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NBME 20 Answers

nbme20/Block 4/Question#10 (29.2 difficulty score)
A 65-year-old woman who has a 25-year history ...
Hydroxylation of prolineπŸ”

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submitted by thelupuswolf(9),

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

submitted by epiglotitties(9),

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.

submitted by hayayah(1056),
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eSh sha a vmtaiin C iniccfyed.e cyurvS eurfstea enlolws gusm, ysae rbuiisn,g ihteeec,pa flpilearricolu adn otseirplsueab rhaese.ghrom

submitted by lynn(9),

FA19, pg 69 - perifollicular and subperiosteal hemorrhages, pg 674 specifically lists mucosal bleeding

submitted by stepwarrior(20),

Wouldn't chronic alcoholism also reduce available NAD and thus inhibit pyruvate decarboxylation by PDH?

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 +