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NBME 22 Answers

nbme22/Block 3/Question#42 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
Inorganic phosphorus: increased;
Parathyroid hormone: increased;
Calcitriol: decreased
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submitted by βˆ—usmleuser007(445),
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OC si redeinsca ihtw 1 ) radedcese a a2dfeotrl) caerisden al3d po)er rancdeIes rtiyclnttciao

An tvesonroiuae tlufisa aetcser an itelreavant rueot orf irlaat bldoo iton het vusoen orauniciltc /ow ggoni apts eht roaeilrtse ht(e aomrj suace of essreu)Tansthic., by odgin so het PRT delft(raao) areesdcse nda teh OC si

submitted by βˆ—bubbles(78),
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nohicCr ranel fnfniiye:siccu

1) oopr aehoshptp anacceelr t-;g-& hihg eursm iraonicng hhuporssoop

2) ihgh uresm tpsphaohe gt--&; solpxmece itwh vanldtie atoicn aC ;&t-g- aC allsf

)3 aC sllaf -;&g-t tgreigrs HTP xsia

4) endyik ifearul ;tg&-- ercdedsae ativticy fo yao1s-hlxdeyr at teh diyekn ;t&--g ssel olaiclitrc

makinallkindzofgainz  this guy renals +8  
paperbackwriter  Someone please help me with this (always trips me up): PTH causes increased vit D production in kidney... are we assuming the increased PTH can't catch up with the kidney failure? Is it the level prior to PTH compensation that they want? D: +  
miriamp3  @paperbackwriter what it works for me ;;;; is find the first abnormality so CKD low calcitriol (no D vit) ---> is gonna increase PTH ---> the kidney are not working (chronic, they don't tell u recently- you can;t revert a CKD so the kidney never going to catch up) --> increase inorganic phosphorus.--> always start with the problem. I also use this for celiac and types of shocks. start with the problem, and trust yourself. +4  
paperbackwriter  @miriamp3 thank you! I will try out your strategy next time!! :) +1  
snripper  I thought renal insufficiency -> inability to reabsorb phosphate at PCT -> decreased phosphate? +3  
skonys  Can someone explain why calitriol is low? Is it just that his kidneys are fucked and he can't make it? So PTH is increasing to try to lower the phos and raise the vit d but the kidneys are like "lol, I can't" +  
madamestep  @skonys pretty much yup! In early renal failure you'll see high PTH levels but NORMAL Ca and Phos. Becuase it's able to keep up but barely. At a certain point though, the kidney bows out and PTH is high, Phos is high, Ca2+ is low, EPO is low, calcitriol is low, Creatine is high, BUN is high. +  

submitted by βˆ—cassdawg(1702),
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fI teh tipnate is gntaik ciaulmc teatcea (a ahheppsot )r,ibedn wyh si ish shohpouprs elevl aien?drsce

submitted by βˆ—sne(54),
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eScin ehs hsa eclaci sreupc ;&-tg- fat vtminia lptonor,sbaaim suht .tiV D is crea eLedosdw v.ti D = wol llcaot,irci owl tsraoiponb of ashotepph fmor ei,ntntsei nda wol onbotspiar of +C2a ncsugia an neecaisr HTP

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