NBME Answers : deathcap4qt's page

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submitted by thotcandy(131), visit this page

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Everyone asking why not PPIs?

if you give NSAIDs which decrease PGs so you get GERD, the simplest way to fix it is to bring those PGs back, so misoprostol.

Just simply -PGs --> +PGs

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hungrybox This is the best explanation IMO Also makes me feel like an absolute idiot +9

guber also per FA, misoprostol is used specifically for prevention of NSAID_induced peptic ulcers +4

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 +4

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. +3

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. +

an1 I changed my answer from PG to PPI because I recall sketchy saying PPI was the best for an ulcer, adn they both had diarrhea in the sketch. but I realized why im wrong Why isn’t this PPI (E)? because PPI’s INHIBIT the pump (should have been a dotted line) Also, PPI’s increase the risk for C.Diff which can lead to diarrhea, they don’t directly cause diarrhea unline PG misoprostol PPI RF’s include osteoporosis, lung decline, increased risk for AI Nephritis, and reduced absorption of Fe, Mg, and Ca (not the best choice for an old guy) +1

kcyanide101 NBME [redacted] HAS A VERY SIMILAR Q THAT THEY CHOSE PPI over PG analog for NSAID induced stomach issue! Really annoying how they flip! +1

submitted by bingcentipede(359), visit this page

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Pink rods is describing a Gram negative bacteria, which has two membranes an outer membrane and an inner membrane (whereas Gram positives have just one thicc membrane).

Both Gram + and - bacteria have an ER, can be inhibited fluoroquinolones (though negatives > positives), both have the peptidoglycan wall (positives thicker than negatives), and either can have polysaccharide capsules.

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deathcap4qt FA2019 pg 124 +2

submitted by cassdawg(1781), visit this page

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This is mesenteric artery stenosis causing postpranidal intestinal ischemia/angina. I definitely did not know this answering the question and I personally got to the answer by attempting to logically think through the symptoms:

Weight loss and abdominal pain in general pointed to intestinal ischemia of some sort and since most absorption of nutrients happens in the jejunum, ischemia there would cause weight loss. Jejunum is supplied by SMA
Bruit to me meant a larger vessel was blocked since to be able to hear it it has to be a pretty large vessel, SMA is one of the larger arteries listed
No liver symptoms (i.e. jaundice) so eliminated hepatic artery

If anyone has a better explanation please offer it.

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deathcap4qt great explanation for not knowing the answer! You're right in that it has to do with a vessel of a larger size. Generally Celia, SMA or IMA. pt hx of atherosclerosis should be a big hint. FA 2019 pg 380. +3

nbmeanswersownersucks SMA is the MOST COMMON vessel involved in ischemic bowel disease. +2

baja_blast I reasoned this out by remembering that the Abdominal Aorta was the most common place for atherosclerosis and picking the only option that branches off immediately from there. Not sure if that's what they were going for but it got me to the right answer. +1

topgunber i think thats a great explanation ^, namely because its possible obstruction at the other vessels may not cause symptoms due to collateral circulation. SMA on the other hand, if stenosed, would have a number of regions with ischemia- not to mention its involved in a watershed area. +

an1 I thought because this said severe pain after meals, it was hinting at gastric ulcers which was cause for the weight loss :( +