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NBME 24 Answers

nbme24/Block 4/Question#16 (40.5 difficulty score)
A 24-year-old woman who has diffuse toxic ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal


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submitted by tinydoc(233),
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hTsi unqestoi is ryve ,ysakne ubt ni censese htsi si wahts hea.nppnig

The acailnedct mlaovre of the THP gdnlas dnigru tooytrymedich ⇒ ↓ THP

THP y rl:mlni-an-o one:b ↑ loeamrv fo ⁺C²a and phtehoPa frmo -eni bno- sndiky:e ↑ ⁺²aC bapnorisetro nda ↓ ³P₄O⁻ oai-es -rnoprb↑t eociosvnnr fo 52, Hxivraynidtomy D ot 521, myxvinadioyrtH D lrlictiCo(a - ietcav romf) iav ↑ tivtcyai of -a1 roHeaydxlys icfdcyeine

eohTerefr a ↓ THP wldou ldea ot:

⇒ ↑ P⁻₄³O ⇒ ↓ ²Ca⁺ ⇒ ↓ 215, ayynrvHtxmoidi D

ehT eisutqno si akeyns (uhcm klie the ters fo siht xame) ecbusae nseeoom hwo sitn cgsufnoi elrlya adrh or in a rshu htmig kcip the inopot C erehw ahppoeth si ↑ adn TPH is ↓ TUB ↓ 25 yxityndvhairom D

shiT si ronwg sa only 25,1 yonhviaytdmixr D dulow be dceas,erde eht onsseocnvri eobefr itsh rae oden by het nksi gthl)snui( adn .iverl

I ylelar whsi eyth loudw opts kanimg eht soiesntqu icnfosnug LREUPY orf teh ksea of imakng emht gcsfoiunn. stnI it huoeng htta we vhae ot nokw tish rloucuiids antumo fo franomt,noii tuhwoit agvhin thme etitlyalnnnio gkainm it edrrha by pnintogi yuo ot 1 rwaens oichce but gnagicnh a iutenm tdaeil to keam uoy srewna w.rong Or nguis a nmador sas tcoaeennlrum fro a iadsese ot aivdo ikngma ti too ispelm SNGP( = "arfeotireivpl )G"N

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1  
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2  
graciewacie9  Amen to the PSGN question. They got me on that one. lol +  
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +  
msw  *pointing +  
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1  
avocadotoast  this bs is prob why the question isnt on step 1 anymore +  
zevvyt  so since conversion of 25 --> 1-25 is disrupted , would 25 be high? I know its not an answer choice, just wondering +  

submitted by trazabone(15),
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nKdeyi seakm 1-52, hdryxoy iitvmna .D dx-5otihair(c) lyrcoy2l vit D ilodl(ccai) si dema in hte vlr,ei dan iisymdorrayaphphto duwol ont caresede sit lveels sa ti tcsa ot icnaeres pa1-lah ysrhoaexdyl in teh ieknyd ot esneacir oalciiltcr tnntiscconaeor ;&t-g- Cpast/pohhae resaoonrtbpi ofrm eht bone and lslma nite.sietn

queezyfish  I'm confused about the phosphate level in questions like these. Decreased calcitriol would decrease phosphate absorption while PTH decrease lowers phosphate excretion. I'm assuming that the PTH decrease has the greater effect with serum phosphate levels? +2  
mousie  PTH = "Phosphate trashing hormone" if PTH is high Phosphate must be low - they are always opposite (unless d/t renal failure then Phosphate will be high - kidneys will be unable to get rid of phosphate) So low Ca d/t low PTH does not effect 25 H. Vit D ... only 1,25 H Vit D (active Calcitriol)? +4  
haliburton  Clarification because I was confused: PTH stimulates kidney to produce 1,25-(OH)2 D3 (calcitriol) via 1α-hydroxylase in proximal convoluted tubule. Therefore, without parathyroid glands, low PTH, 25,D is not converted and therefore not down (normal or up). phosphate "trashed" by PTH as eloquently stated above. +1  
zbird  Here the primary defect is high up from the parathyroid gland, there is decresed or no PTH which normally trashes phosphate but not in this case so serum PHOSPHATE INCREASES and the serum calcium is low because PTH should have prevented the urine calcium so there is calciuria and no resorption from bone-LOW CALCIUM, Vitamin-D is independent of PTH so stays NORMAL +  

submitted by dentist(56),
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oFwlol teh iCmacul nda okwr ↓wrakCaba samen ↓ Posahhept ierotonrps ni het TCP w(chih pllsu aC htiw )ti

vhirdty2oD-5 narlom bc/ sti nulteaerd ot TP.H