NBME 21 Answers : Block 1 : #24 = A 23-year-old man drinks alcohol heavily on a ...

NBME 21 Answers

nbme21/Block 1/Question#24

A 23-year-old man drinks alcohol heavily on a ...

Fatty change

+6 upvote downvote
submitted by vonhippelindau(10),

It’s acute alcohol consumption so fatty change more likely. Cellular swelling indicates alcoholic hepatitis which requires chronic alcohol consumption (See FA 2019 pg 385). At least that’s the logic I used to pick fatty change.

seagull Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +11

nc1992 I think it's just a bad question. It should be "on weekends" +5

uslme123 https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +1

uslme123 So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +

sympathetikey @seagull I agree! +

et-tu-bromocriptine It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +

linwanrun1357 Do NOT think the answer of this question is right. Cell swelling make more sense! +

+1 upvote downvote
submitted by sweetmed(38),

Fatty Change in Liver [2/2 High NADH made by ADH and AldDH -> inhibits FA oxidation, impaired lipoprotein assembly and secretion-> FA accumulates.]

+1 upvote downvote
submitted by usmleuser007(126),

As per FA 1) fatty infiltration 2) cellular ballooning 3) eventual necrosis

hyperfukus thanks u saved me time in looking that up :) +

+0 upvote downvote
submitted by krisgsxr600(1),

Was just going over Pathoma again and he explanes this concept really well in CH 1, "Free Radical Injury", Section II "Examples of Free Radical Injury"

ultimately cell swelling (the hallmark of acute/reversible injury) = ribosomes off RER = decreased protein synth = decreased Apolipoprotein synth = fat accumulation in cells

+0 upvote downvote
submitted by youssefa(21),

Wouldn't acute alcohol consumption even in moderate amount cause reversible hepatic cellular injury characterized by cellular ballooning? It should be the right answer unless the question stem means "Weekends"

hello No. The order of liver damage due to alcohol is: fatty changes --> cellular swelling (cellular balooning) --> necrosis. This Q stem states to the patient consumed large amount of alcohol on a weekend -- he has acutely drank a large amount of alcohol on one weekend --> this corresponds with fatty changes +

krisgsxr600 Its kind of in pathoma Chapter 1, "free radical Injury", Section 2 "examples of free radical injury" goes over how free radicals (caused by drinking) lead to fat accumulation +

sallz You can't get the steatohepatitis before getting the steatosis (fatty change). All the FAs caused by the alcohol consumption eventually lead to cytokine release, inflammation and finally the hepatitis seen in balloon swelling. +