NBME 20

nbme20/Block 2/Question#7

A 30-year-old man comes to the physician because of ...

Increased osteoclast maturation and activity

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submitted by laminin(1),

can someone explain why it says he has an 'intact' PTH concentration...is it to let us know that the PTH concentration is a result of pathology? and what's his dx? thanks!

yotsubato  I swear they make up some of this stuff. Like whats up with the thirst, urination, and peptic ulcer diseases. +2  
redvelvet  hypercalcemia can cause nephrogenic diabetes inspidus; so thirst, urination. hypercalcemia can also cause peptic ulcer disease. His symptoms are all about hypercalcemia due to hyperparathyroidism. +1  
namira  "Hypercalcemia can cause renal dysfunction such as nephrogenic diabetes insipidus (NDI), but the mechanisms underlying hypercalcemia-induced NDI are not well understood." https://www.kidney-international.org/article/S0085-2538(16)30704-9/fulltext +  

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submitted by killme(1),

The concept being tested is "what does PTH do that leads to hypercalcemia" https://i.ibb.co/sKPdVj3/image.png

yotsubato  ugh, bullshit. I was trying to figure out an actual disease process here. +1  

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submitted by sympathetikey(102),

In addition to PTH = osteoclast activity = increased calcium, this person could also be exhibiting symptoms of MEN1.