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NBME 18 Answers

nbme18/Block 3/Question#21 (14.3 difficulty score)
48 yo woman, gradual onset of back pain over ...
Metastatic carcinoma of the breast🔍

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 +2  upvote downvote
submitted by lamhtu(86),
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mteS shdoul yabme ays moes esnlsoi aer iclyt dna oesm era sl.rcoetic tBaser tmes ot bneo si eimdx etyp ndoiagccr to FA? fI ouy og off hte mtes ebing upeyrl ity,cl oen olucd hktni rdtohiy ioracncma is the rorccte mayrrpi ur.mto

lae  thats also what I thought +1  
pg32  Yeah I didn't pick breast for the same reason. Then I didn't pick thyroid because I doubt serologic studies would be normal in thyroid cancer (if you check T3/T4 and TSH). So I went with avascular necrosis -_- +  
lynn  in the FA index, the only things listed under lytic bone lesions are adult T cell lymphoma, langerhan histiocytosis, and multiple myeloma. Obviously there's more than that but those might be the main ones we need to know. You could also say that a giant cell tumor is also technically lytic, considering they describe it as "osteoclastoma." Idk. I thyroid but looking at FA, none of the thyroid carcinomas describe metastatic lytic lesions. Medullary carcinoma might be the one to confuse you, but it secretes calcitonin which inhibits osteoclasts, so it shouldn't cause resorp or lytic lesions. Right?? +  
prp5c  just a different view - I was between avascular necrosis and metastatic carcinoma, but ended up going with metastatic carcinoma because I figured avascular necrosis of the lumbar and thoracic region would be hard since you'd have the artery of Adamkiewicz as a dual supply to the vertebrae? +  

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submitted by ergogenic22(238),

I went with metastatic breast because they made a point of saying metastatic as if the thyroid carcinoma has not spread to the bone.

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submitted by lae(12),

uptodate says it can cause only osteolytic lesions too, and because it says "most likely" and breast cancer is the most common cancer in women, it is breast ...

pelparente  Yah ^ this is why I put breast over thyroid. +  

 +1  upvote downvote
submitted by flapjacks(26),

2 lytic lesions sounds like a metastatic origin

The most common locations for bone metastasis: Prostate, Breast > Kidney, Thyroid, Lung

Lead (PB) K e T t L e