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NBME 18 Answers

nbme18/Block 4/Question#35 (9.8 difficulty score)
73 yo man, 4 months poor appetite and 25 ...
Cytokine effect🔍
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I believe this man has cachexia (from his hx of cancer)--which is mainly due to increased proinflammatory cytokines

santal  Weight loss, muscle atrophy and fatigue that occur in chronic disease (eg AIDS, heart failure, COPD) -- > Cachexia. Mediated by TNF alpha, IFN gamma, IL-1 and IL-6 (These stimulate the ubiquitin proteasome pathway to degrade skeletal muscle proteins) Courtesy: FA 2019 Pg. 228 + uworld +2  

After initial elimation of everything except for Cytokine effect and Tumor hormone production, I thought through it like this: We know he has small cell lung carcinoma and it can't be tumor hormone production because the three paraneoplastic syndromes of SCC are 1. ADH (would increase weight) 2. ACTH (would increase weight) 3. Antibody (Lambert Eaton, no change in weight)

So only could therefore be A!

+2/- tyggles(2),