Primary hyperparathyroidism — SCE Rheumatology MCQ

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EasyMetabolic bone diseasePrimary hyperparathyroidismSCE Rheumatology

A 42-year-old woman has recurrent renal stones, bone pain and fatigue. Examination shows there is no inflammatory synovitis. Investigations show calcium and PTH are raised. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: E — Primary hyperparathyroidism

Primary hyperparathyroidism is the best answer because the pattern described is most consistent with Primary hyperparathyroidism, including the distribution of symptoms and the targeted investigation results. Septic arthritis is a plausible distractor, but it does not account for the key discriminator in the stem. Reactive arthritis and Anti-CCP positive rheumatoid arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while Rotator cuff tendinopathy is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: NICE CG146; NOGG guideline; BNF