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NBME 21 Answers

nbme21/Block 2/Question#29 (66.5 difficulty score)
A healthy 25-year-old man is participating in ...
Alanine🔍,📺
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 +23 
submitted by assoplasty(95),
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Fats rae koigectne ce(pxte ddo cihan ,FA) so yeth rcupoed ontkese rfo rneyge cprnituodo e-oAyAl(t)Cc threra ntha l.cusoge If the inutoseq eskad hwta eht aimrpyr rescuo fo ergyen uprtondoci wsa, it ulwdo llsti eb ggcneoly n(ad tno o)sk,neet aesbeuc shti si thiniw 24 h.urso eewoHrv atfer 24 rohsu the earwns udlco be keoten dse.ibo dsgaesr,leR the unqotsei iplcleysifca dasi eth tp had a emrus egcuols of 0,01 cainintgid ttha we rea iklnoog rfo hosgmtien taht diseopvr a asrbtesut rfo lnoecsnseegigo.u

nDugir doepisr of tr,tsoaianv ttesssuarb rof geisseuglcoenon meoc rmof otw o:rcsesu ()1 rbkdanweo fo segixnit ,emlcsu ro )(2 iva hondcdai- AF rohgtuh oryon.iplAoC-p lae(Vi*n oasl fedes toin pioopnyrl o,CA btu si ont evidnovl ndurig tsrtnovaia --g;&t ese webol)

)1( heT reailvap-auytnne lecyc pvodirse isht ilea(ungtm in seulmc + rapvutye ;g&t-- aeianln &;--gt sego to levri ;g-&-t anstaimarntnio ot etlagt-leuaktroohap -&t;g- yuetrpav si eeaadrpst mfro aetgunilm -;gt&- nlgmaeitu soeg ot auer el,cyc teyvprua seog on to csnse.eloegi)nguo aLtacet nac salo eb udes ti(hs dcuol evha eebn a hitrg rnswea if it erew ldise.t)

(2) Odd chnai FsA ear osla cu,enggcilo ubt critsae acdi pdr(doive ni eth rensaw )eicoch ’nist odd ihnac, so ti is lyno igeeotknc and nac be rulde t.uo

ghAuholt naeliv nda( oreht cerndbah .a.)a eedf otni P-nAryCoo,lipo hyet rea ton dsue in ittansavor beaesuc irtonaastv tytsclir seirle on pahcite elcogngsone.seiu eseTh .a.a ear tno dabzleoeimt ni teh vierl sacbuee het revil scalk inc-banhhrceda a..a aeaesrnrstf ene.yzm nI tsiFr dAi, oeihBcm ton,isec neurd ittigrvFsntS/aaaon, in htbo teh ftagsi“n taste” (whchi si iwtnih the mite frame of this qn)toesui, or eht ntrvio“asat sett,”a htbo iztielu phactei eeoossnieunggc.l yM iptounsmas si hatt eavinl is dues udnirg lrgaeur i,eosmtmabl adn otn irnudg reiospd fo rtavt.soain

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. +8  
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: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1147506/?page=4 so you're right to say that the liver +5  
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 +  
revanthshanmukh  its given that methionine histidine and valine are glucogenic AA.nso why not these form the glucose in the body first compared to alanine? +  



 +17 
submitted by hayayah(1081),
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.P 19 fo AF has a ckiqu aoapxlinetn ofr !stih

csyBlaail oenc reuy'o ni a sgnirtav steat 'etesrh llsit cteahip ngscueieosgnole nggoi on s(a lelw sa giusn FFA) tbu teh ocloeisnsnegegu si oicgnm rfmo hperelriap seusti letacta nad anial.ne




 +1 
submitted by hello(316),
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I wnta ot iphezaserem- hnsotimge htta yls@aosspat sha yeldraa dstate :).

hTe -mQtes staset urmse oeclgsu = 001, dan the Q kass hwy eth enitpat is aelb to aniintam meigrmclon.ayo

,foeeerrTh you cna ielymetimad mlniteaei eoccihs A nad C useceab aatoeaecctte and -ahyrytxdbrtoaeuybte rae oecrsus fo egrney gundir tiegesskeon -- ngeeotessik sdoe otn rpvideo scogleu eynerg eus.socr




 +0 
submitted by frimmy_11(0),
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clueMs eironpt eabrsk nwod ntio hte monia aidc anneail whchi snetre llCaih lecCy to mofr lguscoe ...

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. +  



 +0 
submitted by volcanobuns(2),
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fy1@1m_irm Wyh lwudo riotpen ekbar dnow aerft only 20 hosru? oth’Sdlnu atf eb het omjar tribtonruco n?ow osAl if prnteio is ngbei e,uds tnhe hwy ’istn vinela the iehcco? I’st salo eogu.clincg




 +0 
submitted by hello(316),
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sleaeP plhe

Wyh si nleiva ?nrctiocer

nA aepnnxoital eowlb sysa ttah evnlai uoldw eb trdeecnvo to cgleous nrgiud erarlug beotmaism?l

urlgRae moastblmie = fed ,estta so hwy olwud vniela evne be dcteovner to egs?lcuo