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NBME 22 Answers

nbme22/Block 3/Question#42 (19.3 difficulty score)
A 62-year-old man comes to the physician for ...
Inorganic phosphorus: increased;
Parathyroid hormone: increased;
Calcitriol: decreased
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 +13  upvote downvote
submitted by bubbles(63),
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coChnir narel :nycfcuiifsine

1) opro hshtoeppa aceclrane t;--&g ihgh mseru ancriinog prhosshpouo

2) gihh emusr ptpoahseh g;-&-t sexcopeml iwth deltinav taoicn aC t--;g& Ca lslfa

3) aC lfsla ;--t&g sregrtig TPH axis

)4 dykien efairul ;t--&g drseceade iytcavti fo ehx-syldyrao1 ta eht ekyndi -t&;-g lses liotaccrli

makinallkindzofgainz  this guy renals +4  
paperbackwriter  Someone please help me with this (always trips me up): PTH causes increased vit D production in kidney... are we assuming the increased PTH can't catch up with the kidney failure? Is it the level prior to PTH compensation that they want? D: +  
miriamp3  @paperbackwriter what it works for me ;;;; is find the first abnormality so CKD low calcitriol (no D vit) ---> is gonna increase PTH ---> the kidney are not working (chronic, they don't tell u recently- you can;t revert a CKD so the kidney never going to catch up) --> increase inorganic phosphorus.--> always start with the problem. I also use this for celiac and types of shocks. start with the problem, and trust yourself. +2  
paperbackwriter  @miriamp3 thank you! I will try out your strategy next time!! :) +1  
snripper  I thought renal insufficiency -> inability to reabsorb phosphate at PCT -> decreased phosphate? +2  



 -8  upvote downvote
submitted by sne(36),
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eciSn ehs hsa licaec srpeuc t;--&g atf mtinaiv lpmrsnaobait,o suht i.tV D si dwadee rscoeL v.ti D = wlo laiir,ctolc wlo rnaiboostp of pstphohea rofm isnt,ieetn dan owl rbnpstaioo fo +Ca2 uisngac na aisrcnee PTH