Calcium and Bone Metabolism Questions
Normal Laboratory Reference values
| Laboratory Test | Normal Range in US Units | Normal Range in SI Units | To Convert U.S. to SI Units |
| ALT (Alanine aminotransferase) | F 7-30 units/L | F 0.12-0.50 µkat/L | x 0.01667 |
| M 10-55 units/L | M 0.17-0.92 µkat/L | ||
| Albumin | 3.1 – 4.3 g/dL | 31 – 43 g/L | x 10 |
| Alkaline Phosphatase | F 30-100 units/L M 45-115 units/L | F 0.5-1.67 µkat/L M 0.75-1.92 µkat/L | x 0.01667 |
| Amylase (Serum) | 53-123 units/L | 0.88-2.05 nkat/L | x 0.01667 |
| AST (Aspartate aminotransferase) | F 9-25 units/L | F 0.15-0.42 µkat/L | x 0.01667 |
| M 10-40 units/L | M 0.17-0.67 µkat/L | ||
| Basophils | 0-3% of lymphocytes | 0.0-0.03 fraction of white blood cells | x 0.01 |
| Bilirubin – Direct | 0.0-0.4 mg/dL | 0-7 µmol/L | x 17.1 |
| Bilirubin – Total | 0.0-1.0 mg/dL | 0-17 µmol/L | |
| Blood pressure | Normal: 120/70 to 120/80 millimeters of mercury (mmHg). Top number is systolic pressure, when heart is pumping. Bottom number is diastolic pressure when heart is at rest. Blood pressure can be too low (hypotension) or too high (hypertension). | No conversion | |
| C peptide | 0.5-2.0 ng/mL | 0.17-0.66 nmol/L | x 0.33 |
| Calcium, serum | 8.5-10.5 mg/dL | 2.1-2.6 mmol/L | x 0.25 |
| Calcium, urine | 0-300 mg/24hr | 0.0-7.5 mmol/24hr | x 0.025 |
| CO2 (Bicarbonate) | 20-32 mmol/L | 20-32 mmol/L | No conversion |
| Chloride | 95-108 mmol/L | 95-108 mmol/L | No conversion |
| Cholesterol, Total | <200 mg/dL | <5.17 mmol/L | x 0.02586 |
| Marginal | 200-239 mg/dL | 5.17-6.18 mmol/L | |
| High | >239 mg/dl | >6.18 mmol/L | |
| Cholesterol, LDL | <100 mg/dL | <2.59 mmol/L | |
| Marginal | 100-159 mg/dL | 2.59-4.14 mmol/L | |
| High | 160-189 mg/dL | 4.14 – 4.89 mmol/L | |
| Very High | >190 mg/dL | >4.91 mmol/L | |
| Cholesterol, HDL | >60 mg/dL | >1.55 mmol/L | |
| Moderate | 40-60 mg/dL | 1.03-1.55 mmol/L | |
| Low (heart risk) | <40 mg/dL | <1.03 mmol/L | |
| Cortisol: serum free (urine) | 0-25 µg/dL (depends on time of day) | 0-690 nmol/L | x 27.59 |
| 20-70 µg/dL | 55-193 nmol/24hr | x 2.759 | |
| Creatine kinase | F 40-150 units/L M 60-400 units/L | F 0.67-2.50 µkat/L M 1.00-6.67 µkat/L | x 0.01667 |
| Creatinine (urine) | F 0.6-1.8 g/day M 0.8-2.4 g/day | F 5.3-15.9 mmol/day M 7.1-21.2 mmol/day | x 88.4 |
| DHEA | F 130-980 ng/dL M 180-1250 ng/dL | F 4.5-34.0 nmol/L M 6.24-43.3 nmol/L | x 0.03467 |
| DHEA Sulfate | F Pre-menopause: 12-535 µg/dL | F Pre-menopause: 120-5350 µg/L | x 10 |
| F Post-menopause: 30-260 µg/dL | F Post-menopause: 300-2600 µg/L | ||
| M 10-619 µg/dL | M 100-6190 µg/L | ||
| Eosinophils | 0-8% of white blood cells | 0.0-0.8 fraction of white blood cells | x 0.01 |
| Erythrocyte sedimentation rate (Sed Rate) | F £ 30 mm/h M £ 20 mm/h | F £ 30 mm/h M £ 20 mm/h | No conversion |
| Folate | 3.1-17.5 ng/mL | 7.0-39.7 nmol/L | x 2.266 |
| Glucose, urine | <0.05 g/dl | <0.003 mmol/L | x 0.05551 |
| Glucose, plasma | 70-110 mg/dL | 3.9-6.1 mmol/L | |
| Gamma glutamyl transferase (GGT) | F £ 45 U/L M £ 65 U/L | F £ 45 U/L M £ 65 U/L | No conversion |
| Laboratory Test | Normal Range in U.S. Units | Normal Range in SI Units | To Convert US to SI Units |
| Hematocrit | F 36.0-46.0% of red blood cells | F 0.36-0.46 fraction of red blood cells | x 0.01 |
| M 37.0-49.0% of red blood cells | M 0.37-0.49 fraction of red blood cells | ||
| Hemoglobin | F 12.0-16.0 g/dL M 13.0-18.0 g/dL | F 7.4-9.9 mmol/L M 8.1-11.2 mmol/L | x 0.6206 |
| Lactate dehydrogenase (LDH) (total) | £ 270 U/L | £ 4.5 µkat/L | X 0.016667 |
| Lactic acid | 0.5-2.2 mmol/L | 0.5-2.2 mmol/L | No conversion |
| Leukocytes (WBC) | 4.5-11.0 x 103/mm3 | 4.5-11.0 x 109/liter | No conversion |
| Lymphocytes | 16-46% of white blood cells | 0.16-0.46 fraction of white blood cells | x 0.01 |
| Mean corpuscular hemoglobin (MCH) | 25.0-35.0 pg/cell | 25.0-35.0 pg/cell | No conversion |
| Mean corpuscular hemoglobin concentration (MCHC) | 31.0-37.0 g/dL | 310-370 g/L | x 10 |
| Mean corpuscular volume (MCV) | F 78-102 µm3 M 78-100 µm3 | F 78-102 fl M 78-100 fl | No conversion |
| Monocytes | 4-11% of white blood cells | 0.04-0.11 fraction of white blood cells | x 0.01 |
| Neutrophils | 45-75% of white blood cells | 0.45-0.75 fraction of white blood cells | x 0.01 |
