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NBME 24 Answers

nbme24/Block 4/Question#16 (31.9 difficulty score)
A 24-year-old woman who has diffuse toxic ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal


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 +20  upvote downvote
submitted by tinydoc(187),
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hsTi snoeuqti is yrve eyskn,a utb ni secseen shit si htsaw nigae.nhpp

heT lanecadcit olveram fo hte HPT nldasg rngiud oyeihydcrottm ⇒ ↓ PHT

PHT - y-nani:orlml e:obn ↑ lrvoame of C⁺²a dan opahhPet rfmo bn neio-- n:eidyks ↑ ⁺a²C iopraeonrstb dna ↓ ₄O³⁻P t↑-r -rnaopsoeib cienosonvr of 52, moatyxniydvirH D to 5,21 yvdnxtmiiHoayr D crilC(taiol - avecit rfom) aiv ↑ ctviatyi fo 1-a Hyesxoyradl necidficye

ehfTroere a ↓ HTP udolw alde ot:

⇒ ↑ ₄PO⁻³ ⇒ ↓ ²aC⁺ ⇒ ↓ ,152 nraiHmtoiyxvdy D

ehT utqsineo si eknysa mchu( ekil het rest of tihs emx)a aceesbu soemneo woh tisn gsnicuof raeyll hdar or in a ursh thmgi cikp eth npoiot C eewrh pothpeah si ↑ dan TPH is ↓ BTU ↓ 52 daitivymronxhy D

shTi is grown as ynlo 1,25 xhmtvrniyoaidy D lodwu be aerc,esedd eht esrnoiosvcn oeberf sith era oend yb hte insk gh)ni(uslt nad rivel.

I aeryll wshi ehyt ulwdo tosp aknigm eht itessnquo ifunoscgn PELUYR rfo teh esak of kigman meht nocgs.nuif Itns it neuhgo atth ew ehav to knwo isht lruioudsic aotunm of ofnmiio,rtna oihwttu agvnhi emht aieonltynnitl agmnki it ehdrra yb gnioptni ouy ot 1 seawrn hicoec btu aicnnhgg a ietumn leaidt to amke oyu sewnar o.gwrn Or gsuni a domrna ass crtaeleunmon orf a eaesisd ot ivaod gkmnai ti oot eimlps (PGNS = tlrvaeir"pieof N"G)

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 +  

 +1  upvote downvote
submitted by trazabone(12),
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Keidyn mskae 25,1- xhyordy aiinvmt D. l( lath)oi-orxdc2riy5yc vit D )idicloa(lc is made ni eth ire,lv dna ayrpidohthaprsiomy olwdu ton eeaesdcr ist lsvele as it scta ot rnaiseec aa-ph1l osexydhryla ni het edkyni to ecerasin tlrlcicoia etnrnotnisacoc g-;&-t aeoas/htCphp ernobapoistr mrof eth onbe nda lamls en.ensitit

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? +1  
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. +  
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 +  

 +0  upvote downvote
submitted by dentist(40),
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oFolwl eth umCicla nad wokr aw↓saCacbk. dr nmsae ↓ ephaPtosh rptoernois ni het CTP (hwihc lpslu aC ithw t)i

r-v5yDhiod2t omnlra /cb sit euledtnar ot .PHT