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Retired NBME 22 Answers

nbme22/Block 2/Question#44 (reveal difficulty score)
A 3-day-old full-term male newborn is brought ...
Hepatic UDP-glucuronosyltransferase activity ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +4  upvote downvote
submitted by โˆ—ilikecheese(46)
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There is a high indirect bilirubin concentration (8 mg/dl out of the total 10 mg/dl) so there must be a problem with conjugation. the enzyme needed for conjugation is UDP-gluronosyltransferase.

In this case, this is physiological neonatal jaundice. due to immature enzyme that resolves without treatment in 1-2 weeks. pg 387 FA 2019

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 +2  upvote downvote
submitted by โˆ—waterloo(126)
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I was between hepatic excretion of bilirubin and Hepatic UDP-gluco.... (Rotor syndrome and gilbert/physiologic neonatal jaundice respectively).

FA 387 (2019) helps where they say

  • high UCB (indirect) --> Crigler Najjar or Gilbert syndrome, or physiologic neonatal jaundice.
  • high CB (direct): think excretion defect for this type of vignette (Rotor Syndrome). Had the question said "with a direct component of 8" I think I would have chosen Hepatic Excretion of bilirubin.
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 +1  upvote downvote
submitted by dantescuttlefish(7)
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Babies don't have mature activity of this enzyme when first born...Tx with phototherapy...not same mechanism as enzyme but makes bilirubin more soluble

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