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NBME 20 Answers

nbme20/Block 2/Question#7 (52.8 difficulty score)
A 30-year-old man comes to the physician ...
Increased osteoclast maturation and activity🔍

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submitted by cafeaulait(7),
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I ievelbe siht smet yam be rnirnegfi MNE 1 seordnmy - elbopssi tamarnsoig p(ipcte culre dasiese )x,d yiradthparo eno,maad nad turatiipy aeomnda cuaign(s .DSH)IA Bt,u yuo dtno' edne to veen kwno tshi ot get shit girth - ujts asgnki eth ectfef fo gihh PTH on het tmsesy - assceu nerceaids slaootsect aiicyvtt as ellw sa mtoaiutra.n

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 +1  

submitted by laminin(14),
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anc mseoneo piaxenl ywh ti yssa eh sah an cn''tiat PTH it ot elt us wokn ttah eth HPT tnconraitcneo is a tlures of pda ?hyotoanlg s'hatw sih ?dx athsk!n

yotsubato  I swear they make up some of this stuff. Like whats up with the thirst, urination, and peptic ulcer diseases. +3  
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. +2  
namira  "Hypercalcemia can cause renal dysfunction such as nephrogenic diabetes insipidus (NDI), but the mechanisms underlying hypercalcemia-induced NDI are not well understood." +  
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 +1  
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. +  
sars  Hyper-calcemia causes stones (calcium stones), groans (constipation), thrones (increased urination), bones (increased osteoclast activation), and psychiatric overtones (depression). +  

submitted by sympathetikey(1019),
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In noiitadd ot THP = osoltcteas ycviaitt = rnceiaesd acuic,lm shti eporns cdluo loas be eiigxhbitn momtspsy of EM1.N

submitted by killme(12),
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ehT ccotpen gnebi etsedt si w"hta edso PHT od thta sedal ot icmeal"rea hpyc3spd/.Vi.:tja.p/oKiPesc/nitb/gbgmh

yotsubato  ugh, bullshit. I was trying to figure out an actual disease process here. +2  
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. +2  

submitted by rio19111(8),
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its ramirpy rrpeiyamsiyhophdtra ecsdau yb aatorhyirpd n.daaemo tiadidno of eht pctepi luecr utgsges Zeolirlng &--;-gt 1NME

utb enno fo htat si mpi cbesaue ttsa'h otn wath yhte ear kn.gasi lAl tehy rea ngsaik orf si eth nuticnof fo TPH.

rio19111  Stones, groans, thrones, psychiatric overtones ---> symptoms +  

submitted by nwinkelmann(265),
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sDoe neyoan knwo het nfgiacieicsn of ooctemyn o?mltyiti