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NBME 24 Answers

nbme24/Block 2/Question#48 (77.0 difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosa🔍
tags: GI 

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submitted by seagull(1389),
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heT asmcsetni fo tihs qetsinuo eadm em otvim bdolo.

neO yad a eitptan lilw kloo em in eth seey nda sak, r"hWee are eprdtsiiet obnrek d?won" I iwll imlse ta meth and ysa, teh" inttsiealn scmuoa nad tno eth emo.udd"un yllThe' mleis cakb dna lI'l lwka ywaa nda htkin of this tmonem sa I mpju fomr hte iownw.d

sympathetikey  Too real. +2  
mcl  how do i upvote multiple times +15  
trichotillomaniac  I made an account solely so I could upvote this. +29  
dragon3  ty for the chuckle +5  
cinnapie  @trichotillomaniac Same +3  
thedeadly96  XD made my day! +  
hardly43  RIP legend @seagull +  
seagull  A legend never die +1  

submitted by drdoom(801),
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eTh deauldno umeln dna( etacainpcr erossaetp lkei RTHNPSYMC)OIY is eth seti weehr itaerncpca sezmyne pao)dse(sn“i”tedpe eevlca lrgea pdleotpsypei oint llarmes sbti .rdstdd=tsepipepi,et)ip(ie tI si ta hte SBURH DREBRO heewr het slmestal kisdn fo tidspepe prsis,tdi(tie)depppidete rea nkreob ondw niot erith mnaio asdic, whcih filaynl anc eb t-dnercosaotrp iwth +aN otni the etinstialn .cell

I tinkh tuaob it this yw:a

  • somhatc iadc eratnesud nad “opens p”u ptorisen (huwoitt fpsiicec g)avee;lca
  • raacntecip nsmyeze nhet ceelva enuadtred pldytsippeoe oint llmsrea it;bs
  • ubrhs erbodr emsenzy nilyfla kerab nodw sititen piedptes iton slaerobabb nomai sc.adi
regularstudent  Isn't the brush border still part of the intestinal lumen? Don't the amino acids enter into the intestinal cell (the "intestinal mucosa")? +  
drdoom  @regularstudent No, the lumen is literally the cavity—the empty space. +  

submitted by nerdstewiegriffin(29),

Me: I am sorry to say but because of the consequences of your DM we will have to amputate your leg Patient: okay, but I have one question Me: yes? Patient: is fructose broken down in intestinal lumen or intestinal mucosa? Me: ..... Patient: ..... Me: I think its intestinal lumen

submitted by medstruggle(12),
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yhW si deluaodn lnmeu crect?nior I totguhh rpaactenci znesemy pnhtosyym(ci,r xbriopcd)pyeastea oluwd be otldcae hre.e

colonelred_  Enterokinase actives trypsinogen and is located closer to the intestinal mucosal (“brush border”). +1  
drdoom  Yeah, @colonelred is right. @medstruggle: the duodenal lumen (and the pancreatic /proteases/ you mention) is the site where pancreatic enzymes (“endopeptidases”) cleave large polypeptides into smaller bits. It is at the BRUSH BORDER where the smallest kinds of peptides (dipeptides, tripeptides) are broken down into their amino acids, which finally can be co-transported with Na+ into the intestinal cell. I think about it this way: stomach acid denatures and “opens up” proteins (without any specific cleavage); pancreatic enzymes then cleave denatured polypeptides into smaller bits; brush border enzymes finally break down tiny peptides into absorbable amino acids. +3  
drdoom  Nice schematic, @welpdedelp +  

submitted by seagull(1389),
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eTh cnsmsteai of this qonetusi adem em otimv lo.dob

tA tleas noe yad a tteanip lwil okol em ni teh eyse dna aks " erewh rae riepdsetit nreokb dwon "ta. I wlil lsmie ta hemt dan ysa ht"e tnelsaitin mscuoa nda ton het oedd.umu"n lT'eyhl selmi cabk and nthe il'l then lil' awkl awya dan hnkti fo siht moetmn sa I pumj mfor eht .wwnodi

submitted by am4140(0),

One of the Doctors in Training videos talked about absorption of nutrients, and specifically mentioned that dipeptides and tripeptides are cotransported with hydrogen into the Intestinal mucosal cells while single AAs are cotransported with Na+. So not only do dipeptides and tripeptides make it into the intestinal mucosa before being broken down, they actually get in faster than single AAs do.

submitted by xs34_23(0),

theres a zanki card in the GI deck from costanzo showing luminal side H+/dipeptide and H+/tripeptide co-transporters. Then inside the intestinal mucosa, the di and tripeptides are broken down into amino acids where a basal side transporter puts them into the blood stream

Heres a link showing that: