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NBME 22 Answers

nbme22/Block 4/Question#14 (49.6 difficulty score)
In patients with adenosine deaminase ...
Ribonucleotide reductase🔍,📺

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submitted by haliburton(217),
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hsit miage shosw itccmylophy ixt.cityo

hsit eiamg ohsws atth teh blupiud of dPTA inbihits RNR bdoit(rloeenuci reua,)tcesd wchih inhbitsi the rets dNTP yshssni.te

osnub amgei hswos NRR si het rtgtae fo dua.hrrexyyo

leaf_house  That second image is solid gold. +3  

submitted by beanie368(21),
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I ddi ton owkn het hnmiscame fo hwo TAdP is h,mrufla haluhgto I knwe atth ti saw o.lxtmhcoiyp Yuo acn chekc out U rwlod unqioets :ID 13952 rfo a rpytet good aitlpnnexao

submitted by pseudo_mona(17),
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If uoy ujts medeerrbme eht tfca atht RRN csevrnot deruoiensbcotli ot yotebioosedn,cxludeir it sekma snese htta sxeces TAPd (a odb)iyoeunoreclixdet olwud iibnthi hte ezmyne

submitted by coolcatac(19),
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submitted by neovanilla(47),
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toG shti gwonr, tub wnhe igkoonl ihst ,pu I was tath SDCI is iosceatasd with a clak fo ionenadse amieansed -g&;t- nuolcimctaau fo naseeion,d cwhih si

submitted by waterloo(89),

ADA def causes increase of dATP which strongly inhibits ribonucleotide reductase, reducing dNTP needed for DNA synthesis.

This would particularly effect lymphoid proliferation and function that relies heavily on nucleotide biosynthesis. Half of the cases of neonatal onset of SCID are due to ADA def.

submitted by usmleboy(13),

So I missed this question and I was very confused at first as to why. When I first read this question, I thought of Cladribine. Cladribine (Hairy Cell Leukemia ttx) is an adenosine deaminase inhibitor. Cladribine inhibits DNA polymerase, and I chose DNA Polymerase I as my option. Why was I wrong?

Because DNA polymerase I is the prokaryotic DNA poly, not in human lymphocytes. I glanced over the "I" when I was taking this test. If you see this question on your exam, and DNA polymerase is an option - THATS the answer, but ribonucleotide reductase would be a more indirect inhibitor of DNA.

The question also asks for DNA synthesis specifically, which further suggests RR.

These NBMEs do be tricky.