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MDD continuation — USMLE Step 3 MCQ

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HardPsychiatry (Outpatient Management)MDD continuationUSMLE Step 3

A 67-year-old with metastatic squamous-cell carcinoma is confused and dehydrated. Corrected calcium is 15.8 mg/dL, creatinine is 1.7 mg/dL, and ECG shows a shortened QT interval. Which initial treatment bundle best provides both rapid and sustained calcium reduction?

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Correct answer: E — Give isotonic saline, calcitonin, and renally assessed intravenous zoledronic acid

The best answer is “Give isotonic saline, calcitonin, and renally assessed intravenous zoledronic acid”. Severe symptomatic hypercalcemia needs volume restoration, rapidly acting calcitonin, and sustained antiresorptive therapy. Calcitonin alone tachyphylaxes. Loop diuresis before repletion worsens volume loss. Cinacalcet is not the acute standard here, and antiresorptive therapy does not replace resuscitation. The alternatives are less suitable because they mistime the intervention, omit a necessary component, or apply treatment for a different physiologic problem; the stem's decisive findings determine the sequence.

Reference: Endocrine Society, Hypercalcemia of Malignancy Guideline: https://www.endocrine.org/clinical-practice-guidelines/hypercalcemia