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NBME 23 Answers

nbme23/Block 1/Question#32 (18.2 difficulty score)
Which of the following sets of serum findings ...
Phosphate: increased;
Ca2+: decreased;
Parathyroid hormone: increased
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 +2 
submitted by imnotarobotbut(139),
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reyodaScn rehypstripmiyarhado due to cnhcori anlre .urlfaei Lwo ,aC high ppstohaeh nad ighh .TPH AF 0219 agep 234

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. +4  



 +1 
submitted by mguan1993(8),
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Does egibn eeltyncr eisdodnga vs hvanig KDC rof a ehwli agenhc ihts srn?eaw eht ctrlnee"y osadi"gdne rapt rhwet em fof

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  



 +1 
submitted by dentist(46),
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I otko eth ipcsimtsli pha:arocp I shcoe teh oioesppt of eewhrtva eht ydkein aulysul odse nda nhte lakc of egn THP efebkadc