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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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 +27 
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. +  



 +2 
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 +  



 +1 
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




 +0 
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