All right, welcome. My name is Divine. This is episode 592 of the Divine Intervention podcast. In today's podcast, we're going to be continue our series on the step one free, 120. Again, I really want to get done with this. And again, please, if you're taking step two or step three, you really should try to do these questions and you really should try to listen to this podcast. Let's get right into it. So we're going to go to Question 81.

A 45-year-old woman comes to the office for a full-up examination

two weeks after she sustained the vertebral fracture at L1.

The fracture occurred spontaneously and there is no history of trauma to the area or the fractures.

She gained 60 pounds during the six months before the fracture occurred.

Only medication is hydromorphine as needed for pain. She is 5'4 inches tall and weighs

220 pounds. Her BMI is 38. Her vital signs are completely fine except her blood pressure

that's 145 over 98. Physical examination shows central obesity and purple stri over the abdomen bilaterally.

The low extremities appear thin.

Results of lab studies are shown.

So we see a plasma radium activity is high, a little bit high.

Metanephrine is fine.

Cortisol is elevated.

ACTH is a little bit high elevated, ACTH is,

um, ACTAG activity is a little bit high,

outdoor storage is fine, you're in 24 hour,

cortisol excretion is high, right?

340 micrograms in 24 hours.

Now the most likely cause of the fracture in this patient

is an increase in which of the following processes, right?

So this question is pretty straightforward, right?

This person seems to have like pushing syndrome, right?

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