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NBME 20 Answers

nbme20/Block 2/Question#7 (reveal difficulty score)
A 30-year-old man comes to the physician ...
Increased osteoclast maturation and activity πŸ” / πŸ“Ί / 🌳
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 +19 
submitted by βˆ—mcl(645),
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bdlaeeL CRX wsgnoih tooipisn of eedfitrfn esvla.v


 +10 
submitted by cafeaulait(10),
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I ebielve sthi mest amy be nignrrfei MEN 1 srynmdoe - bsslopei tasgarnmio icp(tep ulrce sdaisee ,)xd ryopditahar oeamnd,a and rityupati aamdone n(iaugcs A.D)IHS u,tB yuo odnt' dnee ot neve nowk hsti to teg tshi rhgti - just ginask eth ftcfee fo hgih THP on hte tymess - uascse srcndeeai csottosael taicyitv sa lwel sa nimturaaot.

fatboyslim  The symptoms of this patient are due to hypercalcemia (stones, bones, groans, THRONES [increased diuresis}, and psychiatric overtones). Hypercalcemia can also cause peptic ulcer disease. So the primary pathology is parathyroid adenoma/hyperplasia causing the hypercalcemia +5  
beetbox  Does anyone know what's up with the 'no abnormalities in humerus Xray'?Did they just throw that in for no reason? I got hooked on it, I thought there was no increased osteoclast activity... otherwise the cortical bones would have been oddly thin or something +3  
topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +3  



 +4 
submitted by βˆ—laminin(18),
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acn snoeoem elipnax wyh it sasy eh sah an ''icantt HTP aec.isn.noi.otctrn it ot let us oknw ahtt eth PHT ncntneiorotac si a urlset of hotdgyaonl ?pa ths'aw ish xd? ntakh!s

yotsubato  I swear they make up some of this stuff. Like whats up with the thirst, urination, and peptic ulcer diseases. +9  
redvelvet  hypercalcemia can cause nephrogenic diabetes inspidus; so thirst, urination. hypercalcemia can also cause peptic ulcer disease. His symptoms are all about hypercalcemia due to hyperparathyroidism. +4  
namira  "Hypercalcemia can cause renal dysfunction such as nephrogenic diabetes insipidus (NDI), but the mechanisms underlying hypercalcemia-induced NDI are not well understood." https://www.kidney-international.org/article/S0085-2538(16)30704-9/fulltext +2  
dulxy071  Why can't the correct answer be C) which points towards renal failure, which may lead to secondary hyperparathyroidism having the same results I believe +2  
pmofmalasia  The secondary hyperparathyroidism in renal failure is due to loss of calcium in the non-functioning kidney. In this question the calcium was elevated, so you can rule out renal failure. +1  
sars  Hyper-calcemia causes stones (calcium stones), groans (constipation), thrones (increased urination), bones (increased osteoclast activation), and psychiatric overtones (depression). +1  



 +2 
submitted by killme(14),
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eTh topcnce gebin esdett si twha" dsoe TPH do atth lesda to cpeemary"aic hls//bm.Vti.P/i.pjtsiga3d:/cbngeopKh

yotsubato  ugh, bullshit. I was trying to figure out an actual disease process here. +7  
rio19111  its primary hyperparathyroidism caused by parathyroid adenoma. addition of the peptic ulcer suggest Zollinger ---> MEN1 but none of that is imp because that's not what they are asking. All they are asking for is the function of PTH. +3  
topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +1  



 +2 
submitted by βˆ—sympathetikey(1532),
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nI tdionida ot PHT = satolsceot yitctvai = decernisa aciuml,c sith nrseop cloud lsao eb tieinhbgix ymsospmt of M1EN.

topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +1  



 +1 
submitted by rio19111(16),
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tsi yrimarp ihpaeryryartipdmsho ecadus yb oarypardhti a.madeon ddiaonit of eht peitpc crlue esgsutg Zlglieorn -&-tg-; 1MEN

but onen fo tath is ipm cesubae tt'ash nto ahwt hyte rea n.gskia lAl ethy aer gsknia orf is the uiftconn of TH.P

rio19111  Stones, groans, thrones, psychiatric overtones ---> symptoms +1  
topgunber  MEN 1 - P P P . Parathyroid, pancreas(gastrin in this case), pituitary lesion. not key to answering this question. pt comes with symptoms of hypercalcemia, moans, groans, thrones (peeing), psych overtones. Look at pth and calcium. we see high ca and high pth. We know that high calcium would lower pth...this means the high caclium was due to the high pth (i.e. parathyroid adenoma) Question is actually asking: what are the effects of PTH? a, c, opposite of PTH D and E i believed aren't related to PTH B-Sounds something like the pathogenesis of pseudohyperparathyoidism F- we definitely know that PTH increases Ca , so by increasing osteoclast maturation/activity you liberate calcium into the blood. this is the best answer. +1  



 +0 
submitted by βˆ—nwinkelmann(349),
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osDe ayenno onkw teh nfsiiccinage fo nocmteyo mit?tylio




 +0 
submitted by arthur_albuquerque(1),
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hWat ehdple em ot erwnas tish neo iqute eaysli was het ogwinflol tieoan:arl

aremylicpaHec + ihhg PHT gt&;- "miarpry e"hotyrdapysiiarphmr

oHw do hhgi HTP deal to mrcaleapcyih?e caIrnsnegi ttlcooesas tyaivi!ct




 +0 
submitted by βˆ—topgunber(64),
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MEN 1 - P P P . yat,Prioahrd riagpern(sncatas ni thsi ,ecas) rtiptuyia os.neli ton kye to srnenawig hsit iu.tsenqo

pt oemcs with mtpsmyso of apiraclyecehm, smna,o ogr,nsa hernsto )ie(engp, shcyp rseot.oven

okoL ta pht dan au.lmcci ew ese ghhi ac dan ighh p.ht We nowk thta hghi icumcla wluod lorwe .p.ihtt.sh smnea the hihg lcucmai aws ude to teh gihh pht .i.e( ryprioadath )dnameao

nsiQueto si acaytlul gsi:kan whta aer het eftsefc of PH?T ,a ,c tosoippe fo PHT

D nda E i deveeibl 'raten dreatel to HTP

uSBs-dno stgmienho lkie eth neshiastgoep of eerophmpipadyiydtshsruoa

-F we iiydlefnet wkno atth HTP asnsireec Ca , so by ernciasgin toetsocals tt/myvaoatauincrtii oyu leerabit mauclci inot the o.dobl thsi is teh tbes wrn.esa




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