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NBME 21 Answers

nbme21/Block 2/Question#6

A 38-year-old woman comes to the physician because ...

Serum calcium concentration

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Recurrent kidney stones should include hyperparathyroidism on your differential, couple that with gastrinoma and you’re looking at MEN 1. Lipomas are also associated with MEN 1.

sympathetikey  Yeah, I probably should have went with that. Just got thrown off, since I know that usually the serum calcium levels for someone with Calcium kidney stones is normal. +  

This question was asking about the adverse effects of proton pump inhibitors especially given previous kidney issues. PPIs decrease serum Mg and serum Ca absorption and can increase the risk of fracture (especially in the elderly).

yotsubato  PPI therapy *begins* the day she presents. She has not taken PPI before +5  
notadoctor  You're right, I missed that! +  
naught  MEN 1 is pituitary (monitor cortisol), pancreas, parathyroid (monitor calcium) but is not the ask of this question. +  

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submitted by monique(0),

The pituitary tumors in MEN 1 are prolactin or GH, so Calcium levels, for Parathyroid adenomas, would be the best answer.

 +0  upvote downvote
submitted by sahusema(30),

When you see a pancreatic endocrine tumor in combination with other weird findings, always think MEN 1

Why would you not check cortisol, if you're worried for MEN1? I assumed high calcium was implied based on the renal stones