Rosh Internal Medicine Boost Practice Exam

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Which condition is indicated by symptoms of numbness, muscle cramps, and carpal spasms with low total calcium?

Hyperparathyroidism
Hypoparathyroidism
Hypophosphatemia
Hypothyroidism

The correct answer is: Hypoparathyroidism

The symptoms described—numbness, muscle cramps, and carpal spasms—coupled with low total calcium levels strongly suggest hypoparathyroidism. In this condition, the parathyroid glands produce insufficient parathyroid hormone (PTH), which is crucial for maintaining calcium levels in the blood. The deficiency in PTH leads to decreased calcium absorption in the intestines, reduced renal tubule reabsorption of calcium, and increased phosphate reabsorption, which exacerbates the problem of low calcium levels. The clinical manifestations of hypoparathyroidism typically include neuromuscular irritability due to hypocalcemia. This can present as paresthesias (numbness), muscle cramps, and tetany, which may include carpopedal spasm—a hallmark sign linked to low calcium levels. Understanding the relationship between calcium and nerve/muscle function is essential; low calcium levels disrupt the normal voltage-gated calcium channels in neuronal and muscular cells, leading to increased excitability. Thus, the combination of low total calcium and the described symptoms aligns with hypoparathyroidism and confirms its role in the presentation of the patient’s condition.