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NBME 23 Answers

nbme23/Block 2/Question#9 (31.6 difficulty score)
A 60-year-old man has had easy fatigability, ...

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submitted by bigbootycorgi(5),
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I ugtthoh fo shti as omuqsaus clle camirnaoc of the ngul acnsigu iednreacs PHTrP adn aamelp.icychre

d_holles  I thought this was medullary thyroid cancer but demographically SCC works better. +  
smc213  Medullary thyroid carcinoma increases calcitonin levels leading to decreased serum Ca2+ by increasing Ca2+ renal excretion. So high levels of calcitonin secreted by the tumor may lead to hypOcalcemia. Source: Pathoma +21  
brise  actually according to pathoma, you rarely see hypocalcemia even though calcitonin is high! +1  

submitted by hello36654(5),
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I edtandrnsu hyw it's lgnu wno, tub I cdkiep ioytrdh ngdal ecuesba ntofe iemst rohdiyt surmto ssrpe no the opaiartdhyr ittgnsi vobae, wihch ussace eht ahyrtrodiaps ot cestere orem ...aCcna esoenom teocnmm if eyh'evt dare hist oot?

paulkarr  I personally have not read that, but I wouldn't be surprised by that fact. I think with these NBME problems though, if you can get the answer within one "step" that should be your choice. Here you can just go Squamous Cell Carcinoma with a direct action on serum calcium levels (via PTHrP). Thyroid requires a few more steps, (assuming your statement is true) so in the eyes of NBME, it ain't gonna be the right choice. Always follow the "KISS" logic! +1  

submitted by nwinkelmann(293),
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,So in arngresihec ihst hftuer,r I dfegiur tuo a way to uerl het reoht eenwasrs to.u rPe hist c,raleti wt6cwpi/0vC.ghobih:amt.8n/nM./p4smin/w/tl8.33ccsPe/rl, olmhrua leeacyiprmach fo cnangiymal si suacde by 4 miscaenhms whti xscees PHrTP norestice bgeni CMC. sEesxc PPTrH crstoiene ccsuor in u"sqmsuao ellc ncsr,eca ryiarnu attcr esanrcc lae(nr reancc nda aeddbrl ccn,era) tsearb a,rncec dookHngin'sn lmao,ymph adn aanirvo rnccae otuncca orf teh miyorjat fo iinclsnmaaeg lagdine to chcpymileraae iva rP."HTP hTe hoetr 3 aseucs cdlunie praaeycieclmh droyncase to eoodvntcpruior of trc,ciialo titosyleoc atseesasmt, nda THP ddtiaeem ceaealchpmryi patarhd(oyir anroccami dan itcocpe iodc).ponrut lo,sA AF lnoy miseonnt HPPrT in adegrrs ot CSC of gnlu dan reanl clle amricaoc.n

astt,Proe nl,ooc and paaencirct cnscear era emor moyonmlc r,oaidocanncmae dan less klyeli ot aelsree T,PHPr nad drtohyi acrnec si aols ssle keliy,l tugohh I did fnid neo talrcei thta ndouf PPHTr deerasel by lla fo eesth srccena so I nt'do o.nwk I sugse I'm tujs oingg ot og ithw SCC fo lgnu gebin CMC of TrHPP lumohra lhmcrpeyicaea fo nailn,maygc upls st'eaitnp hcsomgrpieda 6s0(' m)eal.

submitted by achrondroplease(5),

Why can this not be MEN 1? And the increased serum calcium be a result of increased PTH release from parathyroid?

azibird  None of the answers are parathyroid. +1