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NBME 21 Answers

nbme21/Block 2/Question#6 (58.6 difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration๐Ÿ”,๐Ÿ“บ
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 +15 
submitted by cantaloupe5(78),
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rRetneurc yiendk eostns hldsuo clnideu arterpohpmdryhiiays on oryu ifaendtielrf, luocpe htat wiht snotaiagmr and ouโ€™rye oonlgki ta NEM 1. mspLiao rea aols stoadsacie itwh 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. +1  
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 +5  
zevvyt  Couldn't a Pituatary tumor secrete ACTH, causing high cortisol? +2  
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 
submitted by monique(9),
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ehT uiyirpatt trusom ni MNE 1 ear clnirtpoa ro GH, so luicamC ellsv,e fro tPaairhdory a,snemdao duwlo be eht esbt ewar.sn




 +1 
submitted by sahusema(145),
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nheW you ese a nccatripae cernneido uomrt in tnocoiibanm whti hreto rediw n,dgisinf awysal nkiht NME 1




 +1 
submitted by amphotericin(8),
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yhW dwoul uoy not echck ci,sotolr fi eyruo' iedwrro fro EN?M1 I sdumase high almcuic aws diieplm eabsd no teh elnar steson




 +0 
submitted by notadoctor(159),
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iThs osuteinq swa ksinag obtau the eredsva fseetfc of nortpo pmup sotbihiirn cileeasply igevn poveisur ykndie suis.es sIPP eadcsere umres gM nda uemrs Ca tobaionspr dan nac ernascei teh iksr of errafutc pacsliel(ye ni hte dleelyr).

yotsubato  PPI therapy *begins* the day she presents. She has not taken PPI before +15  
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. +