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Retired NBME 15 Answers

nbme15/Block 2/Question#39 (reveal difficulty score)
A 43-year-old man with a 10-year history of ...
Decreased glutathione ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +8  upvote downvote
submitted by โˆ—ergogenic22(401)
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NAPQI is a toxic intermediate is formed by in small amounts by metabolism of acetaminophen. Depletion of hepatic glutathione stores by NAPQI leads to acute APAP toxicity and acute liver injury.

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cassdawg  Also relevant to the question: the CYP450 pathway is what turns acetaminophen into NAPQI, and chronic alcohol abuse is one of the inducers for the CYP pathway so it increases NAPQI production. Chronic alcohol abuse itself also depletes glutathione, increasing propensity for toxicity when acetaminophen is introduced. +3
specialist_jello  my probably stupid thought process was : treatment of acetaminophen toxicity is N acetyl cystine which regenerates gluathione. so toxicity will be coz of dec glutathione. +17
cheesetouch  FA18 470 & 243 +3
agraham416  Why would increased NADH be wrong? +
fatboyslim  @speciliast_jello your thought process is absolutely right. You are not stupid +
fahad_gondal  @agraham416 because the toxicity is being caused by the acetaminophen and not the alcohol, the stem doesn't mention anything about an acute alcohol overdose but does say he took a lot like 18 tablets in 3 days thats like 9g of acetaminophen but if the stem had instead said it was an acute alcoholic episode that caused all these symptoms we could say NADH increase was the answer but then again decreased NAD+ would also be an answer because the metabolism of ethanol consumes NAD+ to yield NADH so if 1 of them goes up the other must go down and vice versa so the question wouldve been done and styled differenttly with alternative options +



 +2  upvote downvote
submitted by โˆ—trazobone(97)
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NAPQI is a toxic intermediate is formed by in small amounts by metabolism of acetaminophen. Depletion of hepatic glutathione stores by NAPQI leads to acute APAP(?) toxicity and acute liver injury.

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