A 58-year old Caucasian woman presents to the office for a complete physical examination (PE). Her last full PE was 2 years ago.  Since then, she has been in the office on different occasions for an episodic visits of bronchitis x1 and other times for refills of her medications.  Today, she reports vague complaints of increase of lack of concentration especially at work, increase fatigue, some intermittent nausea and recent constipation despite not changing her diet. She states she has been exercising less due to the fatigue and cold weather. She states that she usually does brisk walking about 40 minutes 5x/week but recently has only been able to walk 1-2x/week over the past 3 months. She notes no changes in her sleep pattern which is 6-7 hours/night. She denies depression or anxiety although states it has been difficult watching her elderly parents decline.

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PMH: Breast Cancer-Ductal carcinoma in situ (DCIS) -3 years ago

            HTN- x 6 years

            Osteopenia- Menopause at age 53.

PSH:  repair of right wrist fracture secondary to fall -2014

Right breast lumpectomy-2014 followed by 6 weeks of radiation

FH:  mother- alive age 88, DM II, HTN, hypothyroid, spinal stenosis

Father- alive age 90, CAD, CHF, dementia

1 sister-age 61- obesity, HTN, DM

GYN- last pap and pelvic 1/2019, Last mammogram 2/2019

Health maintenance: Colonoscopy- 2/2014, Bone density- 4/2019

Personal/Lifestyle:  Married, lives in her own home, 1 daughter age 29 healthy, Pt. works as an administrative assistant in a busy real estate office

Medications: Calcium 1200 mg daily, Vitamin D 4,000units daily, Arimidex 1mg. daily, HCTZ12.5 mg daily

ROS:  negative except for what is stated in the HPI

PE: BP 136/90, HR-84 regular, RR- 18, afebrile.  PE: unremarkable

Ht: 5’4”, Wt: 157 lbs BMI: 30

Labs drawn: – CBC, Chemistry and thyroid studies WNL except for calcium 11.2, Vitamin D level- 72


  1. What are the conditions/causes of hypercalcemia?
  2. What 2 medical conditions account for most cases of hypercalcemia and what do you think is the cause of her elevated calcium?
  3. What other labs would you draw? What are the laboratory findings seen in the setting of hyperparathyroidism?
  4. What is the treatment of hypercalcemia? What are the indications for parathyroidectomy?
  5. What else would you address at this visit?

INCLUDE 3 or more REFERENCES -APA- format – (journal articles, research articles, EBP, national guidelines. etc.) **NO textbook,**NO Wikipedia



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