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NBME 20 Answers

nbme20/Block 2/Question#30 (46.5 difficulty score)
A 78-year-old man is brought to the emergency ...

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submitted by hayayah(989),
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H'es nto tniaeg

Oen fo croosslt'i intnocfsu is ot eeaisncr ounglicgnseseeo, ,syopilisl adn lpo.siyetors

ankirin  Why wouldn't it be T3? Thyroid hormones also ↑blood sugar and break down lipids +1  
waterloo  @ankirin his symptoms aren't really specific for T3. They don't mention tremors, exopthalmos etc. I think just in physiologic terms, you can bet cortisol is more increased. It's not a great question though imo +  
rockodude  can someone comment on why his appetite is down, per first aid 2019, page 329, cortisol increases appetite. thank you +  

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submitted by youssefa(99),
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roFm Fiad 1902 wen :greiuf -1FGI nylaim tnfouiscn sa na aioblacn mrnehoo on sumlces adn neobs rettpy( umhc lkie nligi-;nsut& recdesase uesmr gslu)oec. GH ctsa ypltaesaer yb rgtomnpoi unislni nrsteicase ncnirgasie( suemr )gcuoles. oerrThef,e G1-FI si not hte e.rwnas fI GH aws ognma teh aenwssr ti uowld ehav got yllrae giofsu.nnc

charcot_bouchard  Can anyone take a little time to curse on that daughter? +5  
dbg  Sure, charcot. Just wished on her to get a couple of charcots (the triad, your aneuryms, marie tooth, etc). +1  
noorahsaahir  Charcot_bouchard and dbg best comments .... 🤣🤣🤣🤣🤣 +  

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nnAyoe nkwo yhw GIF1- nwl'oudt be iredsacen sa we?ll RGHH si tulasditme in ocehycypmigl

nala_ula  Honestly, it's something that has confused me for a while. Why is it that GH secretion is stimulated by hypoglycemia? I mean, it's literally called growth hormone (for growth!), and hypoglycemia, which is basically a "starvation" state, will stimulate this hormone? +  
shaeking This might help answer your question. I basically didn't pick IGF-1 because it would increase the uptake of glucose leading to a worsen hypoglycemic state. Didn't have a true reason otherwise. +  
temmy  IGF-1 is regulated by insulin. so it will be decreased because insulin levels are also low. +2  
nala_ula  thank you @shaeking! +  
nwinkelmann  I found this and it also explains to a more genetic/cellular level. Essentially, it says that starvation induces some factors that cause GH resistance and IGF1 suppression. +1  
nwinkelmann  Sorry forgot the link: +  

Looked this up. Starvation causes GH resistance. Never heard of this, unfortunately fell into the trap of thinking increased GH would increase IGF-1. Punished for overthinking.

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submitted by rio19111(8),
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I ktnhi a tlo of you essmid eht t.npio eTh enwars is orstiClo ecueasb ti pshle tniianam lbodo urpserse neve in eth ngsitte ewehr eh is e.msnaorhliud

rio19111  FA 2019, Pg. 329 +1  
pakimd  according to pathoma, cortisol is the hormone neccessary for life. in a condition like the one presented in the Q-stem the most important hormone will be cortisol. +2  
pontiacfever  Also Cortisol is generally a stress hormone. Starved body is generally understress--Cortisol +