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NBME 16 Answers

nbme16/Block 1/Question#46 (3.8 difficulty score)
A 55-year-old woman comes to the physician ...
Parathyroid hormone: decreased; 1,25-Dihydroxycholecalciferol: increased🔍
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This is an older woman with sarcoidosis. This commonly happens in this demographic (usually African-American women) and presents with hypercalcemia and noncaseating granulomas.

Sarcoidosis is caused by uncontrolled active vitamin D synthesis by macrophages, leading to increased 1a-hydroxylase activity in the kidneys, leading to more vitamin D.

This increased vitamin D leads to... -Increased Ca by increased intestinal absorption w/ no negative feedback on vitamin D -PTH is decreased because of the negative feedback from calcium