Surgery MCQs Q13

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SURGERY • ENDOCRINE

A 55-year-old woman is found to have elevated serum calcium during routine laboratory testing. Further evaluation confirms primary hyperparathyroidism.

Which of the following is the most common clinical manifestation of this condition?

A Bone disease

B Peptic ulceration

C Constipation

D Renal stone disease

E Polyuria

Renal stone disease is the most common symptomatic presentation of primary hyperparathyroidism. Excess PTH increases renal calcium filtration, leading to hypercalciuria and stone formation.

Decoding Clue

1

CLUE "Primary Hyperparathyroidism"

TRANS The "Stones" part of the classic "Bones, Stones, Groans" mnemonic is the most frequent symptomatic finding.

2

CLUE "Routine lab testing"

TRANS Many patients are now asymptomatic at diagnosis, but of those with symptoms, renal stones lead the list.

Option Analysis

A. Bone disease: Includes osteitis fibrosa cystica. Historically common, but less frequent today due to early biochemical screening.

B. Peptic ulceration: Hypercalcemia stimulates gastrin, but this is a much less common clinical finding than stones.

C. Constipation: A non-specific "Groan" of hypercalcemia, common but not the defining clinical manifestation.

E. Polyuria: Results from nephrogenic diabetes insipidus; less frequent than urolithiasis.

High-yield

The mnemonic "Bones, Stones, Groans, and Psychiatric Overtones" summarizes hypercalcemia. Renal stones are the most common symptomatic clinical manifestation of primary hyperparathyroidism.

Relevant Lab Challenges

Challenge #1: Classic Labs

What are the typical levels of Calcium, Phosphate, and PTH in primary hyperparathyroidism?

Answer: Elevated Calcium, Decreased Phosphate, and Elevated (or inappropriately normal) PTH.

Challenge #2: Most Common Cause

What is the most common underlying pathology for this condition?

Answer: A solitary parathyroid adenoma (~85% of cases).

Challenge #3: Calcium Range

What is the normal range for serum calcium?

Answer: 8.5–10.5 mg/dL (2.1–2.6 mmol/L).

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