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54-year-old African American woman has hypercalcemia and an elevated creatinine level

Written by Med-Challenger | Jan 5, 2025 3:00:00 PM

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

 

This question appears in Med-Challenger Physician Assistant Exam Review with CME

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