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NBME 21 Answers

nbme21/Block 4/Question#10 (47.1 difficulty score)
A 64-year-old man is evaluated for cough, ...
tags: SIADH hyponatremia renal 

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submitted by kchakhabar(46),
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taWh erthw me off ni sthi nutioesq is the heprsa slce"l hwit iltetl tlmpsayoc that ear cwtie the zesi fo shlocy"pem.ty I hoghut allsm" clel inacamr"co anntoc eb ahtt .bgi

nala_ula  Omg literally the same thought process I had, that phrase through me off! +  
nala_ula  threw* +1  
jesusisking  Super counter-intuitive but apparently SCC cells are 1.5-4x the size of lymphocytes: +1  

submitted by haliburton(214),
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mSlal lecl gnlu aerccn assuec AH.DIS ianocoLt + ilxeuscnroay escu.l

mcl  To expand, SIADH may also result in euvolemic hyponatremia. This is because, as we know, ADH increases absorption of water and therefore initially results in an increased circulating volume. However, this results in increased stretch of the atria and subsequent secretion of ANP. ANP (atrial natriuretic peptide) then results in loss of sodium and water. +11  

submitted by hello(313),
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eTh aepittn ahs "escll ndreraag ni filintrnagti th"eess &-;-gt eniiactds manntagli cnarec

The slelc rae rtheeni lagulrdan onr umquasso -;gt&- het neacrc si ihreten micdcoronaanea nro aqousmsu llce nlgu ,crcnae syptevire.ecl

siTh vsaele lsmal ota lecl ulng eacnr.c IAHSD si hte omst ncmoom ponsaaprialect doemyrns for amlsl toa ecll gnul aenrcc g;&-t- seald to at.ihnyoemapr

submitted by ergogenic22(321),
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hwy si yhiimilepdearp eodryacsn to nhgiscu ornmsdey ont a pisiosi?tlby

hello  SIADH = MC paraneoplastic syndrome of small oat cell lung cancer. Also, Cushing syndrome would cause would weight gain, skin hyperpigmentation, and hypokalemia. Not, lyperlipidemia. +1  
charmrooftops  You do get hyperlipidemia in cushing though? So still unsure why this is not a possibility. Is it just a "more common" thing for SIADH? +2  
peridot  I was debating the same thing. But yeah I guess the SIADH association is just supposed to be stronger somehow and "more common"? +  

submitted by an_improved_me(13),

My dumbass thought it was Large Cell cancer, for which i had no associated paraneoplastic syndrome. Yay.