MKSAP: 58-year old woman with fatigue and weight loss

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 58-year old woman is evaluated for a 3-week history of fatigue and weight loss. The patient has no significant medical history and takes no prescription medication, but she does take a daily over-the-counter multivitamin and a calcium supplement. She has a 50-pack-year smoking history. Physical examination reveals a lethargic, ill-appearing woman. Temperature is 37.3 °C (99.1 °F), blood pressure is 136/78 mm Hg, pulse rate is 95/min, and respiration rate is 12/min. Other physical examination findings are unremarkable. Laboratory studies: Hemoglobin 8.3 g/dL (83 g/L) Albumin 4.6 g/dL (46 g/L) Blood urea nitrogen 43 mg/dL (15.4 mmol/L) Calcium 14.5 mg/dL (3.6 mmol/L) Creatinine 2.4 mg/dL (212 µmol/L) Sodium 145 mEq/L (145 mmol/L) A chest radiograph shows a 5-cm mass in the right lower lobe of the lung but is otherwise unremarkable. Which of the following is the most likely cause of her hypercalcemia? A: Malignancy B: Primary hyperparathyroidism C: Sarcoidosis D: Vitamin D intoxication Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how.
Source: Kevin, M.D. - Medical Weblog - Category: Family Physicians Tags: Conditions Cancer Endocrinology Source Type: blogs