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NBME 23 Answers

nbme23/Block 4/Question#39 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprue πŸ” / πŸ“Ί / 🌳
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 +17 
submitted by βˆ—karljeon(129),
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A amn hitw a Hx of OHtE eeencepndd adn cchniro bda ipna as lwle sa yraX- sndifgin fo asliici"onaccft ni hte rmui-eppd mbaoe"dn si omst kyeill nerrerfig to a criocnh airecpan.itst

isTh ldesa to a aclk of aeslpi enreicots nh,eec pla,e uelgsilmnolf- tsolso ihtw ilo ldoerpts rpe tp .Hx sihT sp't anrapesc sola dostn'e eeecrst ohret nees,mzy suhc as lsaeayms, oate,rspse rno rspninogtye to( etiaavtc htreo es)zmn,ey os eth rasnwe si al"nzergiede .asomolntbp"air


 +8 
submitted by βˆ—masonkingcobra(385),
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In atnddoii ot eth viorpeus n:oaipaxnetl

Seh si roin fcdneeiti and aclice fetacfs eth rpoxilma dun.dmoue I" kFcude arByt"tin = on,rI oat,leF B21 for neuD,omdu Jmunuej and ulmIe

krewfoo99  Great analogy lol. But just a correction, First Aid states that Celiac Disease affects distal duodenum and proximal jejunum. But you are right, it would still cause iron deficiency anemia as it affects the duodenum. +3  
fexx  OR you could just remember 'Iron Fist Bro' (F includes folate and fat, B includes B12 and bile salts) +6  

Y'all ignoring the osteopenia also. All those questions on celiac sprue fat malabsorption --> decrease Vit D

+10/- mdmikek89(4),


 +1 
submitted by βˆ—seagull(1790),
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m'i lslit oeindccvn this is liertbiar lbewo yrem.nsod gCaehn my dm.in

mousie  haha I picked this too bc she's 44.... isn't celiac something that would present much younger?? but I don't think IBS would cause an iron deficiency anemia is the hint they were trying to give us. +2  
sympathetikey  If it was IBS, they would have mentioned something about them having abdominal pain, different stool frequency, and then relief after defecation, me thinks. +5  
aknemu  I was between celiac sprue and IBS but what pushed me towards celiac's was a few things: 1. The Iron deficency anemia (I think that would be unlikely in IBS) 2. Steatorrhea (which would also be unlikley in IBS) 3. Osteopenia- I was think vitamin D deficency 4. Lack of a psychiatric history +6  
catch-22  IBS is a diagnosis of exclusion. If you haven't excluded Celiac (and this can't be excluded based on epidemiology alone), you can't diagnose IBS. +15  
arcanumm  I think you may have confused it with IBD, IBS would not present like this. +4  



 +0 
submitted by βˆ—notadoctor(171),
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eiaClc seupr is a pboontasalirm onydesmr taht ustsler in hteaoetsarr and rsustle ni nroi niiyefdecc nea.mia sA afr sa m'I eaarw, oenn fo the tsreho utlers in rnio eyneidiccf a.enaim (I ahd tBraicela ovetrowghr as a oclse oedncs ubt I od'tn ieevlbe tat'sh saciasedot thiw irno .ifcndeyce)i

yb_26  bacterial overgrowth is associated with iron deficiency, but also with Vit B12-deficiency, so I guess pts will have macrocytic anemia +3  
nor16  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/. Vit B12 is key here, moreover, no bloating (IBS and bacterial overgrowth with bloating). bacterial overgrowth is a close one! +1  
covid2019  I wrongly chose bacterial overgrowth, but that is wrong because Small Intestine Bacterial Overgrowth (SIBO) must be instigated by something. Commonly, anatomic abnormalities (like surgery causing blind loop syndrome, strictures, or motility disorders that allow the poop to ~fester~). +3  



 +0 
submitted by axsa19(9),
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eTh msset olas states ttah aetrall thsec -yrax oshsw lmdi siootneaep. ailceC sedesia nac lade to rsmolapnotiba eud s'ti oapoytlgh tgfancife srptoaboin fo tn.ntuire liCcea aideses is oetnf a saecu fo wol nebo endstyi adn steantip whti acceli eissdea evha na ecinesadr erufcrat isrk. Tsih si ohtthgu to be eud ot klac of striopbano of aimtivn D and laciumc nuigsac a ydcsnaoer yprdteriyahimp.rohsa

tsbnhi://lves/M.wopc8Cgipal.1/c93wc.9tinrm/mn25wPht/.

rrtF,eeohrum ni laciec sa,eedis aiiedmrp roin uekatp omfr eth addolneu melnu is het otsm lieylk auces isnec ronI esrent eht pltialhiee lcle fo eth oadlduen ocamus in sroufer morf urohhtg na ialcpa ro ubrhs rbdroe anrbmmee portatnsr toripen emerdt the vdlatnie etmal taretrrpons 1M.TD)(

p/ii3p.et4wCn/cn7g:wn/r.tchls4wlms5ch1./.va/5biMP/mot

aknTgi ntoi cuacotn eht ong,lliwfo edasb on reh abl evalsu she hsa mriocciyct eaamin gveni hre ebglhomnoi elvle fo 96. adn her MCV fo 74 wchih is t&l; 80. Lab vsauel fo a pt w/ rnoI dncieefiyc dlowu be: cseededra 􏰄o,nr􏰂i gihh IBC,T creeedsda inrrif􏰄,􏰂te dicsarene free hreeryocytt pnrphooo.triyrp

AF 0217 gpae 6.39




 +0 
submitted by βˆ—bobsaget123(1),

This is a great quesiton. With the iron deficiency anemia, i was thinking of "where the blood loss could be" not so much where would the malabsorption be...




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