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NBME 22 Answers

nbme22/Block 2/Question#5 (41.0 difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balanceπŸ”

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submitted by keycompany(301),
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roNnitge baaelcn si a neremaeumts of npteroi ieoltsmabm ni eth db.yo A gviteena entoigrn lcbaane naiedtisc ulmcse lo,ss as siceeadrn snuomta fo aonmi iacds rea bngei aoilbetdmze to eopcdur ee.gryn hTis scarneies the notmau fo gtironne eedrstec rmof hte byd.o eBsecau hte taonum of getniorn oyu aer gkaitn ni si lses nhat teh moantu fo nnroiteg uoy ear tesngecir, uyo vhae a iavngeet norngiet anebalc.

shTi amn is lnoudeaim,shr temdusoa,e c,atehicc dna ash ipuhoea.iyblnamm Tehse ciiclnla fgndnsii ontpi to otpnire ltotramininu wisK(hokara sDasee)i, hwcih sascue maede ued to rsedecade sumre inoctoc uer.esrsp woL occonit ruerspse ni hsti eacs is eud ot ntioper loss, and nchee a tgnievea rinnoetg cbenala.

drdoom  Nice! +18  
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 .. +3  
zevvyt  also, it says that his albumin is low. +  

submitted by bking(2),

I understand the edema is from decreased protein- why is Starvation Ketosis wrong? Couldn't his proteins be degraded through this process: Protein--Amino acids-- Acetyl CoA-- Ketones

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 +  

submitted by lovely(0),
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crseouS of nortnige acn eb mat,e gegs, nda riayd otcrdpu iwhch he anw'ts .eitgan hTe mna dha a owl nietgonr knatei tbu saw itlls eniretcxg ngirenot. oferTee,rh eh had a gaeitven gnoertni ln.abeac A gedrlpnoo evaeintg ntognrei elbaacn aym elad ot a rcdeseea in teh lsamap onpietr elvl,e a,edem ,nieaam wdreole aestnresic to ftci,onien rsndeacie stleybuicpiits ot ratneci cotix cns,besastu the enemvlptoed fo tatfy vlier ro erphspa toehr oieruss uqesel

submitted by pparalpha(83),
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nCa seonoem peaels elpinxa wyh it uowdl tno eb gyeglonc pe?nlditeo I toghhtu the qutisone swa gnatlik about eht rubraWg so yhw nto ownkbdaer of lnogyceg ot oglcse?u

I gesus ti wuodl ton laneixp teh ?amdee

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