NBME 18 Accentuation of mu-opioid myenteric plexus receptor (NBME Answers)

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NBME 18 Answers

nbme18/Block 3/Question#32 (reveal difficulty score)
25 yo woman, 2 years of intermittent, ...
Accentuation of mu-opioid myenteric plexus receptor 🔍 / 📺 / 🌳 / 📖
tags: pharm GI

+5 upvote downvote
submitted by ∗tinydoc(276)

I picked E) inhibition of TNF-a because I thought 2 years of diarrhea sounds like IBD (specifically crohns Disease without bloody diarrhea vs uc which must have bloody diarrha). I still don't see any reason why I wouldnt guess that.

tinydoc Nevermind just saw the "typically relieved with defecation" which is a pretty big indicator of IBS. +8

pg32 I still agree with you though. This sounds like a case of IBD and I picked E to try and tone down inflammation. Giving someone an opiate for intermittent diarrhea seems kind of dumb... +3

pg32 Just googled, "Indications for loperamide" and this is what came up: Imodium® (loperamide hydrochloride) is indicated for the control and symptomatic relief of acute nonspecific diarrhea and of chronic diarrhea associated with inflammatory bowel disease. +1

gyabo92 lol, I feel dumb. I knew it was IBS (half my fam has it and just manage through dieting). Went into overthinking hyperdrive, and all it was was your standard anti-diarrheal. step has taken away all my sanity. +14

+3 upvote downvote
submitted by ∗sympathetikey(1598)

Person probably has Irritable Bowel Syndrome. Regardless, it seems like they're trying to treat symptoms with an oipoid anti-diarrheal like loperamide.

cbreland "intermittent" made me think IBS as well +

heenaasnani Was i the only one to think that it could be carcinoid syndrome as it is episodic? +

heenaasnani tumor* +

heenaasnani I thought it is a carcinoid tumor and not a syndrome yet, as the patient has only GI manifestations. Can someone explain why can't it be that? +

fatboyslim @heenaasnani even if it was, there is no answer choice targeting treatment of carcinoid, which would be octreotide (somatostatin analog). I agree with you though, carcinoid was on my differential while reading the question. +

-1 upvote downvote
submitted by ∗md_caffeiner(83)

yo sketchy veterans.

do you remember that loping back and forth lop eared rabbit that was increasing the phasic segmentation and therefore icreasing stool transit time?

This is it now.

jaramaiha back and forth.....back and forth.....:D +1

namesthegame22 MOA of Loperamide +

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