1.       Primary Hyperparathyroidism	7.Vitamin D toxicity
2.       Paget’s Disease of the bone	8. Paraneoplastic syndrome
3.       Secondary Hyperparathyroidism	9. Loop diuretics
4.       Sarcoidosis	10.Multiple myeloma
5.       Thiazide diuretics	11. Milk-Alkali syndrome
6.       Tuberculosis	12. Thyrotoxicosis

Choose the most appropriate cause of hypercalcaemia from the list of options below, each option may be used once, more than once or not at all.

 

 

1.       A 52 year old man presents with abdominal pain and aching legs, he claims that this is making him feel depressed. Blood tests reveal a raised calcium at 2.9mmol/L, his phosphate was 0.6mmol/L and PTH was 8pmol/L.

 

2.       A 36 year old Afro-Caribbean woman presents with debilitating colicky, abdominal pains. In the brief history that you are able to elicit she mentions a problem with her lungs and long-standing, red rash on the front of her shins. Renal stones are found on x-ray and her serum calcium is 2.83mmol/L, your registrar tells you that there is an underlying cause that explains all the problems.

 

3.       A 72 year old chronic smoker is brought in by his daughter, she tells you that he has been very ‘low’ lately and that in the last two days he has become confused. Over the last three months he has lost 8kg of weight, he has had a recurrent cough and is sometimes coughing up blood. His calcium is 3.2mmol/L and his PTH is undetectable but raised PTH-related peptide is found.

 

4.       A 68 year old man is found to have a calcium of 2.8mmol/L on a blood test at his GP two months after starting a new drug to help control his hypertension.

 

5.       A 32 year old banker present with abdominal pain and constipation. He admits to a long history of indigestion but says that over the last few months he seems to have it under control. His calcium is 2.75mmol/L.

Answers

1.       Primary hyperparathyroidism

2.       Sarcoidosis

3.       Paraneoplastic syndrome

4.       Thiazide diueretics

5.       Milk-Alkali syndrome