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Retired NBME 22 Answers

nbme22/Block 3/Question#49 (reveal difficulty score)
A 42-year-old man is brought to the emergency ...
Dopaminergic neurons in the substantia nigra ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—yotsubato(1208)
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"MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) is a prodrug to the neurotoxin MPP+, which causes permanent symptoms of Parkinson's disease by destroying dopaminergic neurons in the substantia nigra of the brain. It has been used to study disease models in various animal studies." Wiki

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ilikecheese  pg 508 FA 2019 +19
sbryant6  I thought this was testing "lead pipe rigidity" aka Neuroleptic Malignant Syndrome and its connection to dopamine. Had no clue what MPTP was and got it right still. Probably wrong train of thought though. +
xmen  @sbryant6: Wrong thinking, you got it by chance and your reasoning is wrong. +



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submitted by โˆ—medstudent(18)
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Without knowing what MTPT did (p. 520 in 2020FA) I reasoned through it like this:

Cholinergic in Nucleus Basalis of Meynert=ACh. Possibly but disease here causes alzheimers/huntingtons even though it is increased in parkinsons. Dopaminergic in neostriatum= Didnโ€™t know so I just kinda ignored it ๐Ÿ˜‚ Dopaminergic in substantia nigra = Parkinsons so it sounded like a good choice. Serotonergic in dorsal raphe nuclei = serotonin. A lack or excess here wouldnโ€™t cause this. Serotonergic in locus ceruleus = norepinephrine. Same as last.

Ultimately chose dopaminergic in Sub. Nigra because of the rigidity on exam and feeling frozen in ice.

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submitted by sunny(9)
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FA pg 508 (19) mptp causes parkins..................................................

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mkreamy  ...... +4



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