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Retired NBME 19 Answers

nbme19/Block 1/Question#1 (reveal difficulty score)
53 yo woman w/GERD. Diet change, stress ...
Omeprazole ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—ajguard26(55)
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So although Misoprostol DOES increase mucus production and is gastro-protective (and in FA does state that it decreases acid production), thereby decreasing symptoms and aiding in healing, omeprazole is the "more correct" choice. This is because omeprazole is a proton-pump inhibitor, which will act directly on the proton pumps of the stomach and decrease the offending agent more than the misoprostol will. Therefore, it is the first line drug for GERD.

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an_improved_me  These questions can be so frustrating... I mean most people know PPIs are your go to when considering GERD / peptic ulcer disease... but when you speicfically add "both relieving Sx ... promoting healing", why even add a drug that specifically and directly does both... I mean PPIs promote healing, but so indirectly. This hurts my heart +4
chaosawaits  Seriously, FA2019, p393 specifically states misoprostol "increases production and secretion of gastric mucous barrier and decreases acid production" What does it say for omeprazole, you might ask? "Irreversibly inhibits H+/K+ ATPase in stomach parietal cells" and that's it. +
leap1608  if u focus on the question it asks the healing of esophageal mucosa. prostagladins protect gastric mucosa? PPI`S would perhaps prevent the metaplasia of chronic gerd and heal the esophageal mucosa +



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