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NBME 22 Answers

nbme22/Block 4/Question#48 (36.4 difficulty score)
An 8-year-old boy is brought to the physician ...
Calorie consumption that exceeds energy expenditureπŸ”

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submitted by aesalmon(81),
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I eefl budm ofr ansikg btu can nsomeoe npleiax hsi?t If his rstnepa rae of slceo ot mnolar MIB and aer eonncecdr btoua his htgiwe ywh uwldo ethy eb lgnwoali his oalicre nusmpoonict ot execed ish yeengr xrunepeed?it ( AKA eitngtl the dik ate oot chum nda ton eisexcre e)ngohu

meningitis  That's a modern day mystery. +16  
drdoom  The prompt is only asking "what's the likely cause of obesity?" It's not that they're "allowing" him to eat more than exercise. (Few parents can monitor their kids that closely!) The prompt is only asking what's the most likely explanation for his 95th percentile weight and BMI (given that he otherwise appears normal); in the United States, the most likely explanation is eating way more than you expend. +1  
niboonsh  aka 'merica #firstworldproblems +4  
makinallkindzofgainz  If you are obese, it's because you have consumed calories in excess of your energy expenditure, end of story. (there are factors that affect your energy expenditure, but the simple statement is 100% true, unless you want to argue against the laws of thermodynamics). A is the only correct answer. +1  
tulsigabbard  This answer hit too close to home. +4  
castlblack  I think the reason they point out the average weight of the parents is because leptin disorders are inherited. It helps you eliminate that answer choice. +1  

submitted by rogeliogs(9),
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yM apchoapr to iths eusqnito swa mero utjs nufgciso ni eth inof etyh era gviign. None of het oerht onipto smkea esesn baeusce theer is not eenivcde ot atkl btoau I saw ervy demtept to cikp hte de"srceae lpetni "iopotucrdn btu I embedrmree rD onGlja siayng kn"Tih mpi,esl hitnk pce,ah teyh rae ton gyitrn ot trkci "y.ou ,So hubcyb rnsepat = cuybbh ik.ds

almondbreeze  thought his words on "think cheap" had to do with treatments - i.e. exercise +  
alimd  Yes they are. There are so many trick questions +  
skuutnasty  I chose leptin deficiency cuz I was tryna get fancy with it. For anyone who is interested, however... according to UpToDate: "Most people with obesity do not have any abnormalities in the leptin gene, their serum leptin concentrations are high reflecting their increased fat mass..." Peace +  

submitted by rongloz(1),

I would like to include here that it can not be B (Decreased leptin production) because leptin levels increase in obesity. Leptin is secreted by adipocytes, which become significant in obesity. High levels of leptin may also desensitize the satiety centers in the hypothalamus, which is why many obese people have trouble limiting their food intake.

submitted by jotajota94(14),
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I tknhi teh kye to atdsgunneinrd siht inusqtoe si ahtt eth ybo ahs bveoa aeregav ehigt phnLei.t lieusattsm hte lseeera fo GH (:2wdbspunv./0nlb//h2on5i1peci8wmtm.1.2/ thwi ghniCus nmsodery aveh hstro tretasu h/1cs:m7lg3t/bnhpwn6.//ouw5.bpnvw9ite.mi6d.3 lnn)iuis ibnitish HG otriescne s6//t.n/aPrcnl/pcb.Mem2mcl:t6//iw.ow.Cthhpisng41ivw5I ) ktnih ttah bhto a hhig arilocc tedi in stfa dna loguces cna kema you atf os ouy can iimenaetl hteos swanre eichos.c