Rosh Internal Medicine Boost Practice Exam

What physical exam finding is most likely in a patient with calcium levels of 12.3 mg/dL and constipation?

1. Carpal spasm upon occlusion of the brachial artery

2. Contraction of facial muscles upon tapping the facial nerve

3. Decreased muscle strength in the extremities

4. Lower extremity edema

The correct answer is: Decreased muscle strength in the extremities

In a patient with elevated calcium levels, such as 12.3 mg/dL, one of the significant physical exam findings can be decreased muscle strength in the extremities. Hypercalcemia can lead to neuromuscular manifestations, including muscle weakness. This condition may arise from direct effects of calcium on neuromuscular transmission, which impairs muscle contraction and can lead to a general sense of weakness or fatigue. It's important to recognize that the symptoms related to hypercalcemia, including constipation, often reflect the effects of calcium on smooth muscle and neuroexcitability. As such, muscle strength can be compromised as the balance between calcium's excitatory and inhibitory effects in the nervous system is disturbed. In this case, muscle weakness aligns with the anticipated consequence of elevated calcium levels. Other physical exam findings associated with hypercalcemia such as carpal spasm, facial muscle contraction upon tapping, or lower extremity edema do not typically manifest in the context of hypercalcemia. Carpal spasm and facial muscle contraction are more related to hypocalcemia, while lower extremity edema might be associated with other conditions rather than directly linked to hypercalcemia. Hence, decreased muscle strength represents a more consistent and expected finding in this clinical scenario.