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NBME 15 Answers

nbme15/Block 2/Question#29 (7.2 difficulty score)
A 2-month-old male infant is brought to the ...
Glycine receptor🔍
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submitted by medninja(11),

This question sounded like botulism, anybody knows why is tetanus?

bingcentipede  I think it's because of the last sentence - asks about a defect in an inhibitory neurotransmitter, with glycine being the only possibility. I think it's one of those "here's a stem, but just look at the last sentence" questions. +2  
cassdawg  This actually is not tetanus or botulism. The deficit has been present since birth. He has glycine encephalopathy, a rare disorder (https://en.wikipedia.org/wiki/Glycine_encephalopathy). Definitely could be tricked into thinking botulism but defect in "inhibitory neurotransmitter" points to glycine deficit as glycine is the only inhibitory neurotransmitter listed! +1  
cassdawg  (Disclaimer that I am assuming his deficit is just a weird kind of glycine encephalopathy because normally its a disease of metabolism not receptor; but it presents with the hiccups and seizures like seen in this baby. Big thing is the last sentence as was already said) +1  

Here is more about glycine encephalopathy, which presents like the stem: https://ghr.nlm.nih.gov/condition/glycine-encephalopathy

+/- cassdawg(548),


Glycine is the only inhibitory neurotransmitter present. He likely has glycine encephalopathy is a rare autosomal recessive neurological disorder. Tetanus toxin - blocks release of inhibitory NT's gaba and glycine. Botulism - 'floppy baby ate honey' - inhibition of ACh release at the neuromuscular junction.