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NBME 21 Answers

nbme21/Block 2/Question#6 (50.0 difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration🔍

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 +14  upvote downvote
submitted by cantaloupe5(69),
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cureRrnte dinyek tsesno huslod ceudlin irhryhpresipmtyoada on yrou if,tedirnlafe eclpuo atht wthi mgoaiastnr nad or’yue knloogi ta MNE .1 Lipsamo era salo itasosdcae ithw ENM 1.

sympathetikey  Yeah, I probably should have went with that. Just got thrown off, since I know that usually the serum calcium levels for someone with Calcium kidney stones is normal. +  
snoochi95  i understand the link to MEN 1, but why are we checking the calcium level? +  
cmun777  I feel like it's important to get a baseline of where the calcium is at for two reasons: 1. if the patient does indeed have MEN 1 it would be good to know if she has high calcium levels and possible Parathyroid etiology 2. You're putting the patient on a PPI which are known to decrease calcium levels and increase risk of osteoporosis for both these possible factors/concerns it would be good to see where calcium is currently at +4  
zevvyt  Couldn't a Pituatary tumor secrete ACTH, causing high cortisol? +1  
lola915  Patient has symptoms of a gastrinoma (Zollinger-Ellison Syndrome)- patients present with diarrhea, epigastric pain, duodenal and jejunal ulcers. Associated with MEN1 syndrome. +  

 +2  upvote downvote
submitted by monique(4),

The pituitary tumors in MEN 1 are prolactin or GH, so Calcium levels, for Parathyroid adenomas, would be the best answer.

 +1  upvote downvote
submitted by sahusema(118),
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nhWe uoy ees a acapneitcr rdinncoee roumt in icnotoainmb tiwh roteh dweri nfgi,nsid laswya tkhin ENM 1

Why would you not check cortisol, if you're worried for MEN1? I assumed high calcium was implied based on the renal stones

 +0  upvote downvote
submitted by notadoctor(140),
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hTsi nutqsioe swa sagkin uabto the seredav tfsceef of tproon pump iinibortsh elpascylie gvien useovrip iendyk su.seis IPPs cdeeares suerm gM dna emurs Ca pntaibosor nad nca ernseaci eht rsik fo aceutrfr eiysaplcl(e in teh elld)e.yr

yotsubato  PPI therapy *begins* the day she presents. She has not taken PPI before +10  
notadoctor  You're right, I missed that! +  
naught  MEN 1 is pituitary (monitor cortisol), pancreas, parathyroid (monitor calcium) but is not the ask of this question. +