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NBME 24 Answers

nbme24/Block 3/Question#8 (46.4 difficulty score)
A 37-year-old man who is a farmworker comes ...

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submitted by lsmarshall(396),
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vshummy  Synaptobrevin is a SNARE protein. Why they couldn’t just give us SNARE I’ll never know. +42  
yotsubato  Cause they're dicks, and they watched sketchy to make sure our buzzwords were removed from the exam +42  
yotsubato  Oh and they read FA and did UW to make sure its not in there either +34  
soph  This toxin binds to the presynaptic membrane of the neuromuscular junction and is internalized and transported retroaxonally to the spinal cord. Enzymatically, tetanus toxin is a zinc metalloprotease that cleaves the protein synaptobrevin, an integral neurovesicle protein involved in membrane fusion. Without membrane fusion, the release of inhibitory neurotransmitters glycine and GABA is blocked. -rx questions! +6  
qfever  So out of curiosity I checked out B) N-Acetylneuraminic acid It's sialic acid typical NBME +2  
alexxxx30  shocked they haven't started calling a "farmworker" a "drudge" <-- word I pulled from thesaurus. +2  
snripper  "You shouldn't memorize buzzwords. You gotta learn how to think." Lemme pick another random ass word that doesn't have anything to do with critical thinking skills and use it instead. +5  
mw126  Just as an FYI, there are multiple "SNARE" Proteins. Syntaxin, SNAP 25, Synaptobrevin (VAMP). From google it looks like Tetanospasmin cleaves Synaptobrevin (VAMP). Botulism toxin has multiple serotypes that target any of the SNARE proteins. +2  
wrongcareer69  Here's one fact I won't forget: Step 1 testwriters are incels +2  
baja_blast  FML +  
j44n  its not an ACH-E inhib because he doesnt have dumbell signs +  

submitted by faus305(7),

C tetani causes paralysis by cleaving SNARE proteins (e.g. synaptobrevin) and preventing the release of inhibitor neurotransmitters (e.g. GABA and glycine).

C botulinum causes paralysis by inhibiting ACh release at the neuromuscular junction.

To prevent from getting these confused (like I do sometimes): Think about why botulinum toxin is used in botox and not tetanus. Because we want the action to only work at the NMJ (so we want to inhibit ACh release at NMJ). If we used tetanus, something tells me it wouldn't work the same ~yikes~.