Calcium and Parathyroid USMLE Step 1 Practice Question
A 58-year-old man with recently diagnosed primary hyperparathyroidism presents asymptomatic. Vital signs: BP 138/86 mmHg, HR 78 bpm, RR 16, temp 37°C. Labs show serum calcium 11.8 mg/dL, PTH 142 pg/mL, creatinine 0.9 mg/dL, and 24-hour urine calcium 180 mg/day. Bone density is normal. He denies nephrolithiasis, fractures, or neurocognitive symptoms. He declines surgery and seeks medical management. Which medication is most appropriate?
Answer choices
- ABisphosphonates to inhibit bone resorption and lower calcium
- BThiazide diuretics to promote renal calcium reabsorption
- CCalcimimetic agents (cinacalcet) to enhance calcium sensing and suppress PTH secretionCorrect answer
- DHigh-dose vitamin D to suppress secondary hyperparathyroidism
- ELoop diuretics to increase urinary calcium excretion
- FDenosumab as an anti-resorptive agent inhibiting RANKL to protect bone without lowering serum calcium
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