share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
introducing : the “predict me” score predictor NEW!
NBME 23 Answers

nbme23/Block 2/Question#33 (64.3 difficulty score)
A 68-year-old man who has been treated for ...
Area labeled β€˜Bβ€™πŸ”,πŸ“Ί

Login to comment/vote.

Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

submitted by thotcandy(88),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

evEyerno gaiksn hwy ont PPIs?

if ouy eigv DNsSIA iwhch ereescda sGP os uyo teg D,ERG the lptsemsi yaw to fix it is ot nrgbi ehost sGP ,kabc os orlssomt.oip

sutJ lipyms -PGs t;&--g P+sG

hungrybox  This is the best explanation IMO Also makes me feel like an absolute idiot +8  
guber  also per FA, misoprostol is used specifically for prevention of NSAID_induced peptic ulcers +3  
cuteaf  I think the key to answering this question is to remember the specific side effects associated with misoprostol -> severe diarrhea. No other GERD medications in the answer choices have this side effect. Antiacids could also cause diarrhea (MgOH) but not in the answer choices +2  
deathcap4qt  Actually one of the side effects of PPI use is diarrhea (and other GI issues). Not in FA but emphasized in AMBOSS and Sketchy. I got this Q wrong for that reason but I see now why Misoprostol is the better answer. +1  
veryhungrycaterpillar  That's wild. I take PPIs like candy and I've never had diarrhea, but I chose histamine blocked because Pepcid/Famotidine gives me the WORST diarrhea ever. +  

submitted by emh(9),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

saiPsdltngrona inscraee GI iiltytom eud to pelaits.irss tsI' the amse eroasn ywh het teuurs anctcrsot nigdur a.nstournmeit

samsam3711  Also Misoprostol is used for the prevention for NSAID induced peptic ulcers +1  

submitted by mousie(237),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

toN usre I ma nndauesgrdnti iths qisnutoe - the tiatnpe gto na DNAIS fro RA nad hsit seecraedd her angpldosnirtas os ehs eoddpevle EG..D.R cDo addde loorosMstpi to ruacttcneo hte dseacdeer stgnPdsnoriala I teh tug nad na esevrda iocanert of osolosMpitr si iaarhrde .. or?Ccert

chris07  Yes. Diarrhea is a side effect of misoprostol. +3  

submitted by dubchak7(1),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

eyTh ggsuste Mospsiortol to reacnuoctt .sS..NDAI hyW ont I?sPP

hayayah  PPI's don't have many side effects! If the question didn't involve the diarrhea side effect the answer would have been to give her a PPI. +3  
tsarcoidosis  I guess one takeaway is that PPIs don't directly cause diarrhea, but they do increase the risk for C-diff, which causes diarrhea. +16  
usmleuser007  PPI side-effects: + increased risk for C. diff + Increased risk for resp infections + can cause hypomagnesia + decrease absorption of (Ca2+, Mg2+, & iron) + increased risk of osteoporotic hip fractures (d/t low serum calcium) +2  
temmy  The patient got severe gastric burning and discomfort as an effect of the drug. My logic was since the patient was taking an NSAID it had to be a COX 1 inhibitor that destroys the protective barrier of the GI mucosa due to inhibition of prostaglandin so we needed to treat with a drug that will regenerate prostaglandin and prostaglandin is a vasodilation which might be the reason for the diarrhea. +1  

submitted by hhsuperhigh(41),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

My ugsse rof ont oincohgs PIP is ebaecsu het uitdnrao of ursdg-nuig. IPP seiresnac eth rsik of C. fdif by -egtmonrl igsnu chihw dcedrnoeis sa ovre 1 ryae fo n.usig siTh pt lhdosu evha usde eht descno grud sels hant 4 kesew dgroiacnc ot het So IPP is leuylkni to cseua .C diff haarider tinwhi hsit orths poedri of uaseg, iylaelpces nhwe tihs pt is ont ,rosnoipeicmmmdmou ro sniug itinitacosb.

submitted by xw1984(5),

English is not my first language.

I think the reason that not using PPI is the Q mentions other adverse effects than gastric burning:

"... has severe gastric burning and discomfort... THESE adverse effectS".

Therefore, I guess PPI can relieve gastric burning but not discomfort, so we give the patient what he is lack of.

submitted by criovoly(15),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

The srtif udgr vgein asw na DINAS psnsalg(adnirto tib)rihoni hsit acdseu DGRcuESle/r uaecesb of eardscee aomcslu

The consed rgud wsa msoorpsiolt chiwh vegis asomcu tpcooirnet dna a onommc side ecffte is rair.hade

submitted by donttrustmyanswers(65),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

I tusj zereldia rhete rewe iolds owrsra adn ddseah warros ni eth .miage sI erteh a igntnifcasi ot teh saddhe rwosar vs hte dsoil ?arwors

faus305  The solid lines are the correct answers. lol jk but not really +  

submitted by usmleuser007(417),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

PPI e:d-sfceeitsf + ascieedrn krsi fro C. fifd + aesenIrdc irsk rof sper tnionfisec + anc uaces hengasompaiy + aecresde ispotobarn of a(,2C+ +g2M, a;p&m inor) + sediarenc krsi fo osoetocrptoi hip retucfars t/(d olw emrsu )clucima

imnotarobotbut  That's not the right answer tho, the answer is the binding of PGE to it's receptor +  
tinydoc  Can someone explain to me why the PPi answer is wrong if it increases the risk of C Dif wouldnt that also cause severe diarrhea. PPIs make a lot more sense to be given to this patient in the first place. +1  
maxillarythirdmolar  Keep it simple, stupid. +1  
roaaaj  @tinydoc You are correct about PPI increasing the risk of C. diff, but there was no history of antibiotic use. +