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NBME 22 Answers

nbme22/Block 1/Question#50 (32.6 difficulty score)
A 9-year-old boy is brought to the physician ...
Protein structureπŸ”
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 +5 
submitted by organicmechanic(2),
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eeIacsnrd aswet and aN+ nceornncoiatt solduh inotp ot sytcci irbssfoi )FC.( heT bprlmeo wthi CF si tno that the neeg is bgein itsrncerdba sl,es utb that teh tioernp atht eth nege oscde fro si ltaered, hhcwi dseal to the FC acenhnl eibng eagrddde ued to dn-gsolifmi &tg--; essl FC orectrsep no ecll recfaus ;-g&-t ionteyhpcp FC.

ls3076  why not membrane receptor? +7  
a1913  delF508 is a 3 base pair deletion of phenylalanine at amino acid position 508. Mutation causes impaired post-translational processing of CFTR (improper folding) which rough ER detects. Sends mutant misfolded CFTR to the proteasome for degradation, preventing it from reaching cell surface. So problem is not malfunctioning CFTR channels in the surface; problem is complete absence of CFTR on cell surface (since they keep getting misfolded and sent to proteasome to be trashed). Source of primary problem: error in protein structure +7  
angelaq11  @Is3076 because the CFTR is a channel not a receptor. +17  
rainlad  FA 2019 p. 60 +  
dysdiadochokinesia  @a1913 is correct- as for @angelaq11, you can still have a receptor that also functions as a channel as they are not mutually exclusive. An example of this is the nAChR found on postsynaptic NMJ neurons. This is a non-selective, ligand-gated, ionotropic receptor that functions as a channel once its ligand (i.e., ACh) has bound to the active site to induce conformational change. Similarly on the same realm: CFTR is an ionotropic receptor that concurrently functions as a Cl- channel once its ligands (ie. 2 ATP) is bound to open the channel and enable Cl- flux. This question in particular is asking for the underlying pathophysiologic mechanism for cystic fibrosis, which boils down to an issue with the primary structure of a protein resulting in its misfolding and subsequent sequestration/degradation. +1  



 +4 
submitted by paperbackwriter(102),

FYI this is nth* question I've seen that wants to see if you know that the CFTR mutation results in a misfolded protein that gets stuck in the rER.

Where n = a very big number

castlblack  I knew that but I thought the chaperone proteins counted as protein regulation :( +1  



 +2 
submitted by a1913(12),
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Fd05el8 si a 3 bsae arip oidlenet fo ypaelhelinann ta naimo idac ptniioso 058. nattiMou saescu pdrmaiie tanasronplotast-li grocnesisp of TRFC rpiermp(o fonildg) wichh huorg RE cestt.ed Sensd muantt ildosemfd RFCT ot the tmseeaopor rof daer,aitgdon eepvrgnnit it ormf hecnaigr ellc saufr.ce So roepmlb si nto agiontnlufmicn RTFC sneclahn ni eht ;rsfeuca omprebl is cmlpteeo aesbcne fo RTCF on ellc surfeac es(nci they keep gitgnte fieosdlmd dan nset to esoptoemar to be e.atrhd)s oSruec fo ypmriar roeblpm: rreor ni epinrto csttureru