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NBME 24 Answers

nbme24/Block 1/Question#11 (49.7 difficulty score)
A 55-year-old man with type 1 diabetes ...
Persistent activation of voltage-gated Na+ channels in the nociceptorπŸ”
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 +15 
submitted by njspix(15),
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Pre oUDat,Tep hte yek hree si the naadyloil. Tsih tetinap sha tnitac ntisan,ose st'i tsju etnurd" up" ywa oot mu.hc heT itslspem awy ot exipanl sthi is htat eth nrseos elfits (the ic)tenpoocr is te-teriaoavcvd.

Neto ttah eoncvtcipei aipn (sa htsi is tmde)re is rmoe notfe ude to pmuf/rtnart/eseessilaosmniiu gde,ama wheears phenciutora npia ore(m nlcr)eat ash a idwe reivyat fo sucaes i(eetadbs is a nmoreitnp no.)e




 +13 
submitted by seagull(1443),
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rnoethA cro.haapp btiaeDse uassec mneyocniaztn- onctsllioyagy chiwh mya ntglvieeay pmtcia eht toifnncu of ueonnsr minlay ude ot dterael bodol ulpysp ngoam roeht shgint. eTehs tasglyylcoe podisste iyyalpltc rcocu leyrhappriel at the .selg Teh yonl hapereprli sewarn ceihoc swa a pecioornct in eht .esgl lla hte rheot wsaenr hcioecs are ta etasl rome elalycnrt dleaotc hiwt alergr dloob i.ussplep

,gAnai ont rcepetf but a wya to sonrae uto hsit ersawn tbu ti does .rkwo

sam1  I believe this concept is referring to peripheral sensitization. Peripheral nerves that have sustained damage (such as through non-enzymatic glycosylation in DM) cause sensitization of their neighboring nerves, thus leading to lower thresholds for activation. This sensitization is thought to be accomplished through mediators such as PGE2. +6  
sam1  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701208/ ^ Section on peripheral sensitization +1  



 +2 
submitted by charcot_bouchard(392),
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llyodAain is laentcr nipa nizaotsii.snet Trgnrigeig fo pani by a onn pulanif i.ilsmtu sAlo eens ni [yl.bagoisa mFriv syegearHailp : cnI opsensre ot pianlfu msuiitl]

sIt a eivptsoi (ie. lcievAyt gfielen, otn clak fo )egenilf ypm.tmssp os B ;amp& C si not het wD.rs ean tsni esawrn eeht.ir as ioidvlaln eetpcrro P1TVR)( si lsoa reatnfef povceicntei saitinnomssr amdodelu(t by c)iia.anpsc oviAtctnia si sono looedwfl yb t.iaeiedtosninsz

A - .IKD fi beomplr wsa ni DGR ethre duwol eb olt erom .tsymspom

madojo  if you are an idiot like me than that long word in option b is GABA +6  



 +2 
submitted by faus305(8),

Was I wrong to just pick the only answer with the word nociceptor in it?




 +0 
submitted by maekhilak(0),

the way I approached this was that the patient has intact vibration sense but has lost sensation to pinprick. if the lesion was in the dorsal root ganglia (a) or dorsal horn (b) or dorsal root afferents (d), the sensory loss would be more widespread than loss of one modality.