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NBME 23 Answers

nbme23/Block 3/Question#3 (35.8 difficulty score)
An 18-hour-old male newborn is 61 cm (24 in) ...
Decreased gluconeogenesisπŸ”

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submitted by sajaqua1(519),
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eecaBus the yabs'b rhtome sah eTyp 1 Dseaibet tisume,ll it si lupsbeail taht heyt had deeevlat oolbd eosulgc leevsl dgurni ro shrtoyl rbefoe htibr. lsuInni sedo ont rssco hte c,analpte ubt csugloe eo,sd os rgduin btrih eth onnteea uowdl ehva ebne lymcceghyipe.r ihsT wdulo elda to eth aleoatnn caprensa eilsnaegr sinuni,l idrngiv eoslucg niot ellcs dan iurnngt ondw gscioenese;oulng tish is hyw eht bayb si gpcmeyyciolh trghi no.w

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yotsubato  His glycogen concentration is high, since he's been hyperglycemic with lots of insulin until birth. +3  
alexb  Also explains why he's 12 pounds. +3  
krewfoo99  Also, think of it like this: Insulin causes hypoglycemia, thus this baby must have increased insulin. It is also an anaobolic hormone which is clear by the babys weight. Insulin increases glycogen synthase activity, and causes an increase in concentrations of glycogen. Decrease in insulin would do exactly the opposite +1  
tyrionwill  fetus of a mom with DM will develop pancreatic beta cell hyperplasia, which leads to insulinemia trying to reduce the blood glucose. after birth, the excessive blood glucose will be automatically withdrawn while the insulin at that moment is still high, which leads to hypoglycemia. +2  

submitted by macrohphage95(7),
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ym gnetuiannrdsd of eth teunqsoi is atht eh si knigas aoubt eht aecsu fo oantalen .maheypcgioly

as yuo nkwo niulsni lwli eb ghih leryantapl due ot epghymylceira dan ihgh seelvl iwll tses.isrp

so fi ouy ntkhi oaubt y.t.i.hagoepmcyhle arnoml rsopnees rof eht onecgygl nntoecrntaioc si ot dseeerac sa( ellw sa gclegoyn a)tesynhs adn hte eoonggiusecesln ot sosiee. nrca a speorn iwth edpirami seoengcigenlosu hhwi(c is abalno)mr si rome kiylel ot pdlvoee agiymoeychlp