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Self-Assessment Questions


Calcium and Bone Metabolism: Review Questions

Catherine Anastasopoulou, MD, FACE

Dr. Anastasopoulou is a housestaff endocrinologist at
Albert Einstein Medical Center, Philadelphia, PA.

Choose the single best answer for each question.

Questions 1 and 2 refer to the following case study.
A 55-year-old woman with a history of sarcoidosis and Graves’ disease who is taking corticosteroids and antithyroid medication is hospitalized because of hemoptysis. Results of initial laboratory measurements show a serum calcium level of 10.9 mg/dL (normal, 8.8-10.2 mg/dL); further testing reveals an intact parathyroid hormone level of 50 pg/mL (normal, 10-65 pg/mL).

1. Which of the following is the most likely cause of hypercalcemia in this patient?
  1. Hyperthyroidism
  2. Lung cancer
  3. Medications
  4. Primary hyperparathyroidism
  5. Sarcoidosis
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2. When the patient is questioned about symptoms, she reports no fatigue, constipation, or weakness. Results of further biochemical blood tests are normal, including indicators of renal function. Which of the following tests should be ordered next in the evaluation and management of hypercalcemia in this patient?

  1. Bone scan
  2. Computed tomography of the chest
  3. Dual-energy x-ray absorptiometry bone density measurement
  4. Lung biopsy
  5. Measurement of vitamin D levels
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3. A 45-year-old man is brought to the hospital with a hip fracture following a minor fall. Bone density measurement of the patient’s spine and hip reveals osteoporosis. Which of the following serum levels should be measured in this patient?

  1. Growth hormone
  2. Magnesium
  3. Sodium and potassium
  4. Vitamin B12 and folic acid
  5. Vitamin D and calcium
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4. Which of the following statements is true regarding the bisphosphonate medications used for the treatment of patients with osteoporosis?
  1. The newest of these medications are completely safe for patients with gastrointestinal problems
  2. They are contraindicated in patients with renal impairment
  3. They are safe to use during breast feeding, because they are not secreted into the breast milk
  4. They can cause osteomalacia when used continuously
  5. They increase bone mass by stimulating osteoblasts to form new bone
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5. A 70-year-old woman with no significant medical history presents with severe back pain. Radiography of her spine and pelvis shows diffusely decreased bone mass, and general laboratory measurements reveal a low calcium level. Which of the following is the most likely cause of this patient’s hypocalcemia?

  1. Multiple myeloma
  2. Osteoporosis
  3. Primary hyperparathyroidism
  4. Renal failure
  5. Vitamin D deficiency
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6. Which of the following statements is true regarding Paget’s disease?

  1. It can be complicated by osteosarcoma
  2. It is characterized by a uniform pathology pattern
  3. It occurs commonly after chemotherapy for lymphoma
  4. It occurs more frequently in women than in men
  5. It presents with abnormal calcium and phosphorus levels
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