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NBME 21 Answers

nbme21/Block 4/Question#30 (33.1 difficulty score)
A 5-year-old boy is admitted to the hospital ...

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submitted by tinydoc(197),
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eTpy 1 alFiamli siymiDilepda g(.p 94 AF 91 )

iedrcnesa TG --t;g-& cipsratteina uc rpeiEt / usrripit admatn Xohnas MSH

nCa eb saedcu by rnotiiLppoe lapsie or oeAriopnpt CII edyiicecfn

yeth disa htat PLL is nife os tis AOP ICI

eiarnHp arstpeese LLP ofrm apHenrri efSltua iMeoyt on aVsc ouldheimtEn aolnigwl us to stte tis foicnutn ni hte lab.

I tgo it wrnog oot - dutSpi oetR miemaoionztr eracll u.nietsoQ

masonkingcobra  I think you need to know that ApoCII activates LPL not necessarily know the disease +9  
yotsubato  Knowing the disease makes it easier to remember the details though +2  
pg32  Mnemonic for these 4 types of dyslipidemias and their causes: 1 = LP meaning LPL is deficient (or anything associated with activating LPL, like C-II) 2 = LD meaning LDLR is deficient (or anything involved in interacting with LDLR, like B-100) 3 = E meaning ApoE is defective and 4 for more (VLDL) ("more" just meaning more letters in the cause (VLDL oversecretion)) +1  
castlblack  One too many chylomicrONs, two much cholesterol, threE apo E gone, 4 put the fork down fatty +1  

submitted by madojo(125),

Going over the other answer choices:

  • ApoC2 defect as already explained in the other comments is Type 1 hyperchylonmicronemia with increased TG and chylomicrons, creamy layer in the supernatant, and is associated with pancreatitis and eruptive xanthomas.

  • LDL receptors are defective in Type 2 which is associated with a MI before age  29 20, accelerated atherosclerosis and increased LDL levels.

  • Someone with a pancreatic lipase defect will probably have pancreatitis and have increased triglycerides in their stool because pancreatic lipase can break down the TG into FFA.

UW has a question on the familial dyslipidemia III which is a defective ApoE. ApoE is what mediates chylomicron remnant uptake into the liver and so if its defective the liver cant efficiently remove chylomicrons and VLDL from the circulation. You get an increase in those things causing premature atherosclerosis, palmar xanthomas.

this stuff is hard

madojo  typo per FA age 20* swy +