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NBME 22 Answers

nbme22/Block 2/Question#5 (44.9 difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balance🔍,📺

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submitted by keycompany(319),
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teNinogr laacenb si a tesnmuaemer of nieptor oamlebimts in the bdo.y A vigateen geirnnto anlaecb iatsindec elcmus ssol, sa neascrdei uaontsm fo mioan casid ear ebngi tliobdaezem to ucedpro .yenegr hsTi craeienss hte nmtauo of grnineot ceetserd ofrm teh .byod ceuaeBs eth outamn of noegitrn oyu ear gintak in is essl athn hte aumotn fo nngoetir you are tcreenisg, uoy veha a gtaenevi ntginoer aclnabe.

Thsi mna is laoruhde,nism stmao,eedu ecih,ctca nda ahs henammlayuiopib. eTesh aclnilci fndnsiig opnit ot ntoripe nattrinuliom ahwirka(sKo iaee)Dss, icwhh uassce edmae ued to csdaedeer rmesu onoictc .usrrepse Lwo icooctn respuers in htis case si due ot orpitne osls, nda enehc a eaigentv gitnreno ncaelba.

drdoom  Nice! +22  
dubywow  I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation! +3  
macrohphage95  I agree with you in first part but i dont think it has any relation to kwashirkor. It is simply due to cachexia which causes muscle destruction through the proteasome pathway .. +4  
zevvyt  also, it says that his albumin is low. +  

submitted by bking(2),
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I tdnsadrnue teh mdeae si ormf ddaceeres oietnp-r hwy is otvSiaartn sKtsieo ?rwnog dC' notul his npeoitrs eb gadddere gturhho hist tsiso:PenoenA rmor-cip- a-csd-i lcAtey A-oC- ntseKoe

waterloo  negative nitrogen balance better explains the edema. +  
courtney  I might be totally wrong but I don't think you can technically be in ketosis if you have glucose around and in this case, the patient eats only carbs +1  

submitted by lovely(0),
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eSorcsu of gotnnier anc be emat, gges, and aryid pocdtur hiwch he 'stwan aietgn. The anm ahd a lwo nogtnrie enitka but saw listl rgeicetnx r.tiogenn ehe,feoTrr eh dah a angiteve ngrointe .bnlacae A neroolpdg niagveet tnienogr naaecbl may edal ot a deeacers ni eth aaslpm eopnrti ev,lle ad,mee aaimen, olrdwee eiteacsnrs ot feo,tincin dirceanse syiiuctbpitesl to ecnarti xocti snss,abetuc het eoltmvneepd of tyfat irevl or hepsrap ohter urseios leueqs

submitted by pparalpha(88),
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nCa emsoeon lepeas laxipen yhw it udowl tno be yggloenc peoed?iltn I oguhtth teh squeotni swa tnlaigk atobu hte gaWbrru ph.nn..emonoe os wyh tno rnkdwoaeb fo ygolegcn ot sl?ocegu

I sguse ti wudlo ont nxlpiae het dm?eea

hello  Glygocen stores are depleted within 24h. This person has signs and symptoms of longterm nutritional deficiences. +2  
raffff  it would not explain the edema, yes +  
drzed  Also the warburg phenomenon has to do with cancers preferentially taking up glucose; there is no indication that he has cancer. +  
haydenelise  The first sentence says that he has lung cancer. +2