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NBME 24 Answers

nbme24/Block 1/Question#11 (reveal difficulty score)
A 55-year-old man with type 1 diabetes ...
Persistent activation of voltage-gated Na+ channels in the nociceptor๐Ÿ”,๐Ÿ“บ

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submitted by njspix(16),
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rPe Ue,oapDtT eht eky reeh si hte o.yndalail iTsh tantpei has ictant snieaont,s ist' sujt ner"tud "pu yaw too mhu.c ehT pmsestil wya to inxalep hits si taht eth ernoss liesft (het c)crnoepoti is certadie-ato.vv

toeN tath ncpciioeetv pain s(a tish is meder)t si orem eftno eud ot reauuaisse/emonstrin/imflpst eg,aadm sewearh purintheaoc npai m(ero r)telnca ahs a wide rayetvi fo caseus aeestd(ib is a rpnoetnmi e)on.

submitted by seagull(1688),
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eAhrnto oprcha.ap aetDsbei ucasse c-eiynnoatznm galionysctylo hhiwc yam tgalyeevin cpmtai the tncfnoui fo nouesrn alyinm eud ot detelra oodlb pulsyp omgna othre ng.htsi ehseT sleyytgloac sstoiped yctiplayl cucor aylrprlephie ta the l.gse The loyn hpliarerep reawsn hcceoi asw a incepotroc in eth slg.e lal hte terho wnersa heccsio era ta esalt more tenrcalyl lacodte ithw erlarg dlboo liesspp.u

a,iAng ton ptefrec ubt a ayw to erosna out tihs asnwre tub ti deos kwo.r

sam1  I believe this concept is referring to peripheral sensitization. Peripheral nerves that have sustained damage (such as through non-enzymatic glycosylation in DM) cause sensitization of their neighboring nerves, thus leading to lower thresholds for activation. This sensitization is thought to be accomplished through mediators such as PGE2. +7  
sam1 ^ Section on peripheral sensitization +1  

submitted by charcot_bouchard(482),
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nydaoliAl is enalcrt ipna eais.zninoitts egiirnggTr of pani yb a non lpfanui i.timlsu olsA esen ni grai molv[ay.bisF eapgsiyaerlH : Inc rpssonee to lufpnia lstiuim]

tIs a iopsivte ie(. teAiyvlc e,lfengi nto alkc fo flen)gie m.spsympt os B ;pa&m C is tno teh ns.we aDr istn srwnea ieher.t as vdilnaoli rptceeor TPR)1V( is alos freneatf inpetocviec nnioassstmri edatlu(odm yb acincsa.ip) itAictavon is nsoo lewdlfoo by ieietotzisnnsad.

A - KD.I fi bpmlreo aws ni GDR etehr odulw be lot mroe s.ypsmtmo

madojo  if you are an idiot like me than that long word in option b is GABA +6  

submitted by faus305(17),

Was I wrong to just pick the only answer with the word nociceptor in it?

jaramaiha  I'm a simple man...I see pain and think nociceptor shrugs +  

submitted by maekhilak(1),

the way I approached this was that the patient has intact vibration sense but has lost sensation to pinprick. if the lesion was in the dorsal root ganglia (a) or dorsal horn (b) or dorsal root afferents (d), the sensory loss would be more widespread than loss of one modality.