MBBS OSCE · General Medicine
OSCE — Hypercalcaemia and Hyperparathyroidism
Eight-minute OSCE station on Hypercalcaemia and Hyperparathyroidism: focused history, examination priorities, investigations, emergency and definitive management.
On this page
Study tools
Exam tags
Brief (to candidate)
You will assess a patient with a presentation consistent with Hypercalcaemia and Hyperparathyroidism.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.[1][4]
Clinical context
Hypercalcaemia is a corrected serum calcium over 2.6 mmol/L (10.4 mg/dL); it is dangerous above 3.5 mmol/L (14 mg/dL) — hypercalcaemic crisis with confusion, dehydration, AKI and shortened QT. Causes split by PTH: PTH-dependent (primary and tertiary hyperparathyroidism, lithium, familial hypocalciuric hypercalcaemia) versus PTH-independent (malignancy via PTHrP, osteolytic metastases (breast, myeloma), granulomatous disease (sarcoid, TB), vitamin D intoxication, thiazides, immobilisation, thyrotoxicosis). Primary hyperparathyroidism is the commonest outpatient cause (single parathyroid adenoma 80 percent, hyperplasia 15 percent, double adenoma 4 percent, carcinoma under 1 percent); malignanc[1][4]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).[1][4]
Examiner checklist
The station behaviours follow the guideline framework.[1][4]
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Corrected calcium over 3.5 mmol/L (14 mg/dL) with confusion, dehydration or AKI |
| Safety | Shortened QT interval on ECG — risk of ventricular arrhythmia; treat promptly |
| Safety | Hypercalcaemia with a PTH that is not suppressed (inappropriately normal or high |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable.[4] Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.[1][2]
References4ShowHide
- [1]Turner JJO. Hypercalcaemia - presentation and management Clin Med (Lond), 2017.PMID 28572230
- [2]Major PP, Coleman RE. Zoledronic acid in the treatment of hypercalcemia of malignancy: results of the international clinical development program Semin Oncol, 2001.PMID 11346861
- [3]Nussbaum SR. Pathophysiology and management of severe hypercalcemia Endocrinol Metab Clin North Am, 1993.PMID 8325291
- [4]Davidson TG. Conventional treatment of hypercalcemia of malignancy Am J Health Syst Pharm, 2001.PMID 11757206