KMU Past Paper Practice

A 42-year-old patient has persistent hypercalcemia with an elevated PTH concentration. At neck exploration, all four parathyroid glands are enlarged rather than one gland being dominant. Which pathological process best explains this pattern?

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A 36-year-old woman with chronic intestinal malabsorption has low serum calcium and a persistently elevated PTH concentration. Renal function is normal. Which disorder best explains this hormonal response?

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A 58-year-old patient with long-standing PTH excess develops diffuse bone pain and a fragility fracture. Bone tissue shows marked osteoclastic activity with replacement of marrow by fibrous tissue. Which skeletal lesion is most likely?

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A patient with prolonged severe hyperparathyroidism develops an expansile skeletal lesion containing fibrous tissue, hemorrhage and giant cells. The lesion has a characteristic brown appearance. Which feature is mainly responsible for the color?

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A 55-year-old man with PTH-dependent hypercalcemia complains of intense thirst and passes large volumes of dilute urine. Which physiological disturbance best explains these symptoms?

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A 63-year-old woman has mild primary hyperparathyroidism discovered on routine testing. She has no renal calculi, significant skeletal involvement or troublesome symptoms and is not proceeding to surgery. Which management approach is most appropriate?

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A patient with severe symptomatic hypercalcemia has received appropriate intravenous fluid replacement. The physician wants an additional agent that can lower serum calcium relatively rapidly while longer-acting treatment takes effect. Which therapy is most suitable?

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A hospitalized patient with severe hypercalcemia receives fluids and a rapidly acting calcium-lowering agent. Additional treatment is required to provide a more sustained reduction in calcium while the underlying disorder is addressed. Which option best serves this purpose?

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A patient with chronic kidney disease has severe secondary hyperparathyroidism despite appropriate management of phosphate balance, vitamin D metabolism and other medical measures. PTH remains markedly elevated with progressive complications. What is the next major management principle?

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A man with advanced renal failure has markedly elevated PTH and an increased serum phosphate concentration. In another patient with primary hyperparathyroidism, serum phosphate is reduced. Which factor best explains the high phosphate in the patient with renal failure?

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A patient develops persistent hypocalcemia and low PTH after neck surgery. Operative records indicate that the parathyroid glands were not intentionally removed. Which surgical event can still account for the hormonal deficiency?

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A 39-year-old patient with severe hypocalcemia develops painful carpopedal spasms followed by sudden difficulty breathing and inspiratory airway obstruction. Which complication should be recognized immediately?

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During examination of a patient with suspected hypocalcemia, tapping over the facial nerve just anterior to the ear produces twitching of the ipsilateral facial muscles. Which clinical sign has been demonstrated?

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A teenager with hypoparathyroidism since early childhood is reviewed for chronic complications. Which finding is particularly associated with longstanding calcium disturbance beginning during development?

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A 45-year-old woman with poorly controlled chronic hypoparathyroidism reports progressive changes in her skin and nails. Which examination finding is most compatible with the chronic endocrine disorder?

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Two patients have confirmed hypocalcemia. One has vitamin D deficiency with an appropriate compensatory endocrine response, while the other has failure of parathyroid function. Which laboratory finding most strongly identifies the patient with true hypoparathyroidism?

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A patient with chronic hypoparathyroidism continues to have difficult biochemical control despite carefully supervised conventional calcium and active vitamin D therapy. Which specialist treatment may be considered in selected cases?

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A patient has an elevated PTH concentration but no clear evidence of autonomous hypercalcemia. Before labeling the condition as primary parathyroid disease, the physician wants to identify common physiological causes of secondary PTH elevation. Which combination is most useful?

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A patient with established primary hyperparathyroidism develops recurrent flank discomfort and microscopic hematuria. The clinician suspects renal complications of prolonged hypercalcemia. Which investigation best evaluates the suspected end-organ involvement?

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A patient with chronic hypoparathyroidism is receiving long-term replacement therapy. The clinician explains that treatment should relieve hypocalcemic symptoms without creating avoidable renal complications. Which therapeutic goal best reflects this principle?

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