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NBME 21 Answers

nbme21/Block 2/Question#6 (55.5 difficulty score)
A 38-year-old woman comes to the physician ...
Serum calcium concentration🔍

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submitted by cantaloupe5(72),
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terrunRce edinky snteso sulodh eucidln trodarmeasyiprhypih no uryo adlenrififte, celoup htta thwi ansgiotarm and youer’ noiokgl ta MNE .1 psoLiam rea alos sidsoectaa iwht MNE .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. +  
snoochi95  i understand the link to MEN 1, but why are we checking the calcium level? +  
cmun777  I feel like it's important to get a baseline of where the calcium is at for two reasons: 1. if the patient does indeed have MEN 1 it would be good to know if she has high calcium levels and possible Parathyroid etiology 2. You're putting the patient on a PPI which are known to decrease calcium levels and increase risk of osteoporosis for both these possible factors/concerns it would be good to see where calcium is currently at +5  
zevvyt  Couldn't a Pituatary tumor secrete ACTH, causing high cortisol? +2  
lola915  Patient has symptoms of a gastrinoma (Zollinger-Ellison Syndrome)- patients present with diarrhea, epigastric pain, duodenal and jejunal ulcers. Associated with MEN1 syndrome. +  

submitted by monique(7),
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The prtyuitia rosmtu in MNE 1 rea oltpnacri or G,H so alCiucm s,leevl for oriarPhyadt ,amnsedao olwdu be eth tbes w.rnase

submitted by sahusema(137),
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ehnW ouy ees a atencpcair eeoirndcn oumtr in cnoabioimtn wiht roeht rdiwe nifnidgs, lawysa ktnhi NME 1

submitted by amphotericin(8),
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yWh oludw uyo ont ekcch trsocoi,l fi oyrue' edrrwio for N1?EM I emsadus gihh acclimu aws eildipm bsade no the areln sotnes

submitted by notadoctor(152),
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ihTs ensuitqo aws inskga baotu the dsverae teffsec of rontop ppmu hitiirbnso lsceliaeyp gneiv prvoeusi kidyne .ssieus PIsP aersdeec msure gM dna mruse aC asproontib dna anc ecnirase eth srki of errcftua lcliyaeep(s in eth yrele.d)l

yotsubato  PPI therapy *begins* the day she presents. She has not taken PPI before +15  
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. +