| Phosphorus | 2.5-4.5 mg/dL | 0.81-1.45 mmol/L | X 0.323 |
| Platelets (Thrombocytes) | 130-400 x 103/µL | 130-400 x 109/L | No conversion |
| Potassium | 3.4-5.0 mmol/L | 3.4-5.0 mmol/liter | No conversion |
| Red Blood Cell Count (RBC) | F 3.9-5.2 x 106/µL M 4.4–5.8 x 106/µL | F 3.9-5.2 x 1012/L M W 4.4-5.8 x 1012/L | No conversion |
| Sodium | 135-145 mmol/liter | 135-145 mmol/liter | No conversion |
| Testosterone, total (morning sample) | F 6-86 ng/dL | F 0.21-2.98 nmol/liter | x 0.03467 |
| M 270-1070 ng/dL | M 9.36-37.10 nmol/liter | ||
| Testosterone, Age 20-40
Unbound Age 41-60
Age 61-80 | F 0.6-3.1 pg/mL M 15.0-40.0 pg/mL | F 20.8-107.5 pmol/liter M 520-1387 pmol/liter | x 34.67 |
| F 0.4-2.5 pg/mL M 13.0-35.0 pg/mL | F 13.9-86.7 pmol/liter M 451-1213 pmol/liter | ||
| F 0.2-2.0 pg/mL M 12.0-28.0 pg/mL | F 6.9-69.3 pmol/liter M 416-971 pmol/liter | ||
| Triglycerides Normal (fasting) Borderline High Very High | 40-150 mg/dL 150-200 mg/dL 200-500 mg/dL >500 mg/dL | 0.45-1.69 mmol/liter 1.69-2.26 mmol/liter 2.26-5.65 mmol/liter >5.65 mmol/liter | x 0.01129 |
| Urea, plasma (BUN) | 8-25 mg/dL | 2.9-8.9 mmol/liter | x 0.357 |
| Urinalysis: pH Specific gravity | 5.0-9.0 | 5.0-9.0 | No conversion |
| 1.001-1.035 | 1.001-1.035 | ||
| WBC (White blood cells, Leukocytes) | 4.5-11.0 x 103/mm3 | 4.5-11.0 x 109/liter | No conversion |
Calcium and Bone Metabolism Questions
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- Incorrect
- 1. Question
Which of the following statements regarding treatment failure in osteoporosis is inaccurate?
CorrectIncorrect - 2. Question
Which of these pairs of sequential therapy for osteoporosis is suboptimal.
CorrectIncorrect - 3. Question
A 67-year-old female with primary osteoporosis has been on oral alendronate for 5 years, with a statistically significant improvement in her BMD scores at the hip and lumbar vertebra. She follows fall preventive precautions and is on the recommended dose of calcium and vitamin D. Her current T score at the hip is less than -2.6. She has not sustained any fracture since starting anti-resorptive therapy. She has a high frailty score (SF-36) and has fallen twice within the past year. What would you suggest at this time?
CorrectIncorrect - 4. Question
Which of the following is not an indication for antiresorptive therapy in patients with Paget’s disease.
CorrectIncorrect - 5. Question
A 72-year-old woman with osteoporosis on alendronate presents to her primary care provider’s office with right-sided thigh pain. Patient has been on alendronate for 8 years due to her high fracture risk. A plain radiograph of the right femur and hip joint is significant for a localized area of periosteal thickening of the lateral cortex of the right femur. What should the PCP recommend?
CorrectIncorrect - 6. Question
A 68-year-old is recently diagnosed with Paget’s disease of bone, which of these treatments is guideline recommended for the management of Paget’s disease of bone (PDB)?
CorrectIncorrect - 7. Question
A 72-year-old man presents to the endocrinology practice with a 2-year history of multiple fragility fractures involving 3 thoracic vertebral bodies, rib fractures, and persistent muscle soreness. She endorses persistent lower extremity weakness as well.
Alkaline phosphatase 203 u/L (60 to 120) PTH 60ng/L (15 to 65) 25 Hydroxyvitamin D level 42 (30 to 100ng/mL) 1,25 Hydroxyvitamin D level 12 (15 to 55pg/mL) Calcium 9.8 mg/dL (8.5 to 10.2) Phosphorus 0.8 mg/dL (2.5 to 4.5)
What is this patient’s most likely diagnosis?
CorrectIncorrect - 8. Question
A 32-year-old woman is admitted to the emergency room with symptomatic moderate hypercalcemia. Serum calcium of 12.3 mg/dL (8.5 to 10.3), phosphorus of 4.1 mg/dL (2.5 to 4.5). She has a 1,25 dihydroxy vitamin D level more than twice the upper limit of normal. PTH is 8 pg/mL (15 to 65). Her 24hour urinary calcium is elevated at 680mg (100 to 300). What would you recommend next?
CorrectIncorrect - 9. Question
There are multiple hormones involved in calcium physiology, which of these pairs comparing a hormone with its mechanism of action is inaccurate?
CorrectIncorrect - 10. Question
A 28-year-old woman with recently diagnosed primary hyperparathyroidism is now 14 weeks pregnant. What is your concern for the patient’s unborn offspring, after delivery?
