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NBME 23 Answers

nbme23/Block 3/Question#4

A 31-year-old primigravid woman at 32 weeks' ...

Hypoglycemia

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Malaria can impair hepatic gluconeogenesis and can also consume glucose for its own metabolic demands.

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +16  
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +2  




 +3  upvote downvote
submitted by kai(13),

https://malariaworld.org/blog/glucose-and-malaria

I think we're thinking too hard on this. The parasites are consuming all our sugar! So simple that it's hard.





Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.

shriya goyal  yes I answered it like that +1  
redvelvet  me too :( +  
abigail  me three :( +  
yex  Me four :-/ +  
link981  Slowly raising my hand as well +  
tinydoc  Sammmme +  
bullshitusmle  same here!!!:@ +  




 +1  upvote downvote
submitted by kard(5),

Pregnant women are more susceptible to severe Plasmodium falciparum malaria. Hypoglycemia & severe anaemia is frequently encountered as a complication in falciparum malaria, that is usually ascribed to increased glucose use and impaired glucose production caused by the inhibition of gluconeogenesis.





Hypoglycemia is a frequently encountered complication in falciparum malaria that is usually ascribed to increased glucose use and impaired glucose production caused by the inhibition of gluconeogenesis.

from trends in parasitology: https://www.cell.com/trends/parasitology/pdf/S1471-4922(06)00175-9.pdf





 +0  upvote downvote
submitted by nwinkelmann(104),

So... I've been trying to figure this out and I think I got it...

One of the main clearance techniques by the body is extravascular hemolysis by the RES. Hemolysis of RBCs leads to elevated serum LDH (because RBCs have high amounts of lactate dehydrogenase which is released into serum after hemolysis). Increased LDH can then lead to increased pyruvate to lactate conversion, which would deplete the body of pyruvate and lead to increased anaerobic glycolysis. As the process continues, hypoglycemia results due to overutilization of serum glucose.

I agree with @yotsubato that this is a bullshit question for Step 1 (hopefully it was retired because it was an experimental question at the time and no one knew it, lol). I'm glad that I was able to try to figure out possible pathogenesis, though. That is probably why it was asked, when it was asked, to determine if students could VERY critically think about all of the complications of malaria and what complications those original complications could lead to, just by know normal physiology/pathophysiology of the body. I came to these conclusions based on putting together information from several of Armando Hasudagun's videos (@4:00-4:37 https://www.youtube.com/watch?v=wxzf_rg_Wd4, https://www.youtube.com/watch?v=oQmL6XqCKSU&list=PLqTetbgey0acuF2wsTispLDzZVKDyOEev&index=16).