NBME 21 Serum calcium concentration (NBME Answers)

Retired NBME 21 Answers

nbme21/Block 2/Question#6 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration 🔍 / 📺 / 🌳 / 📖
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+16 upvote downvote
submitted by ∗cantaloupe5(87)

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Recurrent kidney stones should include hyperparathyroidism on your differential, couple that with gastrinoma and you’re looking at MEN 1. Lipomas are also associated with MEN 1.

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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? +1

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 +6

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. +

+3 upvote downvote
submitted by monique(10)

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

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+2 upvote downvote
submitted by amphotericin(11)

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

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ali_hassan Pituitary - GH and prolactinoma PTH - Calcium Pancreas - gastrinoma, insulinoma etc etc.. +

+1 upvote downvote
submitted by ∗sahusema(173)

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When you see a pancreatic endocrine tumor in combination with other weird findings, always think MEN 1

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+0 upvote downvote
submitted by ∗notadoctor(175)

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This question was asking about the adverse effects of proton pump inhibitors especially given previous kidney issues. PPIs decrease serum Mg and serum Ca absorption and can increase the risk of fracture (especially in the elderly).

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yotsubato PPI therapy *begins* the day she presents. She has not taken PPI before +17

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. +

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