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NBME 22 Answers

nbme22/Block 2/Question#22 (47.3 difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclase🔍
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 +8 
submitted by hayayah(1056),
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trohGw oehnmro nslgeeari nhoorme atcs vai epdlouGc- tr.seoecrp G dleopcu poterserc ndee GTP ot omcbee aavetcitd dna PesGaT ot mceeob itvacnea.dit

oN GTa-Pse gt-&;- yhconaicrll civate wogrth hnroome iaeslngre hnmoore porectre -&;t-g tansotnc nitoavtiac of aenlyyld ycsleac / APcM ahyawtp dan leesear of ortghw omr.ohne

mcl  This figure is useful https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png +  
mcl  [link](https://ai2-s2-public.s3.amazonaws.com/figures/2017-08-08/a025a0e224d366e987bc15edd0f7764ef5611e0d/4-Figure3-1.png) +  
meningitis  How did you knkow it was GHRH and not GH perse? +4  
meningitis  nevermind; I just read down below. Thank you +9  



 +8 
submitted by osgoodschlatter10(27),
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hTe rcretpeo ni tqouisen is a G nrieopt croprete no eth yitrauitp sm.sa ihsT ludow eb eth GHHR reotcp.re hTe GH ropceetr llwi eb enptsre mdwstaoner os ttah HG srlaedee ofmr eht itriatpyu nac bndi ot it te(ehs ear AJ/TKSTA HcGHRrt. soree)p tecrseopr ear ¬Gs reecs.ortp Tehse ersrotcep rea ndubo ta the pistn-ubhaula to PDG ni hte vanctiei sa.tet neWh RGHH nsibd teyh itavcdeta ehnw TGP ascatteh to hte uabu-snaphilt atdnie.s ndA htrbeye sproemoot daelyn leycsac ieGPi.sacaTv tty is npirsbolsee ot vlaece ihst PGT mofr teh lphaa sntubiu to ciwhts fo hte p.toecere ehTforer a kalc fo GTsPae cytvitai wlli nrdere he Gs prteeorc ni a dpgenrool on atset  asdecneIr ytctavii fo Adynel sla.eCcy

osler_weber_rendu  Brilliant explanation +  



 +0 
submitted by goldenwakosu(6),
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hyW is het rsanwe lydyalne a?cycsle I deokol ni FA and I swa htta GH sues the TJ2/AASTK aytwhap adn ttah GI1F- ssue het AMP eansKi .ahwpyta oNt seru woh lyayldne ccasely aslpy ntio ith.s

pug_sheen  I think they are talking about the GHRH receptor on somatotrophs, which works through the cAMP pathway. +  
staygoodpupper  I don’t know how it relates to GH/IGF-1 in particular, but the question said there was a mutation in the alpha subunit of Gs, which activates adenylyl cyclase. +3  
kash1f  I agree the patient does have Acromegaly, but in the question it talked about how the patient had a mutation that prevented the GTPase activity of Gas. So Gs would be overactive --> excess adenylyl cyclase +28  
hyperfukus  ugh i was so excited too bc i thought i remembered jak stat epicfail +3