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NBME 20 Answers

nbme20/Block 4/Question#41 (46.0 difficulty score)
A 56-year-old man with a 20-year history of ...
Naloxone🔍,📺
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 +8 
submitted by waterloo(89),

if you look at the answer choices, they are all pain suppressors except for naloxone.

Naloxone is an opoid antagonist so blocking mu receptors would lead to increase in mediators that induce pain.

I don't think you need to know any experimental data, or really anything before the last two sentences. He is given something that reduces pain (opioid agonist), and if you give him naloxone you would be reducing the effect of his opoid agonist.




 +2 
submitted by usmleuser007(419),
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tcvwibm/lbwdeo..nw.:h/pg/.n6h5s0u1/inpm3t8

Reefli of eianbalttrc aipn was ddrcoeup ni xsi numah atptisen by toiuanltmsi fo erstdeolce yreetpnmnal medapinlt in hte eatrpverirnluic dna pteualadreiuqc ygra t.eramt hTe level fo lasiitmtuon tisceuniff ot dcenui aipn ierfel seesm ont ot aretl the catue pina redh.slhot Irntimdecsinia riipeevett lnuiimostat oercudpd terclanoe to hobt rduoesoimtitcnu-aldp npia eirfle dna eth asilngeca noatci of rtcoianc daocemtii;n this ssrecpo odulc eb drversee yb ecstabnine ofmr l.iauoitsmtn dnuorptmotuadSieci-l efirle fo apin aws dsreerev yb aeloxonn in five out fo sxi anettspi. Teseh euslstr sgtuesg htta tasyfriascto naollivieta fo teesipsrtn npai in hmasnu amy eb eoabdnti by eocrcnleti ittlo.auisnm

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +2  
xxabi  I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental. +23  
xxabi  Also its the only one that's an opioid antagonist from the list! +2  
redvelvet  they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it. +4  
champagnesupernova3  Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis. +2  
champagnesupernova3  Enkephalins* not encephalitis +  



 +0 
submitted by neovanilla(47),
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heT uxrc of het eiustoqn si in,asgk if het npttiea esefl cdeeserad inpa (hwcih si nidrve yb iiodop ;elcoeulms t'aths yhw dposoii aer sdmnitiaered as ali,nk)priles hetn owh od uyo otsp eht i?hnotbiini An dooiip atingaonst lneaxo(no is eth lnoy neo thta is an ng)atitnsao

neovanilla  wrong answers: b-endorphin - an endorphin and ACTH hormone (similar to ACTH, POMC) that can bind to the µ-opioid receptor Enkephalin - a neurotransmitter involved in the indirect basal ganglia pathway (along with GABA); it can also bind to delta-opioid receptors Morphine - an opioid agonist (used for pain relief) Oxycodone - Another opioid agonist (~same potency as morphine) +4  
kevin  enkephalin, endorphin, dynorphin are the bodies endogenous opioids +1