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NBME 20 Answers

nbme20/Block 2/Question#7

A 30-year-old man comes to the physician because of ...

Increased osteoclast maturation and activity

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 +1  upvote downvote
submitted by killme(3),

The concept being tested is "what does PTH do that leads to hypercalcemia" https://i.ibb.co/sKPdVj3/image.png

yotsubato  ugh, bullshit. I was trying to figure out an actual disease process here. +1  
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. +1  




 +1  upvote downvote
submitted by sympathetikey(288),

In addition to PTH = osteoclast activity = increased calcium, this person could also be exhibiting symptoms of MEN1.





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submitted by laminin(6),

can someone explain why it says he has an 'intact' PTH concentration...is it to let us know that the PTH concentration is a result of pathology? and what's his dx? thanks!

yotsubato  I swear they make up some of this stuff. Like whats up with the thirst, urination, and peptic ulcer diseases. +2  
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. +1  
namira  "Hypercalcemia can cause renal dysfunction such as nephrogenic diabetes insipidus (NDI), but the mechanisms underlying hypercalcemia-induced NDI are not well understood." https://www.kidney-international.org/article/S0085-2538(16)30704-9/fulltext +  




 +1  upvote downvote
submitted by cafeaulait(1),

I believe this stem may be inferring MEN 1 syndrome - possible gastrinoma (peptic ulcer disease dx), parathyroid adenoma, and pituitary adenoma (causing SIADH). But, you don't need to even know this to get this right - just asking the effect of high PTH on the system - causes increased osteoclast activity as well as maturation.





 +0  upvote downvote
submitted by nwinkelmann(75),

Does anyone know the significance of monocyte motility?





 +0  upvote downvote
submitted by rio19111(3),

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.

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