NBME 23 Phosphate: increased;<br />Ca2+: decreased;<br />Parathyroid hormone: increased (NBME Answers)

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Retired NBME 23 Answers

nbme23/Block 1/Question#32 (reveal difficulty score)
Which of the following sets of serum findings ...
Phosphate: increased;
Ca2+: decreased;
Parathyroid hormone: increased 🔍 / 📺 / 🌳 / 📖
tags:

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submitted by ∗imnotarobotbut(184)

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Secondary hyperparathyroidism due to chronic renal failure. Low Ca, high phosphate and high PTH. FA 2019 page 342

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imnotarobotbut Basically PTH keeps telling the kidney that it wants it to reabsorb Calcium and dump phosphate, but the kidney is broken and cant do that. +8

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submitted by mguan1993(13)

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Does being recently diagnosed vs having CKD for a while change this answer? the "recently diagnosed" part threw me off

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smc213 @mguan1993 yes it does! With secondary hyperPTH due to CKD = incr. phosphate, dec. Ca2+ and incr. PTH. This can then progress to tertiary hyperPTH from longstanding secondary hyperPTH as a result of parathyroid HYPERPLASIA --> autonomously (refractory) functioning parathyroid. This will actually lead to INCREASED Ca2+, and significantly INCREASED PTH. Treatment would be surgical removal of the parathyroid glands. Sources: DIT and FA18 p340 +5

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submitted by ∗dentist(94)

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I took the simplistic approach: I chose the opposite of whatever the kidney usually does and then lack of neg PTH feedback

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