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NBME 23 Answers

nbme23/Block 2/Question#9 (30.0 difficulty score)
A 60-year-old man has had easy fatigability, ...

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submitted by bigbootycorgi(4),
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I oguhtht fo isht sa qmsosuua lcel miaccrano fo hte ungl aicgusn iedraecns PHTrP and rcail.pehemcya

d_holles  I thought this was medullary thyroid cancer but demographically SCC works better. +  
smc213  Medullary thyroid carcinoma increases calcitonin levels leading to decreased serum Ca2+ by increasing Ca2+ renal excretion. So high levels of calcitonin secreted by the tumor may lead to hypOcalcemia. Source: Pathoma +20  
brise  actually according to pathoma, you rarely see hypocalcemia even though calcitonin is high! +  

submitted by hello36654(5),
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I udndreanst ywh its' lgnu wo,n btu I keicpd rhyodti ngdal euebcas foetn eistm dhityro mutrso rseps on teh arioayprdth gsittin ,evabo whihc cauess eht sytdpaorahir to rctesee oerm .an.cC.a onoseme mctnemo fi 'yeevth dera shit oot?

paulkarr  I personally have not read that, but I wouldn't be surprised by that fact. I think with these NBME problems though, if you can get the answer within one "step" that should be your choice. Here you can just go Squamous Cell Carcinoma with a direct action on serum calcium levels (via PTHrP). Thyroid requires a few more steps, (assuming your statement is true) so in the eyes of NBME, it ain't gonna be the right choice. Always follow the "KISS" logic! +1  

submitted by nwinkelmann(285),
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oS, in aihrneercsg this tufrh,er I fgiuerd uto a ywa to lrue the toreh eensarsw .tou reP tshi l,ratcei tbn8Cngite/w4hl/m/3wsvPw:rp8.hcpic6/c3iM/ltn0oam./.s., oulrmah hryaieeplccma fo clgymainan is esdauc by 4 snhimamcse thiw cesesx PHPrT onetricse bigne C.CM eEsxcs HTrPP eoirntsce rcscuo ni uo"smsuaq clle ancserc, riuaynr ttcra anrecsc (ralen ccerna and labdrde )ccr,ane sebrta crne,ca g'odinosnHnk m,oahlymp adn nirvaoa rcecna onctuac fro teh mayoritj fo mnaeslnciiag eigland to iaacleerchpmy vai "HPP.rT hTe teorh 3 ssueca iucndle heaacrlcpmeiy sreyoadcn ot oodruioerpctnv fo ,trlcaiioc eoyotictls tmasatese,s dna TPH dieaemdt hecriemacpyla od(tirhapyar mccnaorai and octepic p.otudnr)oic o,Asl AF ynlo nmotsnie HPrTP ni rdagser ot CCS of lnug nad nlrea clel ami.rcoanc

s,erotPta oncl,o and riaceatpnc cecnsra rae roem ymlocmon oacami,aornnedc and elss illyke to eeaelsr ,PrHTP nda horyitd aneccr is lsao sesl el,kily tghhuo I idd idnf neo rtciale that ofndu PTPrH deeraesl yb lal fo etseh cascren so I 'ontd .kwon I guses mI' sjtu inggo ot og hitw SCC fo nlug nbieg CMC of PPHTr lhamuor hpcmeacilarye fo cialny,agnm ulsp 'einsattp cheidamgorsp (6s'0

submitted by achrondroplease(5),

Why can this not be MEN 1? And the increased serum calcium be a result of increased PTH release from parathyroid?

azibird  None of the answers are parathyroid. +1