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NBME 21 Answers

nbme21/Block 1/Question#24

A 23-year-old man drinks alcohol heavily on a ...

Fatty change

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 +6  upvote downvote
submitted by vonhippelindau(6),

It’s acute alcohol consumption so fatty change more likely. Cellular swelling indicates alcoholic hepatitis which requires chronic alcohol consumption (See FA 2019 pg 385). At least that’s the logic I used to pick fatty change.

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset. +11  
nc1992  I think it's just a bad question. It should be "on weekends" +5  
uslme123  https://webpath.med.utah.edu/LIVEHTML/LIVER145.html +1  
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate +  
sympathetikey  @seagull I agree! +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +  
linwanrun1357  Do NOT think the answer of this question is right. Cell swelling make more sense! +  




 +1  upvote downvote
submitted by sweetmed(33),

Fatty Change in Liver [2/2 High NADH made by ADH and AldDH -> inhibits FA oxidation, impaired lipoprotein assembly and secretion-> FA accumulates.]





 +1  upvote downvote
submitted by usmleuser007(97),

As per FA 1) fatty infiltration 2) cellular ballooning 3) eventual necrosis

hyperfukus  thanks u saved me time in looking that up :) +  




 +0  upvote downvote
submitted by youssefa(12),

Wouldn't acute alcohol consumption even in moderate amount cause reversible hepatic cellular injury characterized by cellular ballooning? It should be the right answer unless the question stem means "Weekends"

hello  No. The order of liver damage due to alcohol is: fatty changes --> cellular swelling (cellular balooning) --> necrosis. This Q stem states to the patient consumed large amount of alcohol on a weekend -- he has acutely drank a large amount of alcohol on one weekend --> this corresponds with fatty changes +  
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION. +