Inborn Errors of Metabolism · USMLE Step 1

A neonate presents with poor feeding, irritability, and a sweet odor in urine. Which inborn error of metabolism is most likely?

  1. Phenylketonuria (PKU)
  2. Maple Syrup Urine Disease (MSUD)
  3. Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
  4. Galactosemia
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Correct answer: Maple Syrup Urine Disease (MSUD)

The sweet (maple-syrup) odor of urine along with early neurologic symptoms is suggestive of MSUD, due to accumulation of branched-chain amino acids and their ketoacids.

Difficulty: Medium Question 4 of 19

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