Hypercalcaemia in Breast Cancer: A 66-Year-Old Woman
A branching clinical case simulation for a patient presenting with confusion, constipation, polyuria. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 4medium20 min6 stages
- Patient
- 66 years, female
- Presenting complaint
- Confusion, constipation, polyuria
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
You are a Year 4 medical student on the acute medical unit of a district general hospital. A 66-year-old woman, Margaret Whitfield, is admitted with confusion, constipation and increasing urine output over the past week. Her daughter accompanied her and says 'she hasn't been herself, she's been drinking a lot but also going to the toilet constantly.' The triage nurse has measured her adjusted calcium at 3.4 mmol/L and is concerned. The patient is on the ward awaiting review. Her observations are shown below. What is your first priority?
What this case teaches
Recognise symptomatic hypercalcaemia; rehydrate with intravenous saline before bisphosphonate; stop contributing drugs; investigate the cause.
How the case unfolds
- 1Taking a Focused HistoryHistory
- 2Physical ExaminationExamination
- 3Ordering InvestigationsInvestigations
- 4Making the DiagnosisDiagnosis
- 5Immediate ManagementTreatment
- 6Monitoring and Follow-upMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.