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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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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  

 +1  upvote downvote
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  

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. +