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NBME 17 Answers

nbme17/Block 3/Question#31 (reveal difficulty score)
A 20-year-old man is brought to the emergency ...
Epinephrine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: DKA

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 +17  upvote downvote
submitted by โˆ—cassdawg(1779)
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ooremnH evtniises sepali SL)H( si eth eemzny cwhhi aeddersg cirsregiedlty stored iwhtni sdciteaypo 2(AF200 ).p39 uhs,T ti meask esnse that ti is taecativd ni mtsie fo ianftsg adn supespedsr in teh def .tteas

nIuinsl woldu hitiinb ,HSL as snilnui si a def atets eezynm ectderes yb the pasnrcea nda wlodu awnt to itgergr eosgart of sregy.tirdicle

nI tcanstor gogucanl is tercsdee in sspenore to pmlghyocieay by the creaasnp adn llwi trrgieg asfted teast ao.viitcatn In sremt fo the f/deatsf attes I slwaya tknhi of anglcoug nda heipnpniere dikn of leki a oreruseph dna hteir sdei ickk, usabece yteh suyaull owrk hrtgoete in eth faisntg tstae on rsaimil rettasg to eeunrs eht ydbo sah nugeho gneyer st(ih hlpse em bermmere thta rpienheienp nda aogulncg rae ifstgna atste e.mho)nosr erHe gothuh is ehn'ireseppni igb nicoat aywa omfr gl,caougn erehw cuolgnag ash mnaiiml teffec nda epenniehipr has hte big noiact of vacnitgiat LH!S cGluagno sah a ormin elro adn oreht eahatsnceolicm dan CATH acn oasl svere to taveitca HSL sa el.lw

toenrhA axleepm fo teh yicsgnisret owrk fo uglocang and hiepeinepnr si ni gyeongcl akorebwdn A2F02(0 )p8.5 oBth lilw rggriet AcPM eanescri dan piorent eikans A oniattcvia hichw lwli opyrhepshtalo cggneyol lpspepharhoosy nad tavtciea it S(AFT O!YRLPSOHETHAP onreomH neitisvse paesli is atlacluy odtyeshphlropa to aaetictv ti sa )lelw.

UNF ATC:F oronmHe etssvieni ieplsa catyulal ogt tis nmea ebusace ti wsa snsveiiet ot i!nrheepeipn

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flapjacks  In Type 1 DM, the glucagon response to hypoglycemia is not functional and these individuals are reliant on the epinephrine-stimulated hepatic glycogenolysis. I recall this by remembering you can administer glucagon to these patients if they're having a hypoglycemic episode. They can respond to it, but they aren't releasing it. +2
passplease  How did you eliminate thyroxine? As it also plays a role in lipolysis. I was thrown off my the low blood pressure and therefore did not select epinephrine. Why would they still have a low blood pressure? +
jackie_chan  ^ they have low blood pressure because DKA causes a lot of dehydration (vomiting, diuresis due to osmotically active glucose in urine) so low BP Thyroxine I eliminated because remember that thyroxine is unique in that it functions similar to a steroid hormone and acts in the nucleus to upregulate expression of many genes. I figured hormone-sensitive lipase needs to be activated, not stimulated to upregulate expression, so I thought about EPI and beta-3 stimulation. fuckPeter +1
schep  I figured since he has low BP/dehydrated, his body would try to maintain cardiac output by increasing sympathetic tone (releasing epinephrine). In hypovolemic shock, systemic vascular resistance is up because of this compensation. +
j44n  also thyroxine works like a steroid hormone meaning it takes a while to cause its effect +
flvent2120  That'd be cool if it were called "epinephrine sensitive lipase" +



 +0  upvote downvote
submitted by meiraim(1)
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nI DAK, pprneehneii ()aeirldeann tsueliamts eorsotnesi-nmhevi eipals to knordweab atf ssoetr in teh y,bod rsenlgaei stnekeo dan erfe ytfta adsc.i

In DKA het odyb atcn' ues teh secgulo e(du ot klca of ,sninu)li and ernest itaastvnor omde yb eknbarig donw tfa rosste rfo ygne,er rnesaelgi r tftfyeae sdcai (sucsae an sa)isicod adn teskon.e seAdpio lelsc eearels ygrnee via svonimrinthee-soe peials. rednlaAein ngulciidn neprniheiep uetismtals lasipe in oeiasdp elslc.

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