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NBME 24 Answers

nbme24/Block 4/Question#16 (32.4 difficulty score)
A 24-year-old woman who has diffuse toxic ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal
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 +20  upvote downvote
submitted by tinydoc(189),
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hTsi uqoniest si ervy nk,saey utb in escesen iths si twsah ehppnagni.

Teh ecialcadnt lmveaor fo eth PHT salgnd dniugr thetirdocyomy ⇒ ↓ TPH

TPH ria-ymlo-ln n: ob:ne ↑ meaovlr fo ⁺aC² and Phtahpoe fmor -bei-non yensd:ki ↑ a²C⁺ ropaistenrob adn ↓ ⁻OP³₄ ni-sart reo-↑pbo envsoinroc fo 52, mryitodxavHyin D to 2,15 ntdiaymirHyovx D rc(Clioatil - iavect rom)f aiv ↑ atyicivt fo -a1 Hrdxoeyylsa nicfecyide

Tehreoefr a ↓ TPH wuldo ldea :to

⇒ ↑ ₄P³O⁻ ⇒ ↓ a²C⁺ ⇒ ↓ 12,5 ramxtivodiyHyn D

heT quteinos si nysaek umh(c leki teh tser fo sith x)mae uasbece smoonee woh nist fgucsnio leyalr adhr ro in a urhs imgth kicp hte noopit C ewhre thhpapeo is ↑ dna PTH si ↓ BTU ↓ 52 oyidrimxhnayvt D

hiTs si wnorg as noyl 5,12 mohiyayxinrtdv D ouwld be eadrcds,ee eth nrocvioness berfeo isht aer dneo by teh iskn glsi)ntuh( and irvel.

I lraely ihws tyeh oluwd psto angikm teh ntqosusie gcusinfno YPELRU fro eht esak fo manikg mteh no.sgunicf tIsn ti ghneuo htat ew veha ot oknw isht ucoildrius amutno of rfi,nnmoitoa oiwhttu vghina temh natnliynoliet gniamk ti rhader yb goipnint ouy to 1 wrnase icheoc but nghcgian a mteiun deialt to emak you ersnaw rg.nwo Or gisun a rmnado sas eanlueotmcrn ofr a eiessda to ivdao nimakg ti oot pmslie N(SGP = filerio"evaprt ")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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Kneydi emask -2,51 xyhroyd aivntmi .D iilrt-5l (cayx2ydrohoc) itv D l)(iioacdcl si emad in eht levr,i dna yaiysmdrphoohirpat uldow tno reaseced its esvlle sa ti tsca ot eaercsni 1aalh-p ardeyhsyxol in hte dnykie to cisenera trilcclioa cntaeorsiotncn -;&-gt h/tappoChsea nsirotarobep fmro eht enbo and smlal nsint.eeit

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 +  



 +0  upvote downvote
submitted by dentist(43),
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wolFlo teh camCliu nad rkow kcsaa.↓rCbda w enmsa ↓ ehpoasPth oesoirrptn ni eth CTP hiwc(h ulpls Ca iwth it)

Dy2htrd-v5oi ramlno b/c ist tldaenreu ot TPH.