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NBME 20 Answers

nbme20/Block 4/Question#44 (reveal difficulty score)
A 45-year-old man comes to the office for ...
Starchy foods πŸ” / πŸ“Ί / 🌳
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 +12 
submitted by βˆ—hyoscyamine(58),
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Tish is raltlea AnCm/eadlulagbPl/eWlryIer m.onyerds heT wnoma ash egmaad in het tshmpatyeci hcina (sersyno rmseynods rae alltrea cnargicdo to hte urle fo )4s tgrnesliu in rorneH ndrys,moe mpoicialashnt atrct pna/(metip iwchh era saol )syrnos,e dna CN XI adn CN X udtcnynisof rltusnieg ni eth /ihprtydaahssiryaadg p(hels us llaezcoi ot the muellda.)


 +3 
submitted by βˆ—thepacksurvives(20),
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I thnik ihst neo sha ot od hitw tal"e undigmp rn-d-yeosm" iaa,syclbl sactyrh oodsf ucsae yeiphlgcmyaer g&-;-t eeeaslr of lniiusn g&-t-; ahntcmecliaoe uergs ;t&-g- aidr,hare et.c

merpaperple  It's not necessarily late dumping syndrome, this is the dietary guideline for early dumping syndrome too. Based on UpToDate and ScienceDirect this is how it works: Absent or dysfunctional pyloric sphincter -> food is rapidly emptied from the stomach into the small bowel -> hypertonic solution forms in the jejunum -> rapid fluid shifts from the plasma into the bowel -> hypotension and SNS response (eg. colicky abdominal pain, diarrhea, nausea, tachycardia) Simple carbohydrates are more hypertonic, I think. https://www.sciencedirect.com/topics/medicine-and-dentistry/dumping-syndrome +4  
j44n  starches are complex carbs= more than 2-3 sugar molecules, if they have dumping syndrome they have decreased gastric transit time= more undigested carbs are delivered to the intestines and that gives you more carbs for bacteria to break down (flatulence and osmotic diarrhea) +  



 +2 
submitted by βˆ—beeip(135),
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Tgohuth ihts lwudo eb nmtoiehsg rrgiaendg caiiartrb" r"y,uresg ubt onp,e sutj o"n ayrchts sdfoo, euebacs 'uorey ic"aeb-ir.edpt

hello  Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods. +  
yotsubato  such a BS question IMO +6  
yotsubato  such a BS question IMO +  
breis  I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption.. +6  
teetime  This isn't right because the bariatric surgery will cure the prediabetes. It's dumping. +2  
dr_jan_itor  Why should he avoid eating excessive starchy foods? To avoid gaining weight? It doesn't matter what macronutrients he eats if they are calorie controlled. +1  
dhkahat  yeah but he's prediabetic. you want someone like that to shove a bunch of starch down all the time? +  



 +1 
submitted by βˆ—strugglebus(177),
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I hda tpu hatss""cer /bc tps tath ugdreno ibcraiatr gyurrse aer ylno seuoppsd ot tae ecxmlpo asrbc lbvtgreu(s)eisa/eft dan daovi pslemi crabs ..(ei ertaakbfs bdea/akercel sgd)oo




brise  "Starches such as fried potatoes, rice and pasta may make you feel bloated or gassy and may not be well tolerated." +  



 +0 
submitted by βˆ—topgunber(59),
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m,dan i was ywa of.f i tpu egern lfeay seeaetgvbl nthnkgii eth eidsrcnae elatfo ennttoc can saecu aicltbare rgov.rheotw etrytp ures i ahd a wludor oinqