--- title: 54-year-old African American woman has hypercalcemia and an elevated creatinine level description: It's Hypercalcemia Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/QUIZ%20TIME.png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/54-year-old-african-american-woman-has-hypercalcemia-and-an-elevated-creatinine-level#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) quick quiz # 54-year-old African American woman has hypercalcemia and an elevated creatinine level It's Hypercalcemia Quiz Time with Med-Challenger! [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Jan 5, 2025 [Personal Education](https://challengercme.com/blog/tag/personal-education) [Physician Assistant](https://challengercme.com/blog/tag/physician-assistant) [Question of the Week](https://challengercme.com/blog/tag/question-of-the-week) [quick quiz](https://challengercme.com/blog/tag/quick-quiz) ### < [All Posts](https://challengercme.com/blog) Try Med-Challenger Start a free trial today and save! Pass-guaranteed board exam review with CME/CE credits built-in. Target weak areas, study smarter, stay on track. Act now and save. [BROWSE COURSES](https://fuse.challengercme.com/store) --- ### Share this article [mailto:?subject=Check%20out%20https://challengercme.com/blog/54-year-old-african-american-woman-has-hypercalcemia-and-an-elevated-creatinine-level&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/54-year-old-african-american-woman-has-hypercalcemia-and-an-elevated-creatinine-level&utm_medium=social&utm_source=email](mailto:?subject=Check%20out%20https://challengercme.com/blog/54-year-old-african-american-woman-has-hypercalcemia-and-an-elevated-creatinine-level&utm_medium=social&utm_source=email%20&body=Check%20out%20https://challengercme.com/blog/54-year-old-african-american-woman-has-hypercalcemia-and-an-elevated-creatinine-level&utm_medium=social&utm_source=email) ### Subscribe ### Subscribe ![54-year-old African American woman has hypercalcemia and an elevated creatinine level](https://challengercme.com/hubfs/QUIZ%20TIME.png) A 54-year-old African American woman who just moved to the area has hypercalcemia and an elevated creatinine level on routine laboratory testing. After you review the patient's medical records from her previous physician, you note that she has had hypercalcemia for nearly 1 year. She denies any complaints except for an unintentional weight loss of 20 pounds in the last few months. There are no other laboratory abnormalities except for proteinuria. Findings on chest x-ray show diffuse interstitial lung disease, and computed tomography of her chest shows interstitial thickening with perilymphatic micronodules and subpleural reticulation, mostly in the bilateral upper lobes. Bronchoscopy with transbronchial biopsy is performed. Cultures and stains are negative. Pathology shows noncaseating granulomas. What is the most appropriate management at this time? - isoniazid and pyridoxine - referral for chemotherapy - continued observation - isoniazid, rifampin, pyrazinamide, and ethambutol - oral corticosteroid therapy The correct answer is: oral corticosteroid therapy   **Educational Objective**: Characterize how to diagnose and manage ILD. **Explanation:** The most likely diagnosis in this patient is sarcoidosis, which is a systemic inflammatory disease with pathology typified by noncaseating granulomas. Any organ system can be involved, but more than 90% of those with sarcoidosis have pulmonary involvement at the time of diagnosis; chest abnormalities on x-ray can also be seen in more than 90% of these patients. There are 5 stages of chest involvement evidenced on x-ray: - Stage 0: Normal - Stage 1: Bilateral hilar lymphadenopathy - Stage 2: Bilateral hilar lymphadenopathy, parenchymal infiltrates (reticular opacities) - Stage 3: Parenchymal infiltrates, no bilateral hilar lymphadenopathy (shrinking nodes) - Stage 4: Reticular opacities with evidence of volume loss (predominantly mid- and upper-lung zones) Masses, traction bronchiectasis, calcification, cyst/bullae formation, and disease progression can lead to distortion or destruction of the lung architecture. Computed tomography of the