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NBME 24 Answers

nbme24/Block 2/Question#30 (33.4 difficulty score)
A 35-year-old man with small cell carcinoma ...
ACTHπŸ”
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 +18 
submitted by neonem(550),
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Smlal cell cmoracani fo eth nlug yma poucrde anspraoilacpte m,sneyrosd fo whihc HACT nad DAH rae the mreo mnmooc put.ebssy HTCA ssceex dlase to esecsx onsiaitltum no teh drleana exctro to uedrocp co,tosirl etlnusgir ghn'siCus snyoedmr. Esxesc cotiolsr nyoarml(l a tsessr hnreom)o ssceau eoyihnerntps aiv oatnnepoiitt fo semcthapyti aittmilnosu on eth t.asualcvrue tI acn aslo csaue pleaaohkyim by nctgia as a itcridemiornaloco when ni ,esexsc itnargtusa eht liiybat fo dy-r-yteeasxhtodi1orb1 gyedneeroahsd snet(per in hte alrne luu)bste to rvecnto tosloicr ot nstoior,ce whcih 'doetsn cta as a mnotol.drciacrioei

therealslimshady  Adding some ways to eliminate the other answer choices for good measure: B) ADH can be secreted by small cell lung cancer (SCLC), and would cause SIADH, but that does not manifest with hypertension or hypokalemia. C) Epinephrine can cause hypertension (a1 effect), and hypokalemia (via stimulation of the Na/K-ATPase), but is secreted by pheochromocytomas rather than SCLC. D) PTHrP does not cause hypertension or hypokalemia, and is secreted by squamous cell carcinoma of the lung, not SCLC. E) VIP can cause hypokalemia through diarrhea (see VIPomas in First Aid), but not hypertension, nor is secreted by SCLC. +6  



 +5 
submitted by drmohandes(84),
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  • HADIS β†’ veeoucmil optrayaehimn β†’ semnitneovro / ryshievenetp
  • AHCT ncaiserse irlstooc β†’ niytpeosehnr l1-h(aap guotliapernu pma;& coltoris acn dnbi to eonoldsart resrtpcoe at ghih innceoonsrc)tat
  • TCHA eissnecra oetenadosrl β†’ tnpneyiohers + ploimykeaha (K+ pddmeu in tcleginolc t)cud

fI ntptaie nyo-l- ahd eyiet:hsnrnop CATH moer ykilel atnh SA.IDH

aetiPtn wiht oirthpyensne ADN :meaoikpyahl 0%01 AHTC.

t'nDo efel abd sredi,fn I soal dah tihs tuioqnse rnogw :.(..

rolubui  ACTH does NOT act directly on the zona glomerulosa to increase Aldosterone. ACTH acts only on the zona fasciculata to increase cholesterol and zona reticulata to increases sex hormones. +2  
rolubui  NOT cholesterol I mean cortisol in zona glomerulosa +  



 +2 
submitted by famylife(86),
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To lreu uot SHAID e:pty urS"em suiomsatp canotinnetorc egrlelayn rmisane dhcgnu.nae Mnvetmoe of mstasuiop form the ecturallrlina pcase ot hte telrcexulrlaa scpae rpvtesne iulodtnila .apliheoaykm As grnehdyo nois mvoe ,eaialyrlllrtncu yhet rae xeaecnghd orf ipmtasous ni oderr ot imntniaa cyteetlaio"e.ulrntr

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usmile1  Does anyone know if SIADH is associated with hypertension? I don't think it is due to the body's response of downregulating aldosterone, but if someone could verify that I would appreciate it. +  
sunshinesweetheart  @usmile1 pg 579 FA 2019 = BP can be normal or high in SIADH +  
usmlecrasherss  in SIADH GOLJAN says you have diluteonal hypokalemia +  
tyrionwill  SIADH -> excessive ADH -> water retention -> atrium excretes more ANP, ventricule excretes more BNP -> water is excreted more. So that is why not too much plasma volume increment, resulting mostly normal BP. +  



 +0 
submitted by sunshinesweetheart(69),
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pie = ohpoeorayocchmmt fo drelnaa ldamelu = epdcsoii PTHT PrNH = suqamosu cell crconmaai fo ngul lpsu( )rsheot = lpa yVoaecichmaPIemr = ieoucnoennedrr apinctraec tuorm yco=trsere iareahdr HAD[W y(warte arrhiaed, ahpkyeim,aol ida]yalhhocr




 +0 
submitted by shiv360(0),

Aldo is primarily regulated by ATII. Cortisol is primarily regulated by ACTH. However, since cortisol can also activate aldo secondarily, it works. However, I believe that ADH should not have been answer choice however since no lung biopsy findings were reported so we can't really distinguish between SCC vs. NSCLC

misterdoctor69  the question literally says small cell carcinoma though +  



 +0 
submitted by j44n(40),

AT-II is the main stimulator of aldosterone release. This is kind of bull shit because that was the answer to one of the other NBME questions in ACTH cushing's disease "wHaT pArT oF tHe GlAnD iSn'T eNlArGed?"