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NBME 24 Answers

nbme24/Block 4/Question#16 (37.5 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(223),
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ihsT setquoni si yevr ankse,y ubt ni esecsne shit is wahst nhg.peaipn

Teh tcdecnilaa arovmle fo het THP gldasn rngidu mehicdttoryyo β‡’ ↓ THP

PTH lnl :n-m-yoair o:nbe ↑ aromlve of Ca²⁺ adn oehpatPh fomr -ebn -oin eyi:dsnk ↑ aC²⁺ rtsbnoaoiper dan ↓ ⁻₄OΒ³P e↑ tnar-riboop-s noocsvrien fo 2,5 oyviiynaxdmrHt D to 12,5 iyxvnioaymdtrH D cioitlra(Cl - etciav mro)f avi ↑ vyictati of -a1 yxrHloedyas nideyceicf

ofeererhT a ↓ PTH uwlod leda t:o

β‡’ ↑ β‚„P⁻³O β‡’ ↓ aC⁺² β‡’ ↓ 251, yHtiyvdixonmar D

eTh uetoqsin is yaksne hum(c ielk teh estr of sthi e)axm abueesc smoneoe how sint cfuniosg elraly darh or in a ruhs mghit pcki het ooitpn C ewher eohhppta si ↑ dan PHT si ↓ TUB ↓ 25 tdaryxyhvmoiin D

ihsT is wogrn sa lyon ,521 tinodmvhyairyx D ouwld eb ,eadescdre eht rocnsnievos orfebe hsit aer nedo yb hte snik )uils(gnth dna lei.vr

I ayller ihws eyht luowd spot mignak hte uqntsieos niunogfcs PURLYE ofr the aske fo iamgkn hetm ion.fgnsuc ntIs it hueogn atht ew ahve ot nkow hist curoldiius nutmao of miiorfnont,a uohiwtt anghvi them iynnteoltnail iamkgn it aehrrd yb pgnnoiti uyo ot 1 eawrsn cchoie ubt nniaggch a tiumne iteald ot make uoy srnaew Or nusig a oadnrm ssa etnclnuaoemr fro a edesias ot doiva giamnk ti oto lpiems N(SPG = foravpielier"t "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 +  
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(14),
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dKnyei kemsa 1,52- hyrxdyo naitmiv .D toc2ahryic llirxo(5)-dy vit D l(oli)caicd is dame in teh el,rvi dna ortpyoirdyhphsaiam wludo otn edeecras tsi slleve sa ti asct ot csairnee lhpaa1- yyhxralodse in eth dikeyn ot easciren aclitcirol eatntsocinnrco t;&-g- oespCphh/aat sopeniotrbar rmfo het bneo adn msall teensitni.

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 1Ξ±-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(49),
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wlFloo teh cliuamC nda korw aar aCwsdb.↓ck seanm ↓ oshetapPh poonrrseit ni eht PCT (whcih lulsp Ca with i)t

Dyodtrh5i-2v mornla b/c its tuldearen ot .THP