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Retired NBME 25 Answers

nbme25/Block 1/Question#7 (reveal difficulty score)
A 68-year-old man has a surgical excision of ...
Kidney ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(20)
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Recall that renal cell carcinoma is also a genetic disorder associated with chromosome 3 (the other being VHL). RCC (clear-cell type as in this question) and VHL have 3 letters for being on chromosome 3.

Additionally, most carcinomas spread lymphatically (e.g., use the lymphatics to metastasize). However, Four, Carcinomas Route Hematogenously (which is usually what sarcomas do):

  • Follicular thyroid carcinomas,
  • Choriocarcinomas,
  • Renal cell carcinoma,
  • Hepatocellular carcinoma

Renal cell carcinoma often presents in older men with a history of cigarette smoking, and the brain is a potential site of metastasis.

PTH-related peptide (PTHrP) functions like PTH and is commonly increased in two malignancies:

  • Squamous cell carcinoma of the lung
  • Renal cell carcinoma

This can often lead to hypercalcemia as a paraneoplastic syndrome.

Erythropoietin (EPO) can cause inappropriate absolute polycythemia (a pathological increase in EPO causing an increase in RBC mass). Recall that a physiological (as opposed to pathological) EPO increase would be something like lung disease, congenital heart disease, or high altitude. Pathological or inappropriate increases in EPO are usually due to exogenous EPO because of athlete abuse and blood doping for sports and malignancies:

  • Hepatocellular carcinoma
  • Renal cell carcinoma

This can often lead to polycythemia as a paraneoplastic syndrome.

Remember that this can invade the renal vein and develop a varicocele if left-sided (because the left-gonadal vein is branch of the left renal vein whereas the right gonadal vein is a direct branch of the IVC).

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shak360  This is tested again in Question 12 in the same block. +



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