Breast and endocrine surgery: hypercalcaemic crisis: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Breast and endocrine surgery: hypercalcaemic crisis

Sample item

A 65-year-old man with primary hyperparathyroidism has confusion, vomiting, dehydration and a serum calcium of 16 mg/dL. What is the first step in management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Aggressive intravenous isotonic saline

Severe hypercalcaemia causes polyuria and volume depletion, which further reduces renal calcium excretion. Rehydration with isotonic saline is the first measure, followed by a bisphosphonate and, if needed, calcitonin or a loop diuretic once euvolaemic, then definitive surgery.

Option by option

  • A. Thiazide diuretic

    Thiazides reduce urinary calcium excretion and would worsen hypercalcaemia.

  • B. Immediate parathyroidectomy

    Surgery is performed after the emergency is controlled.

  • C. Aggressive intravenous isotonic saline (correct)

    Correct. Volume repletion restores renal calcium excretion and is the first step.

  • D. Oral calcium restriction only

    Dietary restriction is far too slow in a crisis.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Aggressive intravenous isotonic saline. Severe hypercalcaemia causes polyuria and volume depletion, which further reduces renal calcium excretion.

Why is "Thiazide diuretic" not the answer?

Thiazides reduce urinary calcium excretion and would worsen hypercalcaemia.

Why is "Immediate parathyroidectomy" not the answer?

Surgery is performed after the emergency is controlled.

Why is "Oral calcium restriction only" not the answer?

Dietary restriction is far too slow in a crisis.

What concept does this question test?

It tests Breast and endocrine surgery: hypercalcaemic crisis in General Surgery. Rehydration with isotonic saline is the first measure, followed by a bisphosphonate and, if needed, calcitonin or a loop diuretic once euvolaemic, then definitive surgery.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Breast and endocrine surgery: hypercalcaemic crisis?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.