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Retired NBME Free 120 Answers

free120/Block 3/Question#5 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Parathyroid gland ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—bwdc(697)
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Functional parathyroid adenomas can cause elevated parathyroid hormone (PTH), which results in hypercalcemia and hypophosphatemia. Hypercalcemia is characterized by the rhyming symptoms: stones (renal, biliary), bones (including bone pain to osteitis fibrosa cystica), groans (abdominal pain, n/v), thrones (polyuria, constipation), and psychiatric overtones (from depression to coma).

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drmohandes  Great explanation, thanks. Does anyone know why this patient is anemic though? Is there some link between hyperparathyroidism and anemia I am missing? +5
drmohandes  *Patient erythryocytes = 3million/mm3 (normal 3.5 - 5.5) +2
melchior  From googling, it looks like it just happens. One author says that high concentrations of parathyroid hormone downregulate erythropoietin receptors. Regardless, it corrects after parathyroidectomy, showing that parathyroid hormone likely causes it, somehow. https://www.ncbi.nlm.nih.gov/pubmed/10790758 https://academic.oup.com/jcem/article/97/5/1420/2536309 +2
flvent2120  So I understand why parathyroid can be the right answer, but why couldn't kidney be correct? This is just my overthinking things, but renal cell carcinoma can present with PTHrp leading to hypercalcemia +2
zolotar4  @flvent2120 "Historically, medical practitioners expected a person to present with three findings. This classic triad[9] is 1: haematuria, which is when there is blood present in the urine, 2: flank pain, which is pain on the side of the body between the hip and ribs, and 3: an abdominal mass, similar to bloating but larger. (10-15% of patients)" -Wiki. I'm thinking the presentation would be different. Also male predominance, latter decades (6th and 7th). +2
aaa1  "Functional parathyroid adenomas can cause elevated Parathyroid (PTH) , which results in hypercalcemia and myopathies (?) Hypercalcemia is characterized by the following symptoms: stones, bones, groans, thrones, and psychiatric overtones" I decoded 90% of it +2



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