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NBME 16 Answers

nbme16/Block 1/Question#26 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Antagonizes VLDL-cholesterol secretion ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—andro(269)
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Niacin( Vit B3)
- inhibits lipolysis ( hormone sensitive lipase ) and hepatic VLDL synthesis /secretion .

Side effects : Facial flushing , secondary to prostaglandin release . Pre treat with NSAIDS
- Also causes Hypergl;ycemia and Hyperuircemia , as such avoid in Gouty patients and Diabetics

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submitted by โˆ—bingcentipede(356)
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Fish oil, from FA 2019: "Believed to decrease FFA delivery to liver and decrease activity of TG synthesizing enzymes" God this Sketchy was awful

Increases catabolism of LDL cholesterol - statins (I think? I found this article Inhibits cholesterol uptake - ezetimibe Activates PPAR alpha - fibrates Inhibits HMG CoA - statins

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feochromocytoma  This is all true, but the question was asking about a vitamin supplement given along the fish oil, which is Niacin (B3). It works by inhibiting lipolysis and reducing hepatic VLDL synthesis +2

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submitted by โˆ—dentist(94)
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Heres how to think this question through:

The key word here is "supplement." Of the 7 lipid-lowering agents (FA2020, p.320), 2 of those are non-pharmacologic agents: Niacin and Fish oil. By process of elimination, we were to arrive at the mechanism for VitaminB3, a "supplement"

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chaosawaits  The key word is "most appropriate vitamin" leaving you with only niacin +

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