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Hypercalcemia of malignancy — USMLE Step 2 CK MCQ

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EasyInternal MedicineHypercalcemia of malignancyUSMLE Step 2 CK

A 57-year-old Hispanic man comes to the hospital because of neurologic symptoms. History and focused examination are notable for confusion, constipation, bone pain, and calcium of 14 mg/dL. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most appropriate pharmacotherapy?

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Correct answer: D — Intravenous normal saline and zoledronic acid

The vignette describes Hypercalcemia of malignancy, supported by confusion, constipation, bone pain, and calcium of 14 mg/dL. Intravenous normal saline and zoledronic acid is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: Endocrine Society 2023 Hypercalcemia of Malignancy Guideline