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NBME 23 Answers

nbme23/Block 3/Question#4 (reveal difficulty score)
A 31-year-old primigravid woman at 32 weeks' ...
Hypoglycemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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 +39  upvote downvote
submitted by โˆ—stinkysulfaeggs(125)

Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.

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redvelvet  me too :( +2
abigail  me three :( +2
yex  Me four :-/ +2
link981  Slowly raising my hand as well +2
tinydoc  Sammmme +2
bullshitusmle  same here!!!:@ +2
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia +19
aisel1787  me five( +1
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency. +4
alexxxx30  sammmeeeee +
snripper  Dumbasses unite lmao +
usmleaspirant2020  lol saaaaame! +
usmleaspirant2020  lol saaaaame! +
anechakfspb  me also :/ sitting there trying to figure it out during the test I thought I was so smart too - like "wow nbme, way to tie in micro and endocrine, not getting me though!" ... i was wrong. +2
veryhungrycaterpillar  I have no idea how I got this right. +
feanor  And here I was thinking that maybe I'm the Lionel Messi of interpreting stems by diagnosing it as Babesiosis lols. +1

 +28  upvote downvote
submitted by โˆ—thomasalterman(181)

Malaria can impair hepatic gluconeogenesis and can also consume glucose for its own metabolic demands.

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yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma +62
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman. +12
focus  ADDITIONAL INFO: If we were asked to identify the stage of the lifecycle, it would be (intra-erythrocytic) schizont stage: Life-cycle: +1
dul071  i solved this question by seeing that there are hemolytic inclusions resembling parasites and that they require glucose being a living organism, hence hypoglycemia. +1
curlycheesefriesguy  I knew that malaria causes hypoglycemia but i saw the word drowsy and like an idiot thought it was african sleeping sickness +

 +4  upvote downvote
submitted by โˆ—kai(30)

I think we're thinking too hard on this. The parasites are consuming all our sugar! So simple that it's hard.

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 +1  upvote downvote
submitted by โˆ—nwinkelmann(366)

So... I've been trying to figure this out and I think I got it...

One of the main clearance techniques by the body is extravascular hemolysis by the RES. Hemolysis of RBCs leads to elevated serum LDH (because RBCs have high amounts of lactate dehydrogenase which is released into serum after hemolysis). Increased LDH can then lead to increased pyruvate to lactate conversion, which would deplete the body of pyruvate and lead to increased anaerobic glycolysis. As the process continues, hypoglycemia results due to overutilization of serum glucose.

I agree with @yotsubato that this is a bullshit question for Step 1 (hopefully it was retired because it was an experimental question at the time and no one knew it, lol). I'm glad that I was able to try to figure out possible pathogenesis, though. That is probably why it was asked, when it was asked, to determine if students could VERY critically think about all of the complications of malaria and what complications those original complications could lead to, just by know normal physiology/pathophysiology of the body. I came to these conclusions based on putting together information from several of Armando Hasudagun's videos (@4:00-4:37,

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 +1  upvote downvote
submitted by โˆ—kard(52)

Pregnant women are more susceptible to severe Plasmodium falciparum malaria. Hypoglycemia & severe anaemia is frequently encountered as a complication in falciparum malaria, that is usually ascribed to increased glucose use and impaired glucose production caused by the inhibition of gluconeogenesis.

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 +0  upvote downvote
submitted by macrohphage95(10)

Hypoglycemia is a frequently encountered complication in falciparum malaria that is usually ascribed to increased glucose use and impaired glucose production caused by the inhibition of gluconeogenesis.

from trends in parasitology:

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 +0  upvote downvote
submitted by โˆ—syoung07(58)

How do you pick which malaria species this is? P. vivax and ovale can remain in the liver so I figured hypoglycemia was a result. But I also know that P. falciparum can cause issues with the brain, lungs, and kidneys. I was between adrenal insufficiency and hypoglycemia for that reason.

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an1  I don't think we can specify from this image as to which strain it was. True about falciparum, but none of those options were actually given in the asnwers +

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