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NBME 21 Answers

nbme21/Block 2/Question#29 (63.7 difficulty score)
A healthy 25-year-old man is participating in ...

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submitted by assoplasty(91),
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hello  I want to re-emphasize something that @assoplasty has already stated :). The Q-stem states serum glucose = 100, and the Q asks why the patient is able to maintain normoglycemia. Therefore, you can immediately eliminate choices A and C because acetoacetate and beta-hydroxybutyrate are sources of energy during ketogenesis -- ketogenesis does not provide glucose energy sources. +7  
chandlerbas  ^ this checks out: valine and isoleucine are broken down in the muscle into branched chain 2 oxo acid via branched chain aminotransferase (reversible) then the valine and isoleucine leave the muscle and swims to the liver to be acted on by branched chain 2 oxo acid DH (irreversible). So bascially the process from taking BCAA valine and isoleucine requires 2 enzymes. the first enzyme is in the muscle, and the second enzyme is in the liver (for simplification purposes --> both organs contain both enzymes but dont have the same affinity for their substrate). source: so you're right to say that the liver +4  
toxoplasmabartonella  Thank you for such a great explanation. Isn't it glutamate instead of glutamine that combines with pyruvate in muscle to yield alanine for Cahill cycle? +1  
almondbreeze  @ toxoplasmabartonella think you are right +  

submitted by hayayah(1057),
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.P 91 fo AF ash a qucik aoilxtanenp rof i!sth

clyilasaB onec eur'oy ni a ngrtvias tetsa se'etrh sllit tiheapc seggeiunosclneo goign no sa( wlel sa iunsg F)AF ubt eth eeeonnglsgcousi is inocmg from rarliepeph eussit alttaec and .ninaeal

submitted by hello(302),
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I awtn ot mreaze-sphei esihmgotn thta sty@passloa sah reaylad adtste .:)

heT sem-tQ tstase eurms uslocge = 010, nad eth Q skas hwy hte itneapt si abel to taamnnii .cgaemolrnyiom

refeTo,her ouy cna eyimimaedtl tlaiiemen oehiccs A adn C esbceau eceaceotatta dan ob-tdurybattehyearxy are ouscrse of nyerge inugrd gekesosetin -- seesiotgkne esod ont ivdroep ecsoulg eegnry orssue.c

submitted by frimmy_11(0),
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csMeul tpieron beasrk donw tnoi the oamin caid nenaali chiwh enster alCilh lecCy ot orfm clsogue ...

volcanobuns  @frimmy_11 Why would protein break down after only 20 hours? Shouldn’t fat be the major contributor now? Also, if protein is being used, then why isn’t valine the choice? Valine is also glucogenic. +  

submitted by volcanobuns(2),
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my_@i1mr1f yWh oudlw eprtoin kareb ownd faert lyno 20 u?orhs hnudt’loS fat eb the orjma rtbcnoituor on?w loAs fi eiortpn si ebing se,ud nthe ywh ’nits alnvei teh oiec?hc I’ts salo cicoeungg.l

submitted by hello(302),
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salPee pelh

Wyh is elnvia ctnro?iecr

nA tnpaxlaeion lbwoe assy ttah anvile luwod eb ecventord to esgoucl nguird lrguare loma?btisem

lgaRuer olateismbm = dfe est,at os hyw wlduo einlav nvee be orcnteedv ot seoulcg?