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NBME 22 Answers

nbme22/Block 4/Question#35 (42.3 difficulty score)
Nicotinic acid acts at which of the following ...
Pathway labeled β€˜Cβ€™πŸ”

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submitted by btl_nyc(56),
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:A mhaeiecyronrlts nad rteoh lebi caid srnies vrnetep eth rpekaute of libe sadic omrf teh .utg

B: sttSnai thinbii oACH-MG detaruc,es vneiptgnre the eirvl ofrm kmagni mnvolaeci ,dcai a uersprocr ot torlceo.hels

:C iiaNcn inc(ncotii di)ac eecsrdu tepciah VLLD sthsyisen dna aols hnbitisi ssiolilpy ni odpiaes esisut by gnnihitiib merhono ieesvints lae.spi

Em&;p:Da tibsaFer elurutgpea iiptonorepl laipse ,)LLP( nniigarces yetiriglcred clacrneea LDV(L nda omcclioshrny rea flul fo )lrcstdieigery nda lsao aivcteta eoerpmxois titcedavi-ptelorfarrao ro-rctpee paalh a-(RhpPPAl)a to iecund HDL yes.ntissh

submitted by mattnatomy(41),
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sAnwre = .C (eadecreDs cietaph LLDV htniyssse)

coicnNtii acid = iNnica. niNcia ksrwo y:b

  1. ihnbnIitgi sypioills honoem(r esvesiint )easpli in espdoia )stiseu

  2. dgncRuei hicapet LLDV ssisntyeh

johnthurtjr  Well color me surprised. I was completely thrown off here. +32  
miriamp3  @almondbreeze go to the cardiovascular pharmacology you will see a draw of lipid lowering agents and you will find niacin en two places ++one on the adipose tissue and the second one in the liver by the vldl production. in the text in the same page is also mention it FA 2018 pg 313. +  
djeffs1  I still don't quite see how C corresponds to those 2 processes... +  

submitted by btl_nyc(56),
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A: rolytaeemncrhsi dna eohrt beli icda rssnie etnpvre the epkarute of beli csida mfor eth Bu. g:t tstnSia inihtbi HMA-CoG urc,eestda pevntrgnei eth leivr ofmr gamink meconilva aic,d a rrpuscreo ot eshe caNini ii(cointnc ci)ad cruesed iptceah VLLD nseshysit dan sola ibithnsi iolislyps in adepsio ssueit yb ginbinithi nhemroo seiivsnte sEm;a lpi&aD.:pe ritseFba reluueaptg otiionpeprl aieslp (L)P,L iagncsrnei eireirdtlgyc naeccelra LDV(L nad iochmyrlcsno ear full fo te)grecsiriydl and loas aaitcvte xersmepooi evtcrraaporoia-dfltite rteor-ecp ahlpa lAah-pRP)a(P to iuedcn DLH shntiseys.

submitted by usmleuser007(377),
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1) blela D L(LVD t-&D-IgL; -&;-gt )DLL = angytinh htta dcresinea LPL = bairseFt iwhch ues pP-ahARaPl x()R are oodg ta gunidcer ;VD]LL[ fte,oreher sles LVLD msane mreo LI.D

2) DLVL ;&-t-g ttfay idca diotanxio = usgni stfa s(AT)G ofr neyerg uoptd rncoi Heer RammgPPAa- palys a erol= wchhi are eTalndsiizihdineoo sl(oa dlleca )tzengaiols are a cssla fo mdsceieni taht yma be uesd ofr eht rtnaetmte fo yetp 2 ba.stedei yehT are salo odgo ta riungcde mresu GTAs

oNte LDVL ear eryv hcri ni AsTG

submitted by gh889(117),
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Cudol enosome aleesp npleaix hhicw drsgu (fi )nya rea at D dan ?E

usmleuser007  1) label D (VLDL -->ILD --> LDL) = anything that increased LPL = Fibrates which use PPAR-alpha (Rx) are good at reducing [VLDL]; therefore, less VLDL means more ILD. 2) VLDL --> fatty acid oxidation = using fats (TAGs) for energy production Here PPAR-gamma plays a role= which are Thiazolidinediones (also called glitazones) are a class of medicines that may be used for the treatment of type 2 diabetes. They are also good at reducing serum TAGs Note VLDL are very rich in TAGs +1