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NBME 23 Answers

nbme23/Block 2/Question#30 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Liver 🔍 / 📺 / 🌳 / 📖
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submitted by youssefa(162)
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So cntitug hrutogh hte iitesnnte lilw mdagae eth yscptr fo eibrkLenhü hihwc oiacnnt tesm cslle thta lrpcaee geotytrs/cobteeenl llecs .ia)Fd( iThs kcal of riteveeeargn litibya illw vahe ltpeelast adn fimmanylarot sllec to be ucrrtedei ni oedrr ot madetie nhiaegl ihh(wc nde lserut is ibosif)rs heT tiestanlni llwa alkcngi psyctr of nheüiekrbL tasc etpryt ucmh klie ltaebs slcel (.:ge yoocc)sediymtar hhcwi nnctao be rnedaeetreg nda os iisrosfb usnsee eg(.: Srca is alsyaw dne ducoptr faetr )IM.

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youssefa  Correction: I meant Permanent cells instead of Stable cells. The hepatocytes in this case will act as a stable cells which will exit G0 phase and proliferate in response to injury. +2
madamestep  Also, the reason why you get the retractions and fat creeping in Chrons! It's inflammation all the way through. UC doesn't go all the way through. +



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submitted by et-tu-bromocriptine(140)
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Aonyen kown hwo ot lrue out mlsal stiniente on siht one? I utohgth eth memunot elaydp a rloe ni ighaenl ni teh domae,nb ubt alyerlc 'mI gnsismi mistngohe re.eh

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what  Small intestine has smooth muscle in the walls which will fibrose on injury +
youssefa  So cutting through the intestine will damage the crypts of Lieberkühn which contain stem cells that replace enterocytes/goblet cells (Faid). This lack of regenerative ability will have platelets and inflammatory cells to be recruited in order to mediate healing (which end result is fibrosis) The intestinal wall lacking crypts of Lieberkühn acts pretty much like stable cells (e.g: cardiomyocytes) which cannot be regenerated and so fibrosis ensues (e.g: Scar is always end product after MI) +3
thotcandy  The way i thought of it was: small intestine PERFORATION repair -> the basement membrane and stem cells were definitely disrupted thus limiting regeneration ability Liver = puncture wound, not necessarily all the way through = basement membranes and stem cells are probably still intact -> regenerate without fibrosis +2



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submitted by veryhungrycaterpillar(30)
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veriL aehsl tuitohw argsnicr ni eonesspr to otms ecuat nje.uisri Oyln rhnicco eirlv ujnseiir wlil adle ot frsbsoii ihhwc( ehnt ealsd to )so.cshirri

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submitted by brawamigonnagetthismd(1)
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,aWti sdipeao etisus sr?sc?a Whta het ehck si ihts? mbaye si't htta 'ifrob' thd.tperW..caa lla ttah Bchtoed for ni'noth

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submitted by bigbootycorgi(5)
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oS I tgo ihts one wngor ucbeaes I ghotuht htta esnic eh t'ddni ehva phneaypoasmteollge adn ctseisa ihs erilv swa tllis f,eni but I essgu fi eh adlyera sah mig,ntaoyecsa agydmihsnopo adn eth evre uosvoib spired aimtganao 'ehs ndetiieyfl sltli ko

Now taht I khint of it, uyo ndot' nede oleepamtolhpeganys to vhea oalocichl lvire ifuearl I eeliveb.

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bigbootycorgi  sorry my bad this was the wrong question i responded to but i still got this one (ED one) and the gynecomastia one wrong i think it's liver for this one because they say it has regenerative potential and because even though the small intestine has regenerative potential, it can apparently fibrose? i have no idea, i put small bowel +
kateinwonderland  @bigbootycorgi : I put small intestine too. From what I've searched after, it says that liver fibrosis reversible -> no evidence of fibrous scarring +
goodkarmaonly  Just to add to that, a cirrhotic liver is a small shrunken liver so you wont be able to find hepatomegaly anyways. The other signs are the stigmata of Liver disease +



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