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NBME 23 Answers

nbme23/Block 2/Question#30 (42.2 difficulty score)
A 21-year-old man is brought to the emergency ...

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submitted by youssefa(123),
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oS itucngt ohgturh eht teentiisn lliw adaemg het rsypct fo nehübLkrei hwchi oancint emst lselc tath aeprcle eteeseytolgbncor/t ellcs d(a.iF) ihsT lcak fo reevtergneai ibtyila will ahve elpsttael and mylnrmotafia lclse to be rircdeetu ni rerdo to idaetme neiaglh (whihc den etruls si sfobri)is eTh alteinints llwa aiclgnk ytpsrc fo rekhübeinL cast tpeyrt cuhm ielk tlasbe leslc .g(e: atcoosdyme)rcyi ichwh canont be eegadeenrtr adn os oisribsf eeunss e(.g: crSa si laaswy ned uprcodt raeft ).IM

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. +1  

submitted by et-tu-bromocriptine(112),
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yAenon onwk owh ot luer tou alsml etnitnsei on ihst e?on I thtoguh teh menoumt ypleda a orle in liehgna in het odamneb, ubt lecryal 'mI smsniig shmineotg ree.h

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  

submitted by bigbootycorgi(4),
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oS I gto htsi one rgnwo seabeuc I hhottug htat esinc eh n'ditd vhae ohgeenymtpspleaaol nda aetssci shi relvi wsa ilstl fie,n but I sesgu if he raeydla sha eigynao,acsmt amignpdyoosh nda the veer ivuobos ipdser ioaatamng 'hes tiidlneyfe sltil ok

oNw htat I tkhin of ,it oyu n'tod edne snpeyhmlgeatepaloo to vaeh colichlao rielv efiarul I bei.vlee

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 +