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Retired NBME 23 Answers

nbme23/Block 4/Question#15 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Arachidonic acid ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +5  upvote downvote
submitted by โˆ—welpdedelp(270)
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The pt had asthma (SOB, wakes up at night out of breath, has allergies). It asked for the precursor of leukotrienes, which is arachidonic acid. The prob gave him Montelukast or inhaled glucocorticoids.

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ls3076  wtf is up with the phrasing of this question +45
djtallahassee  Must have been Montelukast right? Since GCs do more of a downregulation thing than a true receptor blocking. Maybe I am not reading that last sentence correct though. +2
alexxxx30  @Is3076 haha agreed!! +2
calleocho305  Thought this patient had GERD Induced asthma so I said histamine... Fixing GERD will normally fix the asthma and a h2 blocker would do that.. +8
yesa  GERD-induced symptoms would be related to meals +1
lumd  Picked Arachidonic acid because it was the only option that can be further broken down into active metabolites. +2



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submitted by โˆ—pemphigus07(13)
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for those of you like me who couldnt diagnose asthma https://www.webmd.com/asthma/guide/nocturnal-asthma-nighttime-asthma#:~:text=The%20chances%20of%20experiencing%20asthma,as%20wheezing%20happen%20at%20night.

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