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NBME 23 Answers

nbme23/Block 2/Question#30 (44.4 difficulty score)
A 21-year-old man is brought to the emergency ...

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submitted by youssefa(132),
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oS gicutnt ohutghr het eteinstni llwi madage the sryptc of nbüheLirke hhwic nntocai mset sclle taht rceplea gtecbot/ertoysleen ecsll aFd.i() hisT alkc fo eiaeevgrrent iyilbat lwli evah pslteeatl adn mnafomatyril cslle to be duirtceer ni oedrr to eeimtda heialgn w(hcih den etslru si rfbsi)iso eTh ttiasinenl wall galnikc sctrpy of berLekhüni csat tptyre much leki tbasle lelsc e.(g: oemdsiy)crtcayo whcih aconnt eb geeetnredar nda os fsirsibo ensuse (ge:. Sacr is wsaayl dne dutcpor aretf .M)I

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(118),
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oeyAnn owkn hwo to rlue tuo malsl eeitinnts no ihts on?e I tguhtoh het emnomut ydlpea a orle in lgiehna in eth om,abdne tub lclryea 'mI nsmisgi omhtnigse .hree

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(5),
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oS I got sith oen orwgn eacbesu I ttohguh ahtt ncsie eh 'dditn have eohgnlppmtsaeeyaol nda sacteis sih reilv asw itsll i,fne utb I ugess fi eh yraaedl sah acsogay,tienm dhsmyoogpani dna hte ever ovobusi depris mniaaatog sh'e eyiinfdlte tisll ko

wNo thta I iktnh of ,it uyo do'nt dnee ollpsepmyanehgoaet to vahe hccallooi eivlr rileauf I iv.eebel

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 +