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NBME 22 Answers

nbme22/Block 2/Question#19 (reveal difficulty score)
A 50-year-old man comes to the physician 3 ...
Calcium πŸ” / πŸ“Ί / 🌳

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submitted by βˆ—gonyyong(126),
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'nWtas uesr utoba h,toesr ubt ommgahmayrp ofr elenarg ouniopplta nt'si emcrdeedonm untli 04

submitted by βˆ—hopsalong(29),
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ihsT nitqouse tges ta etrhhew ro otn oyu anc cioergzen eauT'ssosur nigS ro ovksCthse' ignS ni kdin fo na usuulan oiaeptt.srnne cyalsBila uyo tge lsucme htectsiw in eht gsttine fo acyoimcleH.ap meaoyHpxi frutrhe rceaxtaebes teh ngsi nad acn uceas tsehwtci yarmlond uuthoghrot hte .dyob

svsteo'hkC ngiS si pnigpta no eht alicfa renve of hte ecaf thta itilsilc a ailfac umecsl a.msps

aT'ersosusu nSig si nwhe ouy tpu a obdlo psreuser ufcf on a apentt.i shTi sescau ecsll in het mra to ont ierecev bdloo t;&g- oN 2O ;-t&g No voeitidax phayroiophsnlto g;t-& aresdeec ni PTA evalaibla t&-g; KN++a/ ppum flsia thiuowt APT &-g;t enscaredI lularinatrcle +aN g-;t& rcInsdeea +aC ueabcse of enrdecais Ca2/+a+N echnraegx -;tg& rdecseeda UERMS +Ca2 -;t&g nloFxie fo ndha.

o'ueTsrusas gSni si ermo tivssneei ofr oaHamlycpcie, tub hbot are g.icosdtani Oetrh sitp ni isth utinesqo - niiTnggl rndaou hte ,htmou hand,s adn feet anc eb etnhora gisn fo emcaiHcy.aopl Bhot alrdeegeinz oiicctnncl-o or focla tomro zersesiu cna ocucr ihtw pahy.omliaecc

waterloo  Something that could help. Gabapentin is a narrow spectrum anti-epileptic drug used to treat seizures. It blocks voltage gated Calcium channels. It also treats neuropathic pain (which this vignette hints at both). My thinking for this question: the patient is having seizures so must be sodium abnormality. But then they mention the pins and needles and involuntary contractions, and this being the first seizure, it sounded less like a sodium issue and more so Calcium. I think what hopsalong said makes a lot of sense. I think there is a pharm angle this question could have taken as well. +2  

submitted by βˆ—jackie_chan(29),
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I fdoun an reisea ayw ot jstu ligoc ouhhrgt shti is het smailnctop rae laisbclya smulce pmas,ss n,ettya iheye.rprfelxa

  • lrbmtsoniaeAi ni acirbboeatn evig mtlcobeai a,il/caoikiassodlss tgnhoin ni mtse iesvg su rnsoae to tinhk rtseeh sabciae/d cal.aebn
  • um,caicl mcilhcpyeaao oxbeottk sift hwit net,yta larihereyefpx
  • abormlan creldoih ton ucmh icyilclaln siiainfgtcn
  • stspaimuo imobilaarnset nac avhe ettyan but oasl hr,htirmaay on igsns of acircda otnvvlenime
  • odumis, yaaphtmeionr nca hvea reuzsesi, phrernamaiyte ahev iltiryriiatb adn sings niulelyk ot eb oinogng rof erinte othnm.
nootnootpenguinn  Thank you so much for the potassium explanation! It was totally a "D'oh!" moment, haha! +3  

submitted by leemax(1),
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nhitk of it sa hsit a-wy eh si ivngah TTGC, dna nthe 1 mhnot /OH - psni adn ensdeel onudar houtm - I hgthuo alciumc mblpreo, nda then again he has ounyvniltra cslemu o.rcctianont

submitted by βˆ—lulumomovicky(3),

Hypocalcemia can present with muscular twitching and spams, might cause tetany, and in severe cases lead to seizures like happened in this patient.

This question can be confusing mainly because whenever u think of seizure or neurologic manifestation, you think of Sodium, but the key here is the 1 MONTH history of episodes of pins-and-needles with involuntary contraction of muscles. Also you can rule out Potassium, because although it can cause muscle cramps, spasms and weakness, it leads to cardiac abnormalities (arrhythmias).

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