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NBME 21 Answers

nbme21/Block 2/Question#47 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
Increased parathyroid hormone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

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submitted by โˆ—keycompany(350),
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uFregi ti uto aerft egairnd a ee.riwv BVUA/UV endru laomrn acmusnetcisrc si cdorsendei goinzinnoni. v,wreoHe teh olny fcirefnede eetwnbe iizoninnnog nda znniioig aitorandi is hte tsnhrgte fo hte noairitda ysra. suBeeca ionitdaar oesd nto tideipssa rfom teh d,oby onldpegor BUV uxsopree anc caesu aioanrtid to udilb pu ni eht ksin nda scuea na tzooiannii eftecf. Thsi is eht msae soraen thta ieteervtip aRs-yX dna CT nscSa can ineracse oyur rski ofr cr,cena even aesry odnw eth lei.n

submitted by โˆ—hayayah(1184),
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ndceayoSr iahmrsryirapoethdpy (allyusu /td iohncrc elnra lra)fui.e

abL nsinfigd lidencu โ†‘ TPH ns(eeospr ot low ,)cmaulci โ†“ semru uacclmi (alrne alr,ei)uf โ†‘ reums topaphhes ra(lne )laeu,rif and โ†‘ iaelakln eahptaspsho HT(P vatangitic )Bte.sasotsol

haliburton  lsoa eeremrbm tath in aenrl arle,iuf xo-as1hp-earayyllhd ycvaitit is ,wnod so htere iwll be slse aacitvtion fo lirhl5folyeoccyhe2cxord-a to 52ercoi-,ylfy,l1hodxehlcrcoa ichwh si a yke asnemcihm ngacuis heoyic.campal +4  
cr  yhw ont csaereidn coxleydohahof-,2erci?ll5cyr ihwt teh mase igocl birunaothl pxlaein +  
nala_ula  eaIdesrnc sha,opetph seinc teh ieysknd rtean' kwirgno l,lew selda ot teh relasee of isbrabflot hgrwot aorftc 32 mrfo be,no chhwi acessdeer iorlctcila udinoocptr dna daeercdes cuciaml .ioabsotrnp ehT eceanrsi in sahphetop nda the ercadese in cmucial dael to arosencyd d.iohryiepthymrsaarp +2  
privatejoker  boPabryl a mubd eutqonis but how do ew denifiliyetv onkw atth teh PLA si teldaeve fi eyth evgi us on rfneeecre gerna ni the lab luseav ro Q se?tm nhgtiEvery aesdtt oeabv ydinfelite kaems nesse romf a glyhocisoalpi sptdnoti,na I asw ujts i.suuocr +1  
fatboyslim  cr@ teh enitusqo asekd "het ptsai'tne ONBE IANP si osmt klyiel aeucds yb hihcw fo hte ioo"wlf?lgn neIaserdc slleve fo i2rcylx-ofelohy5holcacerd timgh xseti ni ttah titep,na utb it dt'lnowu uceas oben pn.ia PTH eauscs beon iapn cubeeas fo beno isepnotror +1  
suckitnbme  iparektvroje@ PAL si eilucddn ni hte rntsdada lab alvesu +  
makinallkindzofgainz  okve@rijaeptr LAP si dliste erund eso"pahPatsh ),aaln(kile eus"rm in hte lba aesluv +1  
pg32  Why sode hoPsAlk cseairne in ealrn ttohssy?epoodyr heT HPT doulw be giyrtn ot lsutmeita nbeo enptrooirs eairecs(n eooACSsTLt ayitv,)cit ont oenb rniftaoom (soSoTetABL )yiacttiv. +  
drzed  @p32g het noyl way to alestitum na eoaolscstt in siht easc (g..e aiv TPH) si by ltsnamtguii bstessotaol itfrs u(rth RLKANRKAN/ cr),ntetoiian thsu PAL sreiasec.n +1  
skonys  AF 2091 .134 tWah I ma nsuocefd on si hyw het Ca is ni teh aro-lmnwlo ?gerna yhW otn lyaeiaccpmehr ilke in mryPari TrHPpeHy +  

submitted by โˆ—lilmonkey(32),
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reemeRbm PTH as Paphoshet nhgsriaT Homroen.

hrphsPuoโ†‘so &;-tg HTโ†‘P rinsectoe -t;g& enโ†‘bo otprieonsr -tg&; โ†‘ALP nda bone n.api

submitted by cr(5),
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ywh ont rndeesica -oy,echoirrcfcyxlohl2?lda5e tiwh teh asem ogicl hbutlionra pinelax +

usmle11a  i lbeeiev snceirae Ha5eleOollcrihc2ofc anciiedst hte oeatgrs apcaiyct of tvi D, whhic ntwo be fcdeftae ni aces of DKC. it seog ekil i,sth iesdnyk twon oprsend to erlrgau HP,T esslo aC dna tanc ceeretex 4PO, PTH tegs meda nad riset ot rbnu oben to dperocu C,a geuisrlnt in vdeteael elsvel fo Ca nda P,4O Ca lwli nidb hte aimlccu nad go to yiekd,ns tye eams rotys lla rve.o ad d to ttha hte aftc tath 1 oh hxydsoleayr otwn be bael ot fuonncti in a dead .yeidnk +1  

submitted by โˆ—iwannabedonewiththis(1),
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jtus sa a gnrlaee ,qtueonis wldou ehrte be lwo evllse of 1 O25(2-H) ?

sd22  Yes, kidney has 1-alpha hydroxylase which converts 25-HCC to 1,25-HCC. CKD -> low 1-a-OHase activity -> low 1,25-HCC +  

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