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NBME 16 Answers

nbme16/Block 1/Question#3 (16.5 difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentrationπŸ”
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 +3 
submitted by medninja(15),

MEN 1--> Pituitary tumors, pancreatic endocrine tumors (zollinger ellison or gastrinoma) and parathyroid adenomas.

nbmeanswersownersucks  the question hints at a possible parathyroid adenoma with her history of 2 episodes of renal calculi. +4  
feochromocytoma  Yup, also as a tip for next time, if you see that a patient has some sort of pancreatic cell tumor, such as Zollinger in this case, look for other MEN 1 associated findings. +  
cheesetouch  FA18 347 +  



 +0 
submitted by rina(6),

why isn't it serum cortisol concentration though. Couldn't that help you identify a pituitary adenoma (i.e. because increased ACTH --> increased cortisol concentration)?

rina  is it because she's showing no symptoms or something? +  
jj375  I'm not sure but I would assume you would want to first confirm that her symptoms are from a gastrinoma (pancreatic endocrine tumor) and a parathyroid adenoma to confirm MEN1 before you would go and then try to preventatively check for a pituitary tumor even without symptoms. So I would guess it is just about what takes priority, focus on the things with the symptoms to confirmt he diagnosis +