NBME 21 Answers : Block 3 : #6 = A 40-year-old African American woman comes to the ...

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NBME Answers & Explanations

NBME 21 Answers

nbme21/Block 3/Question#6

A 40-year-old African American woman comes to the ...

1,25-Dihydroxycholecalciferol

+5 upvote downvote
submitted by nosancuck(30),

This b has Sarcoidosis so her granulomas be activatin dat VitD

sbryant6 Your mom activates my VitD. +

+3 upvote downvote
submitted by medpsychosis(18),

This patient definitely has Sarcoidosis. Clues in question stem: -African American Female -Erythema Nodosum -Bilateral Hilar Adenopathy -Hypercalcemia (due to 1α-hydroxylase–mediated vitamin D activation in macrophages).

FA 2018 (P. 658)

+2 upvote downvote
submitted by dr.xx(35),

~~In sarcoidosis,~~ hypercalcemia normally suppresses the release of PTH and therefore the production of calcitriol (1,25-dihydroxycholecalciferol), but in sarcoidosis and other granulomatous diseases, activated mononuclear cells (particularly macrophages) in the lung and lymph nodes produce calcitriol (1,25-dihydroxycholecalciferol) from calcidiol (25-hydroxycholecalciferol) independent of PTH.

https://www.uptodate.com/contents/hypercalcemia-in-granulomatous-diseases

dr.xx ~~In sarcoidosis,~~ +

hello Probably a typo in the first 2 words of the explanation -- not sure what they meant to say instead +

drdoom I believe @dr.xx meant to strikeout "In sarcoidosis" from his comment; double-tilde is the markdown plaintext that usually accomplishes that. +

-12 upvote downvote
submitted by rocmed(-3),

A "serum Ca concentration of 16 mg/dL" as well as "bilateral hilar adenopathy" indicate squamous cell carcinoma which commonly produces PTHrP, NOT PTH!!! PTHrP will act just as PTH, stimulating the kidney to produce 1,25-(OH)2 Vit D.