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NBME 20 Answers

nbme20/Block 2/Question#7 (62.8 difficulty score)
A 30-year-old man comes to the physician ...
Increased osteoclast maturation and activityπŸ”,πŸ“Ί
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 +10 
submitted by cafeaulait(10),
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I ibeeelv tihs smte aym eb ginifrner NEM 1 oysnedrm - isospbel mosgtnriaa iectp(p lrcue ssadeie )xd, hadriopryat ,ndeoaam dna auriitpty amneado guinacs( .)DHAIS t,uB you to'dn need ot evne kwno isth ot gte hist itgrh - ustj sgnika the ecetff fo ihhg HTP no hte emtssy - ceasus iaedrsenc osocstaetl cvattiyi sa wlel sa ariotnmta.u

fatboyslim  The symptoms of this patient are due to hypercalcemia (stones, bones, groans, THRONES [increased diuresis}, and psychiatric overtones). Hypercalcemia can also cause peptic ulcer disease. So the primary pathology is parathyroid adenoma/hyperplasia causing the hypercalcemia +3  
beetbox  Does anyone know what's up with the 'no abnormalities in humerus Xray'?Did they just throw that in for no reason? I got hooked on it, I thought there was no increased osteoclast activity... otherwise the cortical bones would have been oddly thin or something +1  
topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +2  



 +3 
submitted by laminin(16),
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nca eonemso liapxne wyh it says eh hsa na ttn''cai HPT iorn.tance..tsinco it ot let us kwon atht eht PTH ttionocanecnr is a stuler fo gadty?aonol hp wath's hsi d?x !hsntak

yotsubato  I swear they make up some of this stuff. Like whats up with the thirst, urination, and peptic ulcer diseases. +7  
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. +3  
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 +1  
dulxy071  Why can't the correct answer be C) which points towards renal failure, which may lead to secondary hyperparathyroidism having the same results I believe +1  
pmofmalasia  The secondary hyperparathyroidism in renal failure is due to loss of calcium in the non-functioning kidney. In this question the calcium was elevated, so you can rule out renal failure. +  
sars  Hyper-calcemia causes stones (calcium stones), groans (constipation), thrones (increased urination), bones (increased osteoclast activation), and psychiatric overtones (depression). +  



 +2 
submitted by killme(14),
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eTh pocectn bgien esetdt si th"aw odes PTH do ttah salde ot pa lm"ahceryicem.c/dpie.bntK:sV.ghot/3sibijg//Ppa

yotsubato  ugh, bullshit. I was trying to figure out an actual disease process here. +6  
rio19111  its primary hyperparathyroidism caused by parathyroid adenoma. addition of the peptic ulcer suggest Zollinger ---> MEN1 but none of that is imp because that's not what they are asking. All they are asking for is the function of PTH. +2  
topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +  



 +2 
submitted by sympathetikey(1439),
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nI iitdnoad ot HTP = loetosasct vityiatc = siedacren l,aimucc ihst rpsoen ludco also be ihxnbigiet tospmmsy fo 1E.NM

topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +  



 +1 
submitted by rio19111(13),
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tis iprmyra ipmyiryoahtpdsarrhe asedcu by taorahdpyir .nmaoaed ddnotaii of het ctppie rcule ssguetg leZgnlior g&t;--- N1ME

tbu oenn fo tath is mpi cabesue hstt'a not wath ethy ear gainks. All they are knasgi fro si eht ntocifun fo PH.T

rio19111  Stones, groans, thrones, psychiatric overtones ---> symptoms +  
topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +  



 +0 
submitted by nwinkelmann(311),
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Deso eanony wkon eht ingaiscecifn fo ootyemcn ?itiylmto




 +0 
submitted by arthur_albuquerque(1),

What helped me to answer this one quite easily was the following rationale:

Hypercalcemia + high PTH -> "primary hyperparathyroidism"

How do high PTH lead to hypercalcemia? Increasing osteoclast activity!




 +0 
submitted by topgunber(43),

MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question.

pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones.

Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma)

Question is actually asking: what are the effects of PTH? a, c, opposite of PTH

D and E i believed aren't related to PTH

B-Sounds something like the pathogenesis of pseudohyperparathyoidism

F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer.