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NBME 22 Answers

nbme22/Block 2/Question#5 (37.5 difficulty score)
A 74-year-old man with emphysema and lung ...
Negative nitrogen balance🔍

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submitted by keycompany(269),
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drdoom  Nice! +9  
dubywow  I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation! +3  
macrohphage95  I agree with you in first part but i dont think it has any relation to kwashirkor. It is simply due to cachexia which causes muscle destruction through the proteasome pathway .. +3  
zevvyt  also, it says that his albumin is low. +  

submitted by bking(2),

I understand the edema is from decreased protein- why is Starvation Ketosis wrong? Couldn't his proteins be degraded through this process: Protein--Amino acids-- Acetyl CoA-- Ketones

waterloo  negative nitrogen balance better explains the edema. +  
courtney  I might be totally wrong but I don't think you can technically be in ketosis if you have glucose around and in this case, the patient eats only carbs +  

submitted by lovely(0),

Sources of nitrogen can be meat, eggs, and dairy product which he wasn't eating. The man had a low nitrogen intake but was still excreting nitrogen. Therefore, he had a negative nitrogen balance. A prolonged negative nitrogen balance may lead to a decrease in the plasma protein level, edema, anemia, lowered resistance to infection, increased susceptibility to certain toxic substances, the development of fatty liver or perhaps other serious sequel

submitted by pparalpha(78),
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naC onemeso lapsee aiepnlx ywh ti doluw not eb lynogcge nite?pdelo I thhgtou het nosiqtue swa gnlakit abuto eth gWrbaur nmepneo.ohn.. so yhw nto kbaenodwr fo yoecnggl to lusgeoc?

I gseus ti odwul ont plxenia eht me?dae

hello  Glygocen stores are depleted within 24h. This person has signs and symptoms of longterm nutritional deficiences. +2  
raffff  it would not explain the edema, yes +  
drzed  Also the warburg phenomenon has to do with cancers preferentially taking up glucose; there is no indication that he has cancer. +  
haydenelise  The first sentence says that he has lung cancer. +1