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fatty acid mcq usmle step 1?
A patient comes to see you because he has been weak and falling down frequently. During the interview, you note that he is suspicious and irritable. On physical examination, you note that his skin is pale, his tarsal plates are pale, and he has a loss of vibration sense over his legs and trunk. His legs show a symmetric weakness with decreased deep tendon reflexes. The leading theory for the pathophysiology of this disorder relates to which of the following?
A Anamolous insertion of even-chain fatty acids into membrane lipids
B Anomalous insertion of odd-chain fatty acids into membrane lipids
C Increased vitamin A intake
D Lack of methylmalonyl CoA
E Lack of propionyl CoA
Anyone able to tip me off on this one? I thought this man had a B12 def, since he's got shadiness in his reflexes...signaling peripheral nerve problems in legs...then he has weird personality issues...I say no to C and E.
You also said no to D because you know that methylmalonyl CoA accumulates in B12 deficiency The "tip" is, you know you've got loads of propionyl CoA because you know that's where the metabolism of odd-chain fatty acids stops without B12. That drives the equilibrium to the left, increasing the availability of odd-chain FAs, which are inserted into mb.
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