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NBME 22 Answers

nbme22/Block 2/Question#19 (22.6 difficulty score)
A 50-year-old man comes to the physician 3 ...

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submitted by hopsalong(23),
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waterloo  Something that could help. Gabapentin is a narrow spectrum anti-epileptic drug used to treat seizures. It blocks voltage gated Calcium channels. It also treats neuropathic pain (which this vignette hints at both). My thinking for this question: the patient is having seizures so must be sodium abnormality. But then they mention the pins and needles and involuntary contractions, and this being the first seizure, it sounded less like a sodium issue and more so Calcium. I think what hopsalong said makes a lot of sense. I think there is a pharm angle this question could have taken as well. +2  

I found an easier way to just logic through this is the complaints are basically muscle spasms, tetany, hyperreflexia.

  • Abnormalities in bicarbonate give metabolic acidosis/alkalosis, nothing in stem gives us reason to think theres acid/base balance.
  • calcium, hypocalcemia textbook fits with tetany, hyperreflexia
  • abnormal chloride not much clinically significant
  • potassium abnormalities can have tetany but also arrhythmia, no signs of cardiac involvement
  • sodium, hyponatremia can have seizures, hypernatremia have irritability and signs unlikely to be ongoing for entire month.
nootnootpenguinn  Thank you so much for the potassium explanation! It was totally a "D'oh!" moment, haha! +1