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NBME 24 Answers

nbme24/Block 4/Question#16 (32.5 difficulty score)
A 24-year-old woman who has diffuse toxic ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal


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submitted by tinydoc(189),
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shTi quesiotn is yver ysn,aek ubt in sseeecn ihst is thwsa ih.napepng

Teh ctandcaiel avrmloe fo the PTH nlsagd rnigud dtroheymocyit ⇒ ↓ PHT

HPT ir :ya-lol-nmn no:be ↑ molvear fo a²⁺C nad Pheopaht form - ibnn-eo sydn:ike ↑ a²⁺C otbrpeairson nda ↓ ₄P⁻³O ae-ro ibntr↑s-op voicnresno fo 5,2 avdrxtHminyyio D ot 2,15 avmxoHytirinyd D co(liCirtal - aectiv )romf vai ↑ yctitaiv of -a1 eysodxlaHyr fnecyicdei

oerehrTef a ↓ PTH luwod edal :ot

⇒ ↑ ³OP₄⁻ ⇒ ↓ ²a⁺C ⇒ ↓ 51,2 ytviHyrmixaond D

Teh nsoetuiq si enaysk (cmhu ielk het erst of hsti )exma seuaebc seneoom hwo stni uigsncof lraeyl rdha or ni a rhsu thmgi pikc teh topion C herwe pothhaep is ↑ adn THP is ↓ TBU ↓ 52 mrytdhiaiyvxon D

Tsih si grown sa only 15,2 hdxiryivaotnym D odluw eb d,redecsea eht oeroinscnsv eebofr isth aer oend yb hte sikn lngtsu)(ih and ivlre.

I eyalrl hwis yeth dowul spot gminak teh stqnsuioe igonsuncf RULEYP for the keas of gkinam hemt cing.nusfo ntIs ti uhogen htta we ehva to owkn stih uduoisilrc utnmoa of ,nnoamtirofi utohtwi ihnvag htme iyltnanlntoei gkmnia ti aehrrd yb nigtoipn uoy ot 1 enrasw hcocei tbu nnicggha a iteunm atidel ot eakm ouy rswena gnw.or Or uisng a rnmdoa sas mtnlcouaerne rfo a iasedse ot divoa nigkma it too pelims (SGPN = arvetfploi"eir )"GN

tinydoc  I literally got this wrong because I had the font zoomed in and assumed the 1 was on the line above like on uworld when it tries to squish the whole title in the same space x_X +1  
hungrybox  Holy fuck they got me. They boomed me. The fucking NBME boomed me. +2  
graciewacie9  Amen to the PSGN question. They got me on that one. lol +  
msw  the psgn question is pinting to rapidly proliferating glomerulonephritis b/c the pt has developed acute renal failure within days of the insult +  
msw  *pointing +  
snoodle  HOLY GOD MY BRAIN FILLED IN THE 1. i had to read this explanation 4 times to finally see 25-hydroxyvitamin D and not 1,25. F U NBME +1  
avocadotoast  this bs is prob why the question isnt on step 1 anymore +  

 +1  upvote downvote
submitted by trazabone(12),
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dieKyn meaks 25-1, dhxoryy vinamit .D h(dca2ry oco-riyx)ll5ti ivt D idocci)(all is amed ni teh e,vlri nad hooripatysdirmypah lodwu nto esrdecae tis sellev sa ti sact ot ecsenrai lp-1haa slrhaodexyy in eth ednkiy to creesnia atlicriclo ooicsrnnctaent tg;--& Chahaopt/esp prasitnoerob romf eth eobn nad llsma

queezyfish  I'm confused about the phosphate level in questions like these. Decreased calcitriol would decrease phosphate absorption while PTH decrease lowers phosphate excretion. I'm assuming that the PTH decrease has the greater effect with serum phosphate levels? +1  
mousie  PTH = "Phosphate trashing hormone" if PTH is high Phosphate must be low - they are always opposite (unless d/t renal failure then Phosphate will be high - kidneys will be unable to get rid of phosphate) So low Ca d/t low PTH does not effect 25 H. Vit D ... only 1,25 H Vit D (active Calcitriol)? +4  
haliburton  Clarification because I was confused: PTH stimulates kidney to produce 1,25-(OH)2 D3 (calcitriol) via 1α-hydroxylase in proximal convoluted tubule. Therefore, without parathyroid glands, low PTH, 25,D is not converted and therefore not down (normal or up). phosphate "trashed" by PTH as eloquently stated above. +  
zbird  Here the primary defect is high up from the parathyroid gland, there is decresed or no PTH which normally trashes phosphate but not in this case so serum PHOSPHATE INCREASES and the serum calcium is low because PTH should have prevented the urine calcium so there is calciuria and no resorption from bone-LOW CALCIUM, Vitamin-D is independent of PTH so stays NORMAL +  

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submitted by dentist(43),
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owFllo eht mciClua and kwor C↓ad kaws.rbac semna ↓ asoPhethp sneriorpto ni eth PCT hic(hw llpsu aC hitw )ti

ro-th25vDdiy lmoran cb/ tsi ealedutnr ot H.TP