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30 original questions, modeled on the official NBME Clinical Science Subject Exam: Medicine format. Every question comes with why the answer is right, why the other choices are wrong, a key takeaway and a tip. Practice mode explains each question as you go; Timed mode runs one clock and saves the explanations for the end.
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Medicine Shelf: question 1 of 30
A 64-year-old woman is brought to the emergency department because of 5 days of confusion, nausea, constipation, and frequent urination. She has osteoporosis and gastroesophageal reflux disease and takes a daily calcium and vitamin D supplement but no prescription medications. For 2 months, her son says, she has chewed calcium carbonate antacid tablets, often more than 10 a day. She has not vomited or lost weight and does not smoke. Pulse is 104/min, respirations are 16/min, and blood pressure is 106/64 mm Hg. She is oriented only to person and has dry mucous membranes. A chest x-ray is normal.
| Test | Result |
|---|---|
| Blood | |
| Hemoglobin | 13.2 g/dL |
| Serum | |
| Bicarbonate | 35 mEq/L |
| Urea nitrogen | 41 mg/dL |
| Creatinine | 2.2 mg/dL (0.8 mg/dL 6 months ago) |
| Calcium | 13.8 mg/dL |
| Albumin | 4.1 g/dL |
| Total protein | 7.0 g/dL |
| Parathyroid hormone (intact) | 9 pg/mL |
| 25-hydroxyvitamin D | 41 ng/mL |
Which of the following is the most likely diagnosis?
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NBME® is a registered trademark of the National Board of Medical Examiners, which is not affiliated with and does not endorse ProMed United. These are original practice questions written by ProMed United, not official test questions, and a practice score is not a prediction of your result.
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