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The need for alternative cellular energy leads to an increase in protein catabolism and an increase in amino acid production. Additionally, energy is produced via an increase in gluconeogenesis from proteins, as well as increased muscle wasting and nitrogen loss. (Get more questions and answer practice like this in the Firecracker app!)

You have a patient with insulin deficiency - how will this affect their protein metabolism?

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What is your most challenging class so far this semester in med school?

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Much of the psychologic distress caused by the diagnosis of MVP is related to lack of information, which in this case my be reinforced by the death of a friend. A clear explanation of MVP along with the printed material is a powerful aid in relieving the patient's emotional distress.

A 19-year-old female college soccer player presents with anxiety and difficulty sleeping following the discovery of a heart murmur on her pre-placement physical. A male athlete at her school recently died while playing football because of an undiagnosed idiopathic hypertrophic cardiomyopathy and she is worried she will die in a similar manner. Other than the murmur, her physical examination is normal and her ECG shows no abnormalities. Which one would be the most appropriate ...at this point? a) An exercise tolerance test b) Reassurance regarding the benign course of her condition c) Prescribing an anxiolytic such as Valium d) Referral to a cardiologist e) Referral for group psychotherapy? What would you recommend?