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NBME 13 Answers

nbme13/Block 1/Question#1 (26.4 difficulty score)
A 77-year-old woman dies in the hospital ...
Interleukin-1 (IL-1)πŸ”

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submitted by thegooddoctor2(1),

Remember, HOT T Bone Steak. IL-1 causes severe inflammation and is directly involved in the creation of the lytic lesion.

submitted by pharmtomed(2),

So I think where I got tripped up is that she does, indeed, have multiple myeloma (so there will be increased serum IgG), but the thing that is actually causing her bones to show the osteoclastic lesions shown in the image is IL-1 (osteoclast activating factor). Weird wording. Thanks NBME.

submitted by schep(15),

I thought lytic bone lesion-->multiple myeloma-->hypercalcemia

but I suppose that calcium isn't involved in the process of creating the lytic lesion, that would be IL-1 and TNF