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NBME 23 Answers

nbme23/Block 3/Question#18 (39.6 difficulty score)
A patient with a 20-year history of type 1 ...
Impaired release of glucagon๐Ÿ”
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 +10 
submitted by moxomonkey(20),

glucagon secretion is inhibited by hyperglycemia, somatostatin and insulin FA2019 - 325




 +6 
submitted by mcl(586),
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nAcorcdig ot tsih earpp, iinnuls bihtiins hpala lescl orfm eesgirnla .gguncaol sihT is eht nvrtaeel regfiu from het p.pare

medpsychosis  There are three ways that Glucagon secretion is stimulated: +(1) a stimulatory effect of low glucose directly on the alpha cell, +(2) withdrawal of an inhibitory effect of adjacent beta cells, and +(3) a stimulatory effect of autonomic activation. The response of Glucagon to hypoglycemia is diminished in T1Diabetes. Hence in this pt, the impaired release of Glucagon allows for prolonged Hypoglycemia. Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005043/ +9  



 +5 
submitted by keycompany(301),
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ypeT I eaebtiDs si rtadczcriaeeh sa eth scriodnttue fo eiarcacpnt sltise ilaleisy(pccf abte llse)c by lslcT.e- The tsom elikyl cesua fro oceaiymhylgp wglofionl nliuins ,nirsinitodamta ehftoe,err si teh tncrtueoisd fo paalh ecsll ttah unudrosr teh beat sclle. Tish lwodu ecsau erddacsee selelv fo nacgitlcriu gogalcun.

titanesxvi  I think rather that high insulin is going to block the release of glucagon +6  
mdmikek89  No, his answer is more correct. Obviously insulin will decrease glucagon release, but it says PROLONGED. So if I give a rapid acting insulin, serum glucose decreases, the insulin degrades...no rise in glucagon. The alpha cells are destroyed as well. This is the how I came to the answer and the best explanation. +1  
melanoma  the answer is not correct +1  
melanoma  his answer +1  
prolific_pygophilic  I actually think this has some merit. I believe there is a U world question that talks about how very long history of T1DM (20 years in this patient) can progress to destruction of alpha cells and hence impaired release of glucagon and episodes of hypoglycemia. Thats how I reasoned it. The first answer is also possible. +  



 -2 
submitted by criovoly(13),
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