CorrectIncorrect - 11. Question
A 56-year-old woman undergoes parathyroidectomy for primary hyperparathyroidism. His pre-incision PTH was elevated at 160 (20-65), his intraoperative PTH fell by less than 5% after removal of two parathyroids, it eventually decreased by more than 50% after removal of the third parathyroid gland with a PTH level of 78. The fourth parathyroid gland was normal in size and attached to the superior right lobe of the thyroid gland. What is your interpretation of this sequence of intraoperative events?
CorrectIncorrect - 12. Question
An otherwise healthy 86 year old woman undergoes a successful single parathyroid adenomectomy which lasted 30 minutes. Her pre-operative PTH was 75 (20-63), serum calcium of 10.8 (8.3-10.2), albumin 3.9, ionized calcium 5.5 (4.0-5.2), and 26 hydroxyvitamin D level of 20 (30-100).
She reports to the emergency room 3 days after surgery with persistent acral paresthesias and is noted to have a positive Trousseau’s sign. What is the most likely cause of her postoperative hypocalcemia?
CorrectIncorrect - 13. Question
An otherwise healthy 80-year-old female with a history of stage IIIa chronic kidney disease presents to the ED with severe pain in the lower back after sustaining a fall from a standing height. Vital signs are stable with an unremarkable physical exam except for point tenderness over the L4 spinous process. Her serum calcium is 10.0 (8.3-10.2), albumin 4.0, PTH 66 (20-63). She has an L4 vertebral fracture noted on a plain radiograph of the lumbosacral spine.
What is the most likely diagnosis?
CorrectIncorrect - 14. Question
A 45-year-old woman with end-stage renal disease on chronic hemodialysis presents to the emergency with a dark eschar on her right anterolateral shin which has progressively increased in size over the past few weeks. She has a history of multiple fragility fractures involving the thoracic spine. Her serum calcium is 11.5 (8.3-10.2), albumin 4.0, PTH 926 (20-63) and phosphorus 7.2 (<4.5). She is currently on cinacalcet and sevelamer (phosphate binder). What is the next step in the management of this patient?
CorrectIncorrect - 15. Question
An obese patient with a short stature and dimples over the 4th and 5th metacarpophalangeal joints upon making a fist, presents to your office for an annual physical. Which of these biochemical panels is suggestive of pseudopseudohypoparathyroidism?
Serum Calcium Serum Phosphate Serum PTH 1 LOW HIGH LOW 2 LOW HIGH LOW 3 LOW HIGH HIGH 4 NORMAL LOW HIGH 5 NORMAL NORMAL NORMAL CorrectIncorrect - 16. Question
A patient is referred to you by an ENT surgeon due to refractory hypocalcemia. The patient is a 23-year-old female who underwent an extensive total thyroidectomy for an aggressive papillary thyroid cancer 6 months earlier. She developed permanent postoperative hypoparathyroidism as a result of the extensive surgery. Her current regimen includes 2 grams of calcium carbonate 4 times a day and calcitriol 0.25mcg twice daily. She endorses chronic constipation which has not improved with fiber supplementation and increased fluid intake. She has no subjective symptoms or objective clinical findings for hypocalcemia. Her 24hour urinary calcium excretion is 410 (<300mg per day). Serum calcium is 8.1 (8.3-10.2), albumin 4.0, PTH (not checked by the referring surgeon), phosphorus 4.4 (2.5 -4.5) and a normal serum magnesium.
What would you be your next step in the management of this patient?
CorrectIncorrect - 17. Question
Which of these medications has not shown a demonstrable effect in reducing vertebral, nonvertebral and hip fractures?
CorrectIncorrect - 18. Question
23-year-old female was evaluated by her primary care doctor during an annual physical exam. Her medical history is significant for recurrent acute pancreatitis and cholelithiasis. She was noted to have serum calcium of 11.2 (8.3-10.2), albumin 3.9, ionized calcium 5.4 (4.0-5.2), PTH 57 (20-63) and 25 hydroxyvitamin D level of 42(30-100). Her estimated GFR 62 and a fractional calcium to creatinine excretion ratio is markedly suppressed at 0.005. What is this patient’s diagnosis?
CorrectIncorrect - 19. Question
A 76-year-old female with no significant past medical history. Presented with a 4-month history of generalized bone pain. She had no other symptoms. Physical exam was significant for 2+ pallor and moist mucous membranes. Her laboratory investigations were remarkable for serum calcium of 19 (8.3-10.2), albumin 3.9, ionized calcium 4.2 (4.0-5.2), PTH 25 (20-63) and Cr of 0.5. The patient was diagnosed with multiple myeloma due to hypercalcemia, multiple lytic bone lesions, and an abnormal serum protein electrophoresis.
What should be done next?
CorrectIncorrect - 20. Question
Category: Board Review Endocrinology
A 45-year-old female presents with muscle weakness, lethargy, and an elevated serum calcium level. Further testing reveals an elevated PTH level. Which of the following conditions is most likely responsible for her symptoms?
CorrectIncorrectPrimary hyperparathyroidism is characterized by elevated serum calcium and PTH levels.
- 21. Question
Category: Board Review Endocrinology
A 36-year-old male with a history of bipolar disorder has been on lithium therapy for several years. He presents with mild hypercalcemia and slightly elevated PTH levels. Which of the following is a likely explanation for his findings?
CorrectIncorrectLithium therapy can affect calcium-sensing, leading to mild hypercalcemia and slightly elevated PTH levels.
- 22. Question
Category: Board Review Endocrinology
Which of the following is primarily responsible for regulating parathyroid hormone (PTH) secretion in response to changes in serum calcium levels?
CorrectIncorrectPTH secretion is primarily regulated by extracellular calcium levels through a specific receptor on the surface of parathyroid cells.
- 23. Question
Category: Board Review Endocrinology
In familial hypocalciuric hypercalcemia (FHH), what type of mutation in the calcium-sensing receptor (CaSR) is responsible for the clinical presentation?
CorrectIncorrectFHH is caused by a specific type of mutation in the CaSR that leads to a shift in the calcium-PTH curve, resulting in hypercalcemia.
- 24. Question
Category: Board Review Endocrinology
A 65-year-old woman with stage 5 chronic kidney disease presents with secondary hyperparathyroidism. Which calcimimetic drug is approved in the United States for the treatment of secondary hyperparathyroidism in stage 5 chronic kidney disease patients?
CorrectIncorrectThis drug is a calcimimetic that inhibits PTH secretion and synthesis and parathyroid cell proliferation.
- 25. Question
Category: Board Review Endocrinology
Which vitamin D analog inhibits PTH synthesis and secretion to a greater extent than it stimulates intestinal calcium absorption or bone resorption?
CorrectIncorrectThis analog is used in patients with chronic renal failure and secondary hyperparathyroidism.
- 26. Question
Category: Board Review Endocrinology
Which PTH receptor selectively binds PTH but not PTHrP and is heavily expressed in the central nervous system, cardiovascular, and gastrointestinal systems?
CorrectIncorrectThis receptor may be involved in the perception of pain.
- 27. Question
Category: Board Review Endocrinology
Which part of the PTH molecule possesses hypocalcemic activity?
CorrectIncorrectNovel PTH receptors have specificity for this region of the hormone.
- 28. Question
Category: Board Review Endocrinology
A 45-year-old female patient presents with fatigue, bone pain, and mild depression. Laboratory results reveal hypercalcemia, hypophosphatemia, and elevated PTH levels. Which condition is most likely responsible for the patient's symptoms?
CorrectIncorrectConsider the combination of hypercalcemia, hypophosphatemia, and elevated PTH levels.
- 29. Question
Category: Board Review Endocrinology
In primary hyperparathyroidism, PTH acts on which part of the nephron to stimulate calcium reabsorption?
CorrectIncorrectThink about where PTH actively regulates calcium transport in the nephron.
- 30. Question
Category: Board Review Endocrinology
In primary hyperparathyroidism, how does PTH affect the synthesis of calcitriol?
CorrectIncorrectConsider the role of PTH in the synthesis of 1-alpha hydroxylase and its effect on calcitriol.Q4:) Chronic excess of PTH has been implicated in the pathogenesis of which of the following conditions in patients with chronic kidney disease (CKD)?
- 31. Question
Category: Board Review Endocrinology
A 35-year-old woman with celiac disease presents with fatigue and muscle weakness. Her laboratory results show low serum 25-hydroxyvitamin D (25[OH]D) levels. Which of the following is the most likely cause of her vitamin D deficiency?
CorrectIncorrectConsider the relationship between vitamin D absorption and the patient's underlying condition.
- 32. Question
Category: Board Review Endocrinology
Which of the following is the major circulating form of vitamin D?
CorrectIncorrectThink about the form of vitamin D that is synthesized in the liver and has a longer half-life compared to other forms.
- 33. Question
Category: Board Review Endocrinology
Which of the following is the most active form of vitamin D?
CorrectIncorrectConsider the form of vitamin D that is synthesized in the kidneys and has a shorter half-life compared to other forms.
- 34. Question
Category: Board Review Endocrinology
What is the primary function of 1,25-dihydroxyvitamin D?
CorrectIncorrectConsider the role of 1,25-dihydroxyvitamin D in calcium homeostasis and bone metabolism.
- 35. Question
Category: Board Review Endocrinology
A 58-year-old female presents with fatigue, muscle weakness, and bone pain. She has a history of Crohn's disease and has had multiple bowel resections. Her laboratory results show low serum calcium and elevated parathyroid hormone (PTH) levels. Which of the following is the most likely cause of her symptoms?
CorrectIncorrectConsider the patient's history of Crohn's disease and bowel resections, which can lead to malabsorption issues.
- 36. Question
Category: Board Review Endocrinology
A 45-year-old male with sarcoidosis presents with hypercalcemia and hypercalciuria. Which enzyme is responsible for the extrarenal synthesis of 1,25-dihydroxyvitamin D in this patient?
CorrectIncorrectThis enzyme is involved in the activation of vitamin D and is expressed in extrarenal sites, including the lungs and lymph nodes in granulomatous diseases.
- 37. Question
Category: Board Review Endocrinology
Which of the following factors primarily regulates the renal 1-alpha-hydroxylase enzyme?
CorrectIncorrectThis hormone is involved in the regulation of calcium and phosphate homeostasis.
- 38. Question
Category: Board Review Endocrinology
A 35-year-old woman presents to your clinic with fatigue, polyuria, and polydipsia. She has been taking a daily vitamin D supplement of 60,000 international units for the past month. What is the most likely cause of her symptoms?
CorrectIncorrectConsider the patient's daily vitamin D intake and its possible effects on her calcium levels.
- 39. Question
Category: Board Review Endocrinology
A 45-year-old man with a history of Crohn's disease presents with symptoms of vitamin D deficiency. Which of the following factors is most likely contributing to his deficiency?
CorrectIncorrectConsider the patient's history of Crohn's disease and its effects on nutrient absorption.
- 40. Question
Category: Board Review Endocrinology
A 75-year-old woman is at risk of falls and fractures due to subclinical vitamin D deficiency. What is the recommended daily intake of vitamin D for this patient?
CorrectIncorrectConsider the age-specific recommendations for daily vitamin D intake.
- 41. Question
Category: Board Review Endocrinology
A 2-year-old child presents with signs of vitamin D deficiency. Which of the following is the most appropriate laboratory test to determine the child's vitamin D status?
CorrectIncorrectConsider which laboratory test is the best indicator of vitamin D adequacy.
- 42. Question
Category: Board Review Endocrinology
A patient with sarcoidosis presents with hypercalcemia and hypercalciuria. What is the most likely cause of these abnormalities in this patient?
CorrectIncorrect - 43. Question
Category: Board Review Endocrinology
A 65-year-old man with a history of chronic kidney disease presents with muscle cramps and paresthesias. His total serum calcium concentration is 8.2 mg/dL (2.05 mmol/L), and his serum albumin concentration is 3.0 g/dL (30 g/L). What is the most appropriate next step to assess his calcium status?
CorrectIncorrectConsider the limitations of using corrected total serum calcium in patients with chronic kidney disease.
- 44. Question
Category: Board Review Endocrinology
A 50-year-old woman presents with symptoms of hypocalcemia, including muscle cramps and paresthesias. Her total serum calcium concentration is low, but her ionized calcium concentration is normal. What is the most likely explanation for her laboratory results?
CorrectIncorrectConsider the situation where total serum calcium is low, but ionized calcium is normal.
- 45. Question
Category: Board Review Endocrinology
In patients with severe chronic kidney disease (CKD) and metabolic acidosis, what is the effect of administering bicarbonate therapy or dialysis on ionized calcium concentration?
CorrectIncorrectConsider the relationship between ionized calcium concentration and pH in patients with metabolic acidosis and severe CKD.
- 46. Question
Category: Board Review Endocrinology
A patient with multiple myeloma presents with an elevated total serum calcium concentration but has no symptoms of hypercalcemia. What should be measured to determine the patient's true calcium status?
CorrectIncorrectConsider the potential interference of monoclonal myeloma proteins in the total serum calcium measurement.
- 47. Question
Category: Board Review Endocrinology
A 42-year-old woman with a history of primary hyperparathyroidism presents with an increased ratio of ionized to total calcium. What is the most likely cause for this increased ratio?
CorrectIncorrectConsider the effect of elevated parathyroid hormone levels on calcium binding to albumin.
- 48. Question
Category: Board Review Endocrinology
In a patient with acute hyperphosphatemia, what happens to the ionized serum calcium concentration?
CorrectIncorrectConsider the interaction between calcium and phosphate in cases of acute hyperphosphatemia.
- 49. Question
Category: Board Review Endocrinology
A patient with hypocalcemia symptoms has a low total serum calcium concentration but a normal ionized calcium concentration. Which of the following conditions could be responsible for these findings?
CorrectIncorrectConsider the relationship between albumin concentration and total serum calcium concentration.
- 50. Question
Category: Board Review Endocrinology
In patients with acid-base disorders, how does an elevation in extracellular pH (alkalemia) affect the ionized calcium concentration?
CorrectIncorrectConsider the effect of alkalemia on calcium binding to albumin.
- 51. Question
Category: Board Review Endocrinology
A 65-year-old patient with a history of breast cancer presents with elevated total serum calcium levels. What is the most likely cause of hypercalcemia in this patient?
CorrectIncorrectThink about the relationship between cancer and hypercalcemia.
- 52. Question
Category: Board Review Endocrinology
In a patient with hypoalbuminemia, how does the total serum calcium concentration change?
CorrectIncorrectConsider the relationship between albumin concentration and total serum calcium concentration.
- 53. Question
Category: Board Review Endocrinology
Which of the following conditions can cause pseudohypercalcemia?
CorrectIncorrectPseudohypercalcemia occurs when there is an elevation in total serum calcium without an actual increase in ionized calcium concentration.
- 54. Question
Category: Board Review Endocrinology
Which of the following is a common clinical finding in patients with primary hyperparathyroidism?
CorrectIncorrectThink about the common presentation of patients with primary hyperparathyroidism.
- 55. Question
Category: Board Review Endocrinology
In a patient with confirmed hypercalcemia, which laboratory test should be performed next to differentiate between PTH-mediated and non-PTH mediated hypercalcemia?
CorrectIncorrectConsider the laboratory tests that can help differentiate between PTH-mediated and non-PTH mediated hypercalcemia.
- 56. Question
Category: Board Review Endocrinology
A 45-year-old woman presents with fatigue, bone pain, and constipation. Laboratory results show a serum calcium level of 11.5 mg/dL (2.9 mmol/L) and a serum PTH level of 110 pg/mL (normal range: 10-65 pg/mL). Which is the most likely diagnosis?
CorrectIncorrectConsider the relationship between serum calcium and PTH levels.
- 57. Question
Category: Board Review Endocrinology
A 32-year-old man presents with generalized weakness, polyuria, and polydipsia. Laboratory results reveal a serum calcium level of 11.0 mg/dL (2.75 mmol/L) and a serum PTH level of 18 pg/mL (normal range: 10-65 pg/mL). Further testing shows a high 1,25-dihydroxyvitamin D level. Which additional test should be performed to narrow down the differential diagnosis?
CorrectIncorrectConsider the possible causes of elevated 1,25-dihydroxyvitamin D levels.
- 58. Question
Category: Board Review Endocrinology
A 55-year-old woman presents with a two-month history of nausea, vomiting, and weight loss. Laboratory tests reveal a serum calcium level of 12.2 mg/dL (3.05 mmol/L) and a serum PTH level of 12 pg/mL (normal range: 10-65 pg/mL). She has a history of breast cancer. Which test would be most helpful to confirm the cause of her hypercalcemia?
CorrectIncorrectConsider the patient's history of breast cancer and the relationship between serum calcium and PTH levels.
- 59. Question
Category: Board Review Endocrinology
What is the primary function of the calcium-sensing receptor (CaSR)?
CorrectIncorrectThe CaSR is highly expressed in the parathyroid glands and kidneys and plays a key role in the regulation of calcium balance.
- 60. Question
Category: Board Review Endocrinology
What other ion can activate the calcium-sensing receptor (CaSR)?
CorrectIncorrectThe CaSR is not only activated by calcium but also by another ion and certain amino acids.
- 61. Question
Category: Board Review Endocrinology
Where is the calcium-sensing receptor (CaSR) expressed in the kidney?
CorrectIncorrectThe CaSR has a specific location in the kidney where it plays a role in regulating urinary calcium excretion.
- 62. Question
Category: Board Review Endocrinology
How does the calcium-sensing receptor (CaSR) contribute to reducing calcium reabsorption in the thick ascending limb of the loop of Henle?
CorrectIncorrectThe CaSR influences calcium reabsorption by acting on a specific channel in the luminal membrane.
- 63. Question
Category: Board Review Endocrinology
A patient presents with mild hypercalcemia, hypocalciuria, and normal PTH levels. Which condition is most likely associated with these findings?
CorrectIncorrectThis condition is characterized by inactivating mutations in the CaSR gene and is autosomal dominantly inherited.
- 64. Question
Category: Board Review Endocrinology
Which of the following is NOT a common symptom or sign of familial hypocalciuric hypercalcemia (FHH)?
CorrectIncorrectPatients with this condition usually have few symptoms or signs of hypercalcemia.
- 65. Question
Category: Board Review Endocrinology
Which mutation causes autosomal dominant hypocalcemia type 1 (ADH1)?
CorrectIncorrectThis mutation increases the sensitivity to calcium and decreases the set-point of the CaSR.
- 66. Question
Category: Board Review Endocrinology
What is the primary factor that differentiates familial hypocalciuric hypercalcemia (FHH) from primary hyperparathyroidism?
CorrectIncorrect - 67. Question
Category: Board Review Endocrinology
In a patient with MEN1 and primary hyperparathyroidism, which is the most common manifestation of MEN1?
CorrectIncorrectThe most common manifestation of MEN1 is related to the parathyroid glands.
- 68. Question
Category: Board Review Endocrinology
Which of the following is an additional indication for parathyroidectomy in patients with MEN1?
CorrectIncorrectThe additional indication for parathyroidectomy is related to a complication of gastrinoma.
- 69. Question
Category: Board Review Endocrinology
In the surgical management of MEN1 with primary hyperparathyroidism, what is the preferred approach?
CorrectIncorrectThe preferred approach involves removal of three and one-half parathyroid glands.
- 70. Question
Category: Board Review Endocrinology
What is the rationale for performing a cervically accessible thymectomy during the initial parathyroidectomy in MEN1?
CorrectIncorrect - 71. Question
Category: Board Review Endocrinology
A 42-year-old patient with MEN1 presents with persistent abdominal pain and diarrhea. Blood tests reveal elevated serum gastrin concentrations. Which syndrome is the most likely cause of the patient's symptoms?
CorrectIncorrectThis syndrome is commonly associated with MEN1 and presents with elevated serum gastrin concentrations, abdominal pain, and diarrhea.
- 72. Question
Category: Board Review Endocrinology
Which type of medical therapy is recommended for patients with MEN1-associated gastrinoma?
CorrectIncorrectThis type of therapy effectively inhibits acid secretion and relieves acid-peptic symptoms in patients with gastrinomas.
- 73. Question
Category: Board Review Endocrinology
A 35-year-old patient with MEN1 is diagnosed with an insulinoma. What is the recommended surgical approach for this patient?
CorrectIncorrectThe recommended surgical approach for MEN1 patients with insulinoma includes excision of tumors in a specific region of the pancreas and removal of a portion of the pancreas.
- 74. Question
Category: Board Review Endocrinology
What is the consensus size threshold for surgical resection of nonfunctioning pancreatic neuroendocrine tumors (NETs) in MEN1 patients?
CorrectIncorrectThe consensus size threshold for surgical resection of nonfunctioning pancreatic NETs in MEN1 patients is a whole number.
- 75. Question
Category: Board Review Endocrinology
A 35-year-old male with a family history of multiple endocrine neoplasia type 1 (MEN1) presents with anterior chest pain. Which of the following tumors is most likely associated with his symptoms?
CorrectIncorrectConsider the location of the pain and its association with MEN1.
- 76. Question
Category: Board Review Endocrinology
Which of the following imaging modalities is recommended for surveillance of thymic neuroendocrine tumors in asymptomatic MEN1 patients?
CorrectIncorrectConsider the imaging modality that provides the best visualization of thoracic structures.
- 77. Question
Category: Board Review Endocrinology
In MEN1 patients with concurrent hypergastrinemia, which type of gastric neuroendocrine tumor is most likely to develop?
CorrectIncorrectConsider the type of gastric carcinoid associated with hypergastrinemia.
- 78. Question
Category: Board Review Endocrinology
What is the recommended treatment for a functioning adrenal tumor in a patient with MEN1?
CorrectIncorrectConsider the treatment that directly addresses the source of the functioning adrenal tumor.
- 79. Question
Category: Board Review Endocrinology
What is the primary life-threatening manifestation of MEN1?
CorrectIncorrectConsider the tumors with the highest malignant potential in MEN1 patients.
- 80. Question
Category: Board Review Endocrinology
A 45-year-old female patient presents with a history of diffuse bone pain, muscle weakness, and difficulty walking. Laboratory findings include elevated alkaline phosphatase, low serum calcium, and low 25-hydroxyvitamin D. Which of the following is the most likely diagnosis?
CorrectIncorrectThe patient has characteristic symptoms and laboratory findings indicating a deficiency in vitamin D.
- 81. Question
Category: Board Review Endocrinology
A patient with osteomalacia is more likely to experience fractures in which of the following locations?
CorrectIncorrectOsteomalacia results in reduced bone mineralization, making certain bones more prone to fractures.
- 82. Question
Category: Board Review Endocrinology
Which of the following radiographic findings is characteristic of osteomalacia?
CorrectIncorrectOsteomalacia has a specific radiographic finding that appears as fissures or narrow radiolucent lines.
- 83. Question
Category: Board Review Endocrinology
Which of the following is the primary cause of nutritional osteomalacia?
CorrectIncorrectOsteomalacia primarily results from a deficiency in a specific fat-soluble vitamin.
- 84. Question
Category: Board Review Endocrinology
A patient diagnosed with osteomalacia presents with muscle weakness. Which of the following best describes the pattern of muscle weakness in osteomalacia?
CorrectIncorrectThe muscle weakness in osteomalacia primarily affects a specific region of the limbs.
- 85. Question
Category: Board Review Endocrinology
A 45-year-old woman presents with bone pain, muscle weakness, and a history of gastrointestinal malabsorption. Which of the following is the most accurate diagnostic test for osteomalacia?
CorrectIncorrectThe gold standard diagnostic test for osteomalacia is invasive and not commonly used in clinical practice.
- 86. Question
Category: Board Review Endocrinology
In a patient with nutritional osteomalacia, which of the following laboratory findings is most likely?
CorrectIncorrectNutritional osteomalacia is characterized by low serum levels of calcium, phosphate, and 25-hydroxyvitamin D (25[OH]D).
- 87. Question
Category: Board Review Endocrinology
Which of the following diseases is characterized by low alkaline phosphatase levels and normal serum calcium and phosphate levels?
CorrectIncorrectThis disease is characterized by reduced activity of the alkaline phosphatase enzyme, leading to accumulation of specific substrates in blood and urine.
- 88. Question
Category: Board Review Endocrinology
A 45-year-old woman presents to her primary care physician with complaints of bone pain, muscle weakness, and difficulty walking. Her symptoms have progressively worsened over the past six months. She has a history of Crohn's disease and has had a total colectomy. She reports that her diet is low in dairy products. Based on her history and presentation, which is the most likely cause of her symptoms?
CorrectIncorrectConsider the patient's history and presentation, including her gastrointestinal disease and diet.
- 89. Question
Category: Board Review Endocrinology
A 60-year-old man with chronic kidney disease presents with bone pain and muscle weakness. Lab tests show hypocalcemia, hypophosphatemia, and elevated alkaline phosphatase. Which form of vitamin D is most appropriate for this patient?
CorrectIncorrectConsider the patient's chronic kidney disease and its impact on vitamin D metabolism.
- 90. Question
Category: Board Review Endocrinology
A 25-year-old woman presents with bone pain and a history of multiple fractures. Laboratory tests reveal hypophosphatemia and elevated alkaline phosphatase. Imaging reveals a tumor in her femur. What is the most definitive treatment for her condition?
CorrectIncorrectConsider the patient's laboratory results, imaging findings, and the likely diagnosis.
- 91. Question
Category: Board Review Endocrinology
A 30-year-old pregnant woman presents with persistent musculoskeletal pain and difficulty bearing weight. She has a history of limited sun exposure and malnutrition. What condition is she most likely suffering from?
CorrectIncorrectConsider the risk factors and symptoms associated with bone disorders in pregnant women.
- 92. Question
Category: Board Review Endocrinology
What is the typical initial treatment for pregnant women diagnosed with osteomalacia due to severe vitamin D deficiency?
CorrectIncorrectConsider the recommended vitamin D dosage for pregnant women diagnosed with osteomalacia.
- 93. Question
Category: Board Review Endocrinology
Which laboratory abnormalities are commonly observed in patients with osteomalacia due to severe vitamin D deficiency?
CorrectIncorrectConsider the laboratory findings associated with severe vitamin D deficiency.
- 94. Question
Category: Board Review Endocrinology
What is the most characteristic radiologic finding in patients with osteomalacia?
CorrectIncorrect - 95. Question
Category: Board Review Endocrinology
A 45-year-old female patient has been on prednisone therapy for the past 6 months to manage her rheumatoid arthritis. She complains of acute back pain after lifting a heavy object. Which of the following is the most likely cause of her back pain?
CorrectIncorrectConsider the patient's medication history and its impact on bone health.
- 96. Question
Category: Board Review Endocrinology
Which of the following is a direct effect of glucocorticoids on osteoblasts?
CorrectIncorrectThink about the impact of glucocorticoids on bone formation.
- 97. Question
Category: Board Review Endocrinology
What is the relationship between glucocorticoid dose and fracture risk in patients with inflammatory diseases like rheumatoid arthritis?
CorrectIncorrectConsider the effects of both the glucocorticoid therapy and the underlying inflammatory disease on bone health.
- 98. Question
Category: Board Review Endocrinology
A 56-year-old man with a history of rheumatoid arthritis is being treated with prednisone. He presents with acute back pain after sudden bending. A dual-energy x-ray absorptiometry (DXA) reveals a T-score of -2.7. What is the most likely diagnosis?
CorrectIncorrectConsider the risk factors for bone loss and the patient's DXA T-score.
- 99. Question
Category: Board Review Endocrinology
In men younger than 50 years, which factor is essential to diagnose osteoporosis in the presence of low bone mineral density (Z-score ≤ -2.0)?
CorrectIncorrectThink about the criteria for diagnosing osteoporosis in men younger than 50 years.
- 100. Question
Category: Board Review Endocrinology
Which of the following disorders increases the risk of developing osteoporosis in men?
CorrectIncorrectConsider the disorders that affect bone metabolism and increase the risk of osteoporosis.
- 101. Question
Category: Board Review Endocrinology
A 62-year-old man with a history of prostate cancer treated with androgen deprivation therapy presents for a bone mineral density assessment. Which skeletal site should be prioritized for dual-energy x-ray absorptiometry (DXA) measurements?
CorrectIncorrectConsider the skeletal sites with the highest impact on patients' health and the highest predictive value for fracture.
- 102. Question
Category: Board Review Endocrinology
In a man with a history of prostate cancer treated with androgen deprivation therapy, which BMD measurement may be more sensitive for bone loss?
CorrectIncorrectConsider the BMD measurement site that may be affected the most by androgen deprivation therapy in prostate cancer patients.
- 103. Question
Category: Board Review Endocrinology
A 65-year-old man presents with unexplained low bone mass. Which laboratory test should be performed to screen for primary hyperparathyroidism?
CorrectIncorrectConsider the hormone that is directly related to calcium metabolism and bone resorption.
- 104. Question
Category: Board Review Endocrinology
A 57-year-old male presents with persistent right hip pain and has an elevated serum alkaline phosphatase level. Imaging reveals a pagetic lesion in his right proximal femur. Which treatment option is the first choice for this patient's condition?
CorrectIncorrectFirst-choice treatment for Paget disease
- 105. Question
Category: Board Review Endocrinology
A 62-year-old female with asymptomatic Paget disease has a lesion involving her spine. Why might treatment be suggested for this patient?
CorrectIncorrectReason for treating asymptomatic Paget disease
- 106. Question
Category: Board Review Endocrinology
In a patient with active Paget disease planning to undergo elective surgery at a pagetic site, when should preoperative antipagetic therapy with a nitrogen-containing bisphosphonate be initiated?
CorrectIncorrectTiming of preoperative antipagetic therapy for elective surgery
- 107. Question
Category: Board Review Endocrinology
A 55-year-old woman with a history of Paget's disease presents to your clinic for treatment. Her 25-hydroxyvitamin D level is 18 ng/mL. What is the appropriate management for this patient before initiating bisphosphonate therapy?
CorrectIncorrectConsider the importance of vitamin D levels before initiating bisphosphonate therapy.
- 108. Question
Category: Board Review Endocrinology
A 60-year-old man with Paget's disease is scheduled to start oral bisphosphonate therapy. What instructions should be provided to the patient for the administration of oral bisphosphonates?
CorrectIncorrectConsider the absorption of oral bisphosphonates and how to minimize potential side effects.
- 109. Question
Category: Board Review Endocrinology
A 65-year-old woman with Paget's disease on bisphosphonate therapy requires a dental extraction. What is her risk of developing osteonecrosis of the jaw (ONJ) after the dental procedure?
CorrectIncorrectConsider the risk of ONJ in patients with Paget's disease on bisphosphonate therapy compared to other patient populations.
- 110. Question
Category: Board Review Endocrinology
A 65-year-old male patient presents with bone pain and elevated serum alkaline phosphatase levels. The patient has a history of liver disease. Which marker can be used to assess bone formation rate in this patient?
CorrectIncorrectThis marker is useful for patients with both Paget disease and liver disease.
- 111. Question
Category: Board Review Endocrinology
A 60-year-old female patient has monostotic Paget's disease with normal bone turnover markers at baseline. What imaging modality may be helpful in monitoring the response to therapy after 6 to 12 months of treatment?
CorrectIncorrectThis imaging modality can detect active disease and determine its extent.
- 112. Question
Category: Board Review Endocrinology
A patient with Paget's disease has been treated with pamidronate and now presents with resistance to pamidronate. Which nitrogen-containing bisphosphonate can be used as an alternative treatment?
CorrectIncorrectSeveral alternatives can be effective in case of resistance to the initial treatment.
- 113. Question
Category: Board Review Endocrinology
A 52-year-old woman with a history of chronic kidney disease presents to your clinic with severe bone pain and muscle weakness. A bone biopsy is performed, and histomorphometry reveals a marked increase in osteoblast and osteoclast activity, woven osteoid, and marrow fibrosis. What is the most likely subtype of renal osteodystrophy in this patient?
CorrectIncorrectConsider the patient's bone biopsy findings and the characteristic features of each subtype of renal osteodystrophy.
- 114. Question
Category: Board Review Endocrinology
A 65-year-old man with end-stage kidney disease on hemodialysis presents with generalized bone pain. Bone biopsy demonstrates thin osteoid seams with no active mineralization, inactive-appearing osteoblasts, and fewer osteoclasts and bone resorptive surfaces. Which subtype of renal osteodystrophy is most likely in this patient?
CorrectIncorrectConsider the patient's bone biopsy findings and the characteristic features of each subtype of renal osteodystrophy.
- 115. Question
Category: Board Review Endocrinology
A 59-year-old woman with a history of chronic kidney disease is experiencing bone pain and fractures. Her bone biopsy reveals a marked increase in the volume of osteoid, wide osteoid seams, and delayed mineralization of bone protein. What is the most likely subtype of renal osteodystrophy in this patient?
CorrectIncorrectConsider the patient's bone biopsy findings and the characteristic features of each subtype of renal osteodystrophy.
- 116. Question
Category: Board Review Endocrinology
A 55-year-old woman with stage 4 chronic kidney disease (CKD) presents with bone pain and elevated serum intact parathyroid hormone (PTH) levels. Which additional marker would be most helpful in distinguishing the type of renal osteodystrophy present in this patient?
CorrectIncorrectThis marker is produced by osteoblasts and is a useful indicator of osteoblastic activity.
- 117. Question
Category: Board Review Endocrinology
A 62-year-old man with stage 5 CKD on dialysis has persistently low intact PTH levels (<100 pg/mL). Which type of renal osteodystrophy is most likely in this patient?
CorrectIncorrectThis type of renal osteodystrophy is characterized by low bone turnover and is often associated with low PTH levels in patients on dialysis.
- 118. Question
Category: Board Review Endocrinology
In a patient with CKD and intermediate intact PTH levels (between 100 and 450 pg/mL), which of the following statements is true regarding the prediction of renal osteodystrophy type?
CorrectIncorrectPTH levels in this range can be associated with normal, high, or low turnover renal osteodystrophy.
