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NBME 21 Answers

nbme21/Block 4/Question#6 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Cortisol πŸ” / πŸ“Ί / 🌳
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 +28 
submitted by βˆ—mcl(640),
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noIrtactsel einvs inrda nito the gyaozu/soayiehzgsmu ,vnies hwich nru hitrg tnex to the eavbetlrr .uclmon tehnrAo uuefsl gaadirm oighsnw lfte and htgri entrsoilcat nei.sv


 +19 
submitted by βˆ—beeip(134),
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siTh has eenb a gtohu netcpco ofr me ot get, btu I nihkt 'mI lylnaif :rteeh

hTe tems is debcnrgiis rrapiym eldaran nfnicsei,uyicf or 'sdAodsni.

  • TCAH is eibng cruoeredvp-do ot mltsaeuti het nlderaas to ourdcep s,criolto tbu teyh tn'ac p,osdrne iethre eud ot hytopra ro uerotctdins (BT, emi:uaotmnu ,R4D .cet)
  • heT itsrf 13 moain disca fo HCTA can eb dvaceel ot mrof SH,Ξ±M- hhcwi etautmissl te,nyoeacmls giunacs annhyptromiiegept
jotajota94  Good job! Also, cortisol is involved in maintaining blood pressure. which was decreased in the patient. +7  
tinydoc  Decreased Na and increase K+ --- Hypoaldosteronisim Hypoglycemia, and hypotension --- Hypocortisolism so the adrenals arent working ---- adrenal Insufficiency the Hyperpigmentation comes from the increase ACTH as ACTH is from Proopiomelanocorticotropin. SO - increased ACTH also increases a -MSH ---> Hyper pigmentation. +11  
hungrybox  thank u for this answer +  
bilzcop  Ugh! I misread the question and chose ACTH :( +3  
cienfuegos  @bilzcop: same +  
cienfuegos  @bilzcop: let's never do it again, k? +1  
maxillarythirdmolar  Why does this patient have elevated BUN and creatinine?? +3  
lovebug  @ maxillaryhidmolar > I don't know exactly. but maybe.. Low hypo-adlo -> our body lose water -> hypo-volemia -> Decreased GFR -> Increased Cr,BUN. If I'm wrong. please correct me. +  



 +4 
submitted by βˆ—amirmullick3(66),
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The mest is nbgiecrsdi mypairr alenadr cfnucynif,isei ro d'ossidn.A

CHTA si eginb orvo-ucdpdere to utslimate the reslaand ot ocpderu orlctsio, utb yhte tcan' ,ete rsoernihpd edu to ypraoht ro toeditnrcus (TB, imtnaumeu:o ,D4R cTeeh.t) fistr 31 aomin scida fo TAHC acn eb adcveel to ofmr SΞ±-H,M whcih tsmasuilte yelmnseoca,t uncaisg tetCoohre.gpinsyamnpiil rto lphes wtih BP nad sih si o.wl

eattsPni saol aveh olw wd tse.eoanoorLl aN nda high K is a nsig of an.seoispyootdlhrm astnietP nairet H nad oesl gn.HsL3 COoi 3OHC uscase -lC nntieoter ni the TP.C ihTs all delas to comatlbie so acs.osdsiLi fo toclisor cseusa iaxenora, pehiyla,gcmyo adn a wol BP as esen in sith neatitp.




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