NBME 22 Answers : Block 2 : #16 = A 60-year-old man is brought to the emergency ...

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NBME 22 Answers ↦

nbme22/Block 2/Question#16 (19.5 difficulty score)
A 60-year-old man is brought to the emergency ...
Prostate adenocarcinoma🔍
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submitted by cocoxaurus(52),

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impostersyndromel1000 This was in pathoma, he said prostate cancer causes osteoblastic lesions and "the board examiners really want you to know that". also following the potential site of mets helps choose the answer +1

snripper Also, osteosarcoma is less common in the elderly, more common in males <20 y/o (per F.A 2020) +1

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submitted by lisa(0),

Hints. His age + Multilple blastic lesion pointing out at metastasis. Negative protein electrophoresis ruled out Multiple myeloma

drjungly All primary bone cancer - mc seen in age b/t 20-40 peak at 25. Prostate adenocarcinoma - mc seen age >50 yr old. Source-FA 2018 +3

asharm10 Sometimes instead of osteoblastic they say osteosclerotic that's synonym of Osteoblastic. For multiple myeloma it's always osteolytic. +2

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submitted by nootnootpenguinn(5),

Why are his labs normal?

Protein electrophoresis is to r/o MM. What are the others trying to rule out? Also, if it was prostate adenocarcinoma, wouldn't there be elevated PSA in the urine (which might result abnormal UA)?

lsp1992 Urinalysis provides a microscopic examination of urine, which would tell you about the presence of RBC, WBC, casts, crystals, epithelial cells, and a chemical test for nitrites, bili, urobilinogen, ph, specific gravity, proteins, glucose, blood, and ketones. PSA is a specific protein that would be found in the blood, and a lab test that would have to be ordered specifically. +