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NBME 20 Answers

nbme20/Block 4/Question#10 (reveal difficulty score)
A 65-year-old woman who has a 25-year history ...
Hydroxylation of proline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by thelupuswolf(9)
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Perifollicular hyperkeratosis and hemorrhage are seen with corkscrew hairs, that juicy buzz word for Vit. C deficiency. Hydroxylation of proline in collagen synthesis cannot occur without vitamin c

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athenathefirst  They didn't say corkscrew hair +



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submitted by โˆ—epiglotitties(29)
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There is an abnormally decreased function of the hydroxylation of proline because the 2nd stage in collagen synthesis (hydroxylation of specific proline and lysine residues) requires vitamin C. Since this patient has Scurvy (vit. C deficiency), this process is unable to occur.

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 +1  upvote downvote
submitted by lynn(16)
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FA19, pg 69 - perifollicular and subperiosteal hemorrhages, pg 674 specifically lists mucosal bleeding

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 +1  upvote downvote
submitted by โˆ—stepwarrior(29)
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Wouldn't chronic alcoholism also reduce available NAD and thus inhibit pyruvate decarboxylation by PDH?

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andro  It may also potentially do that , But that has no connection with our patients current symptoms - perifollicular hyperkeratosis and hemorrhages . Inhbition of PDH would be more relevant if they were talking about Alcoholic Lactic Acidosis or decreased energy in alcoholics +1
failingnbme  I thought the same :( +1



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submitted by โˆ—hayayah(1212)
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She has a vitamin C deficiency. Scurvy features swollen gums, easy bruising, petechiae, perifollicular and subperiosteal hemorrhages.

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