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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 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pharm GI

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 +5  upvote downvote
submitted by โˆ—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.

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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: Imodiumยฎ (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 โˆ—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.

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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 โˆ—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.

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jaramaiha  back and forth.....back and forth.....:D +1
namesthegame22  MOA of Loperamide +

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