A 52-Year-Old Woman Comes to the Physician for Routine Follow-Up

question 418

Multiple Choice

A 52-year-old woman comes to the physician for routine follow-up.  She has no complaints and thinks of herself as "pretty healthy."  She takes lisinopril and hydrochlorothiazide for hypertension and lansoprazole for gastroesophageal reflux disease.  She was treated with isoniazid for latent tuberculosis 7 years ago.  Her mother died of uterine cancer at age 62.  The patient does not smoke.  She jogs 3 miles a day and eats a balanced diet.  She takes 2000 units of vitamin D3 a day orally as a dietary supplement.
Her blood pressure is 139/82 mm Hg and pulse is 74/min.  Her BMI is 28 kg/m².  There are no neck masses or lymph node enlargement.  Breast examination is unremarkable.  Lungs are clear to auscultation.  The spleen is not palpable.  There are no skin rashes.
Laboratory results are as follows:

Repeat calcium level is 12.1 mg/dL.  Hydrochlorothiazide is discontinued.
Which of the following is the most likely diagnosis?

• A)Granulomatous disease
• B)Occult malignancy
• C)Osteoporosis
• D)Parathyroid adenoma
• E)Vitamin D toxicity

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Definitions:

Locus Of Control

A psychological concept that refers to individuals' belief about the extent to which the outcomes of their actions are under their own control (internal locus) or influenced by external forces (external locus).

Social Institutions

Structured systems of social order that govern the behavior and expectations of individuals within a society.

Education

The process of facilitating learning, or the acquisition of knowledge, skills, values, beliefs, and habits through various means such as teaching, training, or research.

Religion

A system of beliefs, practices, and moral codes that shapes individuals' spirituality and worship.