Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the second step for the treatment of hypercalcemia if initial management is insufficient?

1. Oral sodium restriction

2. Calcitonin

3. IV bisphosphonates

4. Glucocorticoids

The correct answer is: IV bisphosphonates

The second step for the treatment of hypercalcemia involves using intravenous bisphosphonates, as they are effective in the rapid lowering of serum calcium levels, particularly in cases where initial management is insufficient. Bisphosphonates work by inhibiting osteoclast-mediated bone resorption, which is a primary mechanism driving elevated calcium levels in hypercalcemia. When hypercalcemia is present, management typically begins with measures to increase hydration and possibly the use of diuretics. If these initial steps do not adequately address the hypercalcemia, bisphosphonates can be employed to achieve a more significant reduction in calcium levels. These drugs can lead to a lasting effect and are commonly used in conditions such as malignancy-associated hypercalcemia. Other treatment options might not be as effective in the acute setting. Though calcitonin can lower calcium levels, its effect is often transient and less potent compared to bisphosphonates. Oral sodium restriction is usually part of initial management strategies and may not be relevant as a subsequent step. Glucocorticoids can help in specific underlying causes like granulomatous diseases or certain malignancies, but they do not work as a first-line or rapid intervention for most general hypercalcemia