Rosh Internal Medicine Boost Practice Exam

Which condition is indicated by elevated calcium levels in a patient?

1. Kidney stones

2. Hyperparathyroidism

3. Sarcoidosis

4. All of the above

The correct answer is: All of the above

Elevated calcium levels, or hypercalcemia, can be indicative of several conditions, as they can lead to a range of physiological responses and complications. Hyperparathyroidism is one of the most common causes of elevated calcium levels. In this condition, the parathyroid glands produce excessive amounts of parathyroid hormone (PTH), which increases calcium reabsorption in the kidneys, enhances intestinal absorption of calcium, and stimulates osteoclastic activity in bones, leading to higher serum calcium levels. Kidney stones, particularly calcium stones, can also be a result of hypercalcemia. Elevated calcium in the urine can precipitate stone formation, which is a common clinical manifestation for patients with high serum calcium levels. Sarcoidosis, on the other hand, can lead to hypercalcemia through increased production of calcitriol (active form of vitamin D) by macrophages in granulomas. This condition can cause increased intestinal absorption of calcium and, consequently, elevated serum calcium levels. Because all these conditions—hyperparathyroidism, kidney stones, and sarcoidosis—are associated with elevated calcium levels through various mechanisms, the option indicating all of the above is appropriate. Each of these conditions exemplifies the multifactorial nature of hypercalcemia