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Retired NBME 23 Answers

nbme23/Block 1/Question#45 (reveal difficulty score)
A 56-year-old woman comes to the physician ...
Presynaptic release of acetylcholine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: msk repeat

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 +8  upvote downvote
submitted by โˆ—step420(32)
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Person has Lambert-Eaton syndrome (hx of lung cancer, and muscle activity that is better with use.

Presynaptic Ca2+ antibodies prevent the release of AcH presynaptically because the antibodies prevent the depolarization within the cell and prevents synaptic vessels of ACh from leaving.

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thotcandy  ugh, I saw Ca2+ and stopped thinking. +18
paperbackwriter  @thotcandy Same here :( +2
sidlersofcattan  they got me too with that Ca++ rip +4
psay1  FA2019 pg. 463 +1
meja2  Lesson learnt: read the answer choices very carefully :( Automatically went for Ca2+ +
chaosawaits  I guess you could call that a Cattrap. I'll see myself out. +1

Patients with Lambert-Eaton myasthenic syndrome (LEMS) possess antibodies to voltage-gated calcium channels on presynaptic lower motor neurons, which decreases calcium influx and acetylcholine release to postsynaptic skeletal muscle cells.

In some patients, malignancies (eg, small cell lung cancer) trigger production of these antibodies, resulting in paraneoplastic LEMS Patients present with progressive proximal muscle weakness that improves with repetitive motion and exercise.


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submitted by โˆ—namesthegame22(13)
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The postsynaptic membrane potential (Choice D) may be decreased in LEMS secondary to the decreased presynaptic release of acetylcholine. = WRONG ANS.

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