Calcium and Parathyroid USMLE Step 1 Practice Question
A 68-year-old man with stage 3 CKD (eGFR 35 mL/min/1.73 m²) on lisinopril presents with fatigue. Vital signs: BP 142/88, HR 76, RR 14, temp 37°C. Labs reveal serum calcium 8.2 mg/dL, phosphate 4.8 mg/dL, PTH 120 pg/mL, and 25-OH vitamin D 22 ng/mL. Urinalysis is unremarkable. Which of the following is the most appropriate initial management?
Answer choices
- AParathyroidectomy
- BAcute hemodialysis
- CVitamin D supplementation and phosphate bindersCorrect answer
- DCalcitonin injection
- ECalcium supplementation alone
- FCalcitriol preferred over ergocalciferol in advanced CKD
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