chest is not usually needed for diagnosis, but typical findings include micronodules along the bronchovascular bundles with upper-lobe predominance. An elevated level of angiotensin-converting enzyme is seen in 30% to 80% of patients, but this finding is nonspecific, as are other laboratory findings such as hypercalcemia (1%-4%), hypercalciuria (15%-40%), and polyclonal hypergammaglobulinemia (30%-80%). Treatment is indicated when severe organ dysfunction, including pulmonary symptoms, and myocardial, central nervous system, or ophthalmologic complications are present. Chronic hypercalcemia is also an indication for treatment. Corticosteroids are usually the first line of treatment. If the patient responds favorably, then corticosteroids can be tapered after 3 months. **Reference:** Pereira CA, Dornfeld MC, Baughman R, et al. Clinical phenotypes in sarcoidosis. *Curr Opin Pulm Med.* 2014;20:496-502.   This question appears in [Med-Challenger Physician Assistant Exam Review with CME](https://challengercme.com/physician-assistant-exam-review-cme-course) [Try for free and save](https://fuse.challengercme.com/fulltrial/204). Ace your exams and meet your CME/MOC requirements for just $26 a month! [![subcription_icon_pa-e1519157433195-3](https://challengercme.com/hs-fs/hubfs/Imported_Blog_Media/subcription_icon_pa-e1519157433195-3.png?width=250&height=256&name=subcription_icon_pa-e1519157433195-3.png)](https://challengercme.com/physician-assistant-exam-review-cme-course) [![QuizButton-1](https://challengercme.com/hs-fs/hubfs/QuizButton-1.jpg?width=235&height=81&name=QuizButton-1.jpg)](https://challengercme.com/blog/50-year-old-man-with-abnormal-funduscopic-examination) --- No matter your program, no matter the size, [Med-Challenger for Groups and Institutions](https://challengercme.com/institutional-medical-education-for-groups) can better prepare your program or group, fulfill industry requirements, and increase test scores.   For personal medical education that includes board's prep, MOC, and CME requirements, Med-Challenger has you covered in [Family Medicine](https://challengercme.com/family-medicine-exam-review-cme-courses), [Emergency Medicine](https://challengercme.com/emergency-medicine-exam-review-cme-courses), [Internal Medicine](https://challengercme.com/internal-medicine-exam-review-cme-courses), [Pediatrics](https://challengercme.com/pediatric-medicine-exam-review-cme-courses), [Pediatric Emergency Medicine](https://challengercme.com/category-pediatric-emergency-medicine-courses), [OBGYN](https://challengercme.com/obgyn-exam-review-cme-courses), [Physician Assistants](https://challengercme.com/physician-assistant-exam-review-cme-courses), and [Nurse Practitioners.](https://challengercme.com/nurse-practitioner-exam-review-cme-courses)   Never miss a thing. Subscribe to our blog and save! [![SUBSCRIBE Medical Education Blog & Newsletter](https://no-cache.hubspot.com/cta/default/9106197/703c79e6-b750-4dfa-acfa-b6ca5307c563.png)](https://cta-redirect.hubspot.com/cta/redirect/9106197/703c79e6-b750-4dfa-acfa-b6ca5307c563)   ## Similar posts internal medicine ### [A 40-year-old Hispanic woman has diffuse fatigue and arthritis](https://challengercme.com/blog/a-40-year-old-hispanic-woman-has-diffuse-fatigue-and-arthritis) It's Disorders of Joints Quiz Time with Med-Challenger! Med-Challenger Jan 27, 2025 internal medicine ### [42-year-old presenting with acute heatemesis](https://challengercme.com/blog/42-year-old-presenting-with-acute-heatemesis) It's Acute Heatemesis Quiz Time with Med-Challenger! Med-Challenger Dec 17, 2025 quick quiz ### [18-month-old boy with severe hemophilia A](https://challengercme.com/blog/18-month-old-boy-with-severe-hemophilia-a) It's Hemophilia A Quiz Time with Med-Challenger! Med-Challenger Dec 17, 2025 ## Stay informed. ### Subscribe to our [Medical Education Blog](https://challengercme.com/blog)  Stay informed of new medical education content, certification requirements and deadlines, case-based CME quizzes, and special offers. [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com) #### **Online Medical Education** 1-800-676-0822 Sales - Option 1 Support - Option 2   ### Company - [Get Support](https://support.challengercme.com/knowledge/kb-tickets/new) - [Policies](https://support.challengercme.com/knowledge) - [Special Offers](https://challengercme.com/special) ### Products - [Exam Prep & CME](https://challengercme.com/med-challenger-free-trial-landing-page) - [Institutional LMS](https://challengercme.com/atlas-pro-inst) ### Resources - [CME Blog](https://challengercme.com/blog) - [Knowledge Base](https://support.challengercme.com/knowledge) ### Account - [Create Account](https://fuse.challengercme.com/sign-up) - [Login](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) © 2026 Challenger Corporation. All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "Article", "about" : [ "sarcoidosis", "interstitial lung disease", "hypercalcemia", "noncaseating granulomas", "bronchoscopy with transbronchial biopsy", "chest x-ray staging", "computed tomography of the chest", "corticosteroid therapy", "angiotensin-converting enzyme", "hypercalciuria", "polyclonal hypergammaglobulinemia" ], "articleSection" : "Pulmonary Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2025-01-05T15:00:01.728Z", "datePublished" : "2025-01-05T15:00:00.000Z", "description" : "It's Hypercalcemia Quiz Time with Med-Challenger! Exam-style clinical vignette about suspected sarcoidosis presenting with chronic hypercalcemia and interstitial lung disease — medical education and exam preparation content.", "headline" : "54-year-old African American woman has hypercalcemia and an elevated creatinine level", "image" : [ { "@type" : "ImageObject", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation", "url" : "https://challengercme.com/logo.png" } ], "inLanguage" : "en-US", "keywords" : [ "sarcoidosis", "ILD", "interstitial lung disease", "hypercalcemia", "noncaseating granulomas", "bronchoscopy", "corticosteroids", "ACE level", "chest CT", "exam question", "medical education", "exam preparation", "Med-Challenger" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/54-year-old-african-american-woman-has-hypercalcemia-and-an-elevated-creatinine-level", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "description" : "Med-Challenger Medical Education, a Division of Challenger Corporation", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Oral corticosteroid therapy. The vignette is most consistent with sarcoidosis (noncaseating granulomas and upper-lobe predominant interstitial changes). Treatment is indicated for chronic hypercalcemia, and corticosteroids are usually first-line; if the patient responds, steroids can be tapered after about 3 months." }, "name" : "Most appropriate management for this patient with suspected sarcoidosis and chronic hypercalcemia?", "text" : "A 54-year-old woman has chronic hypercalcemia, proteinuria, interstitial lung disease with perilymphatic micronodules and subpleural reticulation on CT, and noncaseating granulomas on transbronchial biopsy. Cultures and stains are negative. What is the most appropriate management at this time?" } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Oral corticosteroid therapy because the presentation and biopsy are most consistent with sarcoidosis and chronic hypercalcemia is an indication for treatment; corticosteroids are usually first-line and can be tapered after about 3 months if the patient responds." }, "name" : "Most appropriate management for this patient with suspected sarcoidosis and chronic hypercalcemia?" }, "position" : 1 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Micronodules along bronchovascular bundles with upper-lobe predominance; interstitial thickening with perilymphatic micronodules and subpleural reticulation are described in the article." }, "name" : "Which CT chest findings are typical for pulmonary sarcoidosis?" }, "position" : 2 }, { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Elevated angiotensin-converting enzyme in 30%–80% (nonspecific), hypercalcemia in 1%–4%, hypercalciuria in 15%–40%, and polyclonal hypergammaglobulinemia in 30%–80%." }, "name" : "What laboratory abnormalities may be seen in sarcoidosis?" }, "position" : 3 } ], "name" : "Practice Questions", "numberOfItems" : 3 } ```