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Retired NBME 25 Answers

nbme25/Block 2/Question#25 (reveal difficulty score)
A 3-year-old boy is brought to the emergency ...
Mitochondria ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(23)
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I gotuthh this questino swa dcutiffli sueaebc I untoveniseilnd- on hte soisnagdi biegn htciepa ehyatnhpelpcao cw(hhi ti wmheotas s,)i but ti si eacihpt echtnaploeypah sdaenycro ot eyeR nrsyed.om

tMnoilchodair tyndiunosfc is etoacasids wtih eth tsiaehpnsgoe fo Ryee emys,ndor hciwh si ssctaiaeod wiht laiscleayt ues cs(uh sa pis)irna ni rhldeinc iercgendp ilavr nfoiinetc. Ualuy,sl a VVZ or zefnlinau onnictife is tteedra iwht n,psarii adn irinsap toabilseetm dresaeec oeidaxitbaon-t yb sriyrvlbee inginithib RALMOCTNIIODH ynezm.es Teesh hliaidntorcmo ntailameobsir ear edsiosaatc tiwh SHN:IE

  • eiSstoats of vlrie nad yeptcotesha i(eapimdr -diaotbonxieat of ttafy dcisa)
  • melcypyaiHgo dan lhetmopgeyaa
  • fnenoitcI Z(V,V u)zIlfnena
  • tNo aekaw o(ac)m
  • phepEhyltaoanc

You wnta ot ivdao spirnai ni d,lrhecin cxpeet in toseh tiwh waaaskiK umocautceun(os mplyh oend mone)ydrs ssee.aid

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Hepatic encephalopathy is a disease where cirrhosis and portosystemic shunts can lead to decreased NH3 ammonia metabolism leading to neuropsychiatric dysfunction. It can be triggered by increased ammonia production and absorption due to a GI bleed, constipation, or decreased ammonia excretion. The treatment is lactulose which increases ammonium ion NH4+ generation and rifaximin which decreases the number of ammonia-producing bacteria. Glutamate transporters do not have a known role in the pathophysiology of Reye syndrome, but they are implicated in the pathophysiology of hepatic encephalopathy, which occurs when ammonia joins with glutamate in the brain.

+/- shak360(23)

See this question on lactulose also in the block.

+/- shak360(23)


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