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NBME 16 Answers

nbme16/Block 1/Question#31 (7.7 difficulty score)
A 55-year-old woman comes to the physician ...
Parathyroid hormone: down; 1,25-Dihydroxycholecalciferol: up🔍,📺
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submitted by bingcentipede(297),

This is a woman with sarcoidosis, as suggested by her hypercalcemia and noncaseating granulomas. The normal demographic for this is an older African-American woman.

In sarcoidosis, there is increased 1,25-(OH)2-vitamin D (active form), leading to increased calcium resorption in the intestine (leading to hypercalcemia). This increased calcium has negative feedback on PTH hormone release, leading to decreased PTH levels as well.