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NBME 17 Answers

nbme17/Block 4/Question#37 (reveal difficulty score)
An 18-year-old man has yellow nodules on the ...
Absence of functional LDL receptors in hepatocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—cassdawg(1779)
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Yellow nodules (cholesterol deposits) on the achilles tendons have a very high association with Type II familial dyslipidemia, or familial hypercholesterolemia. This is caused most often by a defect in the LDL receptor function. (FA2020 p94)

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cassdawg  NOTE: This patient shows a SELECTIVE increase in LDL so it is a defect in the LDL receptor NOT a defect in ApoB100. A defect in ApoB100 would present with increased VLDL as well! +28
ginachipotle  Note that the answer is ABSENT LDL receptors vs. partial reduction b/c LDL >700 (LDL = 980), indicating individual is likely homozygous for the trait. (FA2020 pg. 94) +12
jdc_md  you trick me nbme. veryy veryy tricky +5
i_hate_it_here  <- +4
kevinsinghkang  Why not E? partial reduction? +
kevinsinghkang  never mind i see it above now. thanks ginachipotle +

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