of something, often used to describe the pointed end of the heart.

Circumflex Artery

An artery that branches off from the coronary arteries to supply the heart muscle with oxygenated blood.

Inferior Vena Cava

The largest vein in the human body, which carries deoxygenated blood from the lower and middle body into the right atrium of the heart.

Pulmonary Vein

A vascular channel that transports blood enriched with oxygen from the lungs to the heart's left atrium.