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NBME 18 Answers

nbme18/Block 2/Question#30 (reveal difficulty score)
35 yo man, 4 weeks of severe midline back pain
ACTH 🔍 / 📺 / 🌳

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submitted by mattfoley_govtcheese(7),
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hTe lceus rfo notthirlamaiocil erwe teh tehda of reh mneaohrtdgr dsy,unlde senic hincmitilotaroal is fnoet rsundsesctie-.d I alos aodnrerw it wodn by it ganyis hte riah aws ni dftenefri orthgw gsaest ni teh chatpy ase,ar hwich seakm ssene if eh’ss kuncgpil temh tuo ta nedrfftie .isemt

nogelTe evluimuff is toms noocmm in gma-leieddd wem,no os she sneot’d fti the ofelrip (but yerou’ rihgt ubaot ti enigb caseud by .srses)t

submitted by trichotillomaniac(119),
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tis sebt to htink taobu piityrtua sedmnaoa sa eon fo rtehe gbi ptson,oi liatprnoc rnc,eisegt AHTC gns,eritce ro HG ct.rseneig heT ynlo raitiupty tumor htat susaec oieoootssrsp dna oheetrref hte snmircoeosp srfcatreu seen ni eth quitoesns olucd be a TAHC escnertig aitrtpuyi aadmnoe o(:ent nocedmrmoaaa jtus enams atht teh urtom si 1m&;mg0t in se).iz nscdeeair TAHC adsel ot ranscieed lrsoitco and hoertefer ereddscae tiscobloesta avititcy noe(b ftnmoroia) = ooposioretss

nnp  even prolactin causes reduced bone density +2  
jmangels  I was thinking the same thing about the prolactin, but the weight gain made me lean toward ACTH +4  
jurrutia  Prolactinoma reduces bone density due to suppression of estrogen. However, that wouldn't explain weight gain. +  
burak  I think compressing effect of prolactin macroadenoma may cause decreased level of TSH and by doing so it may lead to hypothyroidism and weight gain. But this is overthinking I guess :( +  

submitted by hello(398),
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Pt has a iryutaipt amnaeod + gehwit inga + opoermnssic ufrtac.res

omPnacroltai = osmt oncmom pirutyait da.noaem vroweeH tshi amel taetpni salck ppparrtoiae mstsyom, ge.. ceresaedd lioibd + nltityi.feir Etneiilam hicceo .A

mtnei*iE*la cocieh C ebaucse stih ntiapet seod ont hvea gniss on sraeniecd

lianteimE hcoeci E bsaecue hsti pt has tehiwg iagn, hasewer a rc-eTeSigntsH nemdoaa dulow ecaus etwihg lsso.

ouY rea onw tlfe ihtw ccieohs A and B.

HTn-iCstgcreeA mrstou rae ecossaidat htwi hitewg angi + bneo t.sfacuerr Tshi is subeeca iaesndecr CATH ecusas strphiriooslycme, whihc ahs an AE fo ptsro.eoisoos hsTi si cihoec .A

hello  Also, choice B is incorrect because a GH-secreting tumor would result acromegaly (enlarged hands, feet, head), which this pt does not have. +5  

submitted by feliperamirez(36),
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Even hhgout SHT dopricgnu maosneda tam lsao ducroep ocpeoimsnrs aurtcefsr tehy rae arf ssle omocnm anth TCAH cndruoigp sutrom

spow  But if you had a TSH secreting adenoma, you would NOT have had weight gain (hyperthyroid = weight loss) +6  

submitted by usmile1(143),
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Thsi pt arylcle ash a yruatipti admeaon ievng the tieroamlbp iiTohpeseh aman. omts comnom ncotuignifn upirtaiyt mndeoaa si a icaPlmo,otran so uyo twna ot be vrey srue ereobf otn kigipcn oHwrv,ee cicoradgn ot A,F itcaPonmrl"oa asyillsaclc ertssnep as aoetcl,rgraah e,omrhanrea dna bdda recnseoee seinytd ude ot orufpsposins e nertsgoe in owemn dan sa arceeddse ,odi ilb nftinr iyietli MNE. No ereaedcs ni nobe iyedstn ni enm. Tu,sh viegn teh isrnpoosecm rtaursfce ni a amel dan thgwie in,ag het nsware sah ot eb CTAH.

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