NBME 21 1,25-Dihydroxycholecalciferol (NBME Answers)

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NBME 21 Answers

nbme21/Block 3/Question#6 (reveal difficulty score)
A 40-year-old African American woman comes to ...
1,25-Dihydroxycholecalciferol 🔍 / 📺 / 🌳 / 📖
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+13 upvote downvote
submitted by ∗nosancuck(102)

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This b has Sarcoidosis so her granulomas be activatin dat VitD

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sbryant6 Your mom activates my VitD. +23

pg32 Anyone know why there is hepatosplenomegaly? +

gooooose Likely granulomas involving the liver and spleen- Pathoma says any organ can be involved +

fatboyslim Don't call her a b, b. +

+11 upvote downvote
submitted by ∗medpsychosis(147)

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This patient definitely has Sarcoidosis. Clues in question stem: -African American Female -Erythema Nodosum -Bilateral Hilar Adenopathy -Hypercalcemia (due to 1α-hydroxylase–mediated vitamin D activation in macrophages).

FA 2018 (P. 658)

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icedcoffeeislyfe FA2020 pg 676 +

lovebug and FA2019 pg 662: Vit.D usually activated in Kidney. but They can be also activated by Macrphage like this case. +

+3 upvote downvote
submitted by ∗dr.xx(176)

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~~In sarcoidosis,~~ hypercalcemia normally suppresses the release of PTH and therefore the production of calcitriol (1,25-dihydroxycholecalciferol), but in sarcoidosis and other granulomatous diseases, activated mononuclear cells (particularly macrophages) in the lung and lymph nodes produce calcitriol (1,25-dihydroxycholecalciferol) from calcidiol (25-hydroxycholecalciferol) independent of PTH.

https://www.uptodate.com/contents/hypercalcemia-in-granulomatous-diseases

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dr.xx ~~In sarcoidosis,~~ +

hello Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead +

drdoom I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that. +

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