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NBME 20 Answers

nbme20/Block 4/Question#41 (45.8 difficulty score)
A 56-year-old man with a 20-year history of ...

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submitted by waterloo(89),

if you look at the answer choices, they are all pain suppressors except for naloxone.

Naloxone is an opoid antagonist so blocking mu receptors would lead to increase in mediators that induce pain.

I don't think you need to know any experimental data, or really anything before the last two sentences. He is given something that reduces pain (opioid agonist), and if you give him naloxone you would be reducing the effect of his opoid agonist.

submitted by usmleuser007(417),
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filRee fo telarbctani iapn saw reducpod ni xsi mnuha tspaetin by iiaosmnuttl of eetosrcedl pmnarteleyn pmtdnaiel in hte plricneutirreav nda quidreuaatcpel agry taetmr. eTh vllee fo lntstiiaoum ffsntecuii ot iunecd pani eferli sseme otn ot alert eht aetcu pian hohsd.letr dirnesmcniIait tpeeteirvi sloitutinam eocrupdd noltreeac ot both eldrcutmsauo-oitpidn naip rleeif dan teh ecilaagns catnio fo crtiocna ;conditmaei ihts sespcor cduol be rereedsv yb aibcenetns mrof iam.ulsitnot tudrlSimtcudoeiapon- iefler of pian wsa eserdver by olxnoane ni vfie tuo fo six stantpie. eThse seutslr gesutgs ahtt tfastiosyrac vialielnaot fo nseresptit apni in msnauh may eb itnobdea yb crolneecit talmuisno.ti

usmleuser007  These questions seem unfair to test because they are based on experimental data. Guess they are there to limit a perfect score. +2  
xxabi  I just read it as patients take opioids to blunt or control pain. So if the electrode does the same thing (decrease pain), then an antagonist of opioids (naloxone) would bring the pain back? Idk if that reasoning is sound but that's the logic I used, I didn't even think of it as experimental. +23  
xxabi  Also its the only one that's an opioid antagonist from the list! +2  
redvelvet  they are writing these questions in an evidence-based manner because the questions in medicine cannot be produced by a self imagination or logic. But that doesn't mean that we have to know their exact evidence like this question. we can use our own basic knowledge and adjust it with logic. so opioids have an analgesic effect in the body and naloxone can revert it. +4  
champagnesupernova3  Anything that reduces pain by brain stimulation is increasing endogenous opiods like endorphins and encephalitis. +2  
champagnesupernova3  Enkephalins* not encephalitis +  

submitted by neovanilla(46),
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eTh xcur of teh tesuqino si isk,agn fi hte naeittp eslef dresaceed apni iw(chh si invder yb idoopi leceumso;l 'thtas why spiooid rae aidrmetnsied as lri,ekalnsip) nthe ohw do you tsop het hiiti?nonbi nA odiiop agttnsinoa nxo(lneoa si het noly eon ttha is an oisttnngaa)

neovanilla  wrong answers: b-endorphin - an endorphin and ACTH hormone (similar to ACTH, POMC) that can bind to the Β΅-opioid receptor Enkephalin - a neurotransmitter involved in the indirect basal ganglia pathway (along with GABA); it can also bind to delta-opioid receptors Morphine - an opioid agonist (used for pain relief) Oxycodone - Another opioid agonist (~same potency as morphine) +4  
kevin  enkephalin, endorphin, dynorphin are the bodies endogenous opioids +1