NBME Answers : goldenwakosu's page

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Why is the answer adenylyl cyclase? I looked in FA and I saw that GH uses the JAK2/STAT pathway and that IGF-1 uses the MAP Kinase pathway. Not sure how adenylyl cyclase plays into this.

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pug_sheen I think they are talking about the GHRH receptor on somatotrophs, which works through the cAMP pathway. +

staygoodpupper I don’t know how it relates to GH/IGF-1 in particular, but the question said there was a mutation in the alpha subunit of Gs, which activates adenylyl cyclase. +3

kash1f I agree the patient does have Acromegaly, but in the question it talked about how the patient had a mutation that prevented the GTPase activity of Gas. So Gs would be overactive --> excess adenylyl cyclase +31

hyperfukus ugh i was so excited too bc i thought i remembered jak stat epicfail +3

skonys Doesn't GHRH act through an IP3 seconary messanger? +

xmen the tumor secretes GH. GH act via a JAK/STAT Pathway. But the GH secretion is stimulated via a GHRH through a Gs. This Gs in this tumor's cells is mutated and is permanently actif. so cAMP will increase. +1

weirdmed51 @skonys GHRH works via cAMP +

kcyanide101 GnRH is IP3 --- Remember GOAT HAG? GHRH is CAMP remember FLAT ChAMP +

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submitted by natuwalrien(0), visit this page

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meningiomas count as enhancing lesions? (this comment needs to be more than 50 characters apparently.)

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goldenwakosu I think it’s because meningiomas are able to calcify (aka sometimes they have psamomma bodies). I got this question wrong too but I totally did not completely register that the tumor was in the dura (interhemispheric fissure + central sulcus). Hope that helps! +2

pipter the only reason I got this right was because they described the tumour as being near the falx cerebri. +2

fcambridge Other hints include being described as round and seen in a female. Both indicative of Meningioma +17

niboonsh also meningiomas typically present with seizures or focal neurological signs +

suckitnbme I thought enhancing meant it uptakes contrast. Meningiomas are commonly enhancing lesions per Radiopaedia. +

submitted by hayayah(1212), visit this page

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Pregnancy + Hx of thrombosis --> think antiphospholipid syndrome

The PT and PTT are prolonged d/t interference from the antibodies to phospholipids. Thrombin time normal.

Had to find research articles about it so take it from here and don't waste your time...

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monoloco yeah, i’ve never heard of antiphospholipids increasing PT time ... +26

goldenwakosu Not sure if that little detail was to throw us off. I think the point of the question was to ID antiphospholipid syndrome based on the clinical criteria (spontaneous abortion + thrombosis) +5

johnthurtjr I actually went down a rabbit hole with this one recently - essentially in vitro findings =/= in vivo findings, clot-wise with anti-phospholipid antibodies. +4

link981 No mention of lupus anticoagulant, anticardiolipin, or anti Beta 2 antibodies. FA mentios prolonged PTT but nothing on PT. What a piece of shit question. But thanks to the dudes above who explained it +9

yb_26 UWorld mentioned "prolong aPTT (and sometimes PT)" in APS +5

oslerweberrendu @yb_26 Can u please tell the QID because the one I have seen it says, "Although patients often have prolonged ptt (because the antiphospholipid interferes with ptt test), pt is normal." QID: 1298 +1

kevin just to clarify, lupus anticoag is in antiphospholipid and presents with paradoxical increased ptt +/- pt despite increase risk thrombosis +2