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Retired NBME 23 Answers

nbme23/Block 4/Question#7 (reveal difficulty score)
A 3-day-old female newborn delivered at term ...
Increased conversion of bilirubin to water-soluble isomers ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—lfsuarez(160)
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This question asks about the mechanism of phototherapy as it relates to neonatal jaundice. With phototherapy, bilirubin is simply converted to water soluble isomers that are then able to be excreted by the kidney. This however does not conjugate the bilirubin.

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almondbreeze  FA 2019 pg 387 +
abhishek021196  Physiologic neonatal jaundice At birth, immature UDP-glucuronosyltransferase = unconjugated hyperbilirubinemia = jaundice/ kernicterus (deposition of unconjugated, lipid-soluble bilirubin in the brain, particularly basal ganglia). Occurs after first 24 hours of life and usually resolves without treatment in 1โ€“2 weeks. Treatment: phototherapy (non-UV) isomerizes unconjugated bilirubin to water-soluble form. +1
azharhu786  The water-soluble form is called Lumirubin. +2



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submitted by โˆ—makinallkindzofgainz(315)
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Helpful image to understand that its isomerization:

https://www.viapath.co.uk/sites/default/files/upload/Newsletter/jaundice%20fig2.png

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drzed  That made me want to vomit tbh; I forgot about NMRs until just now. I hated those things. +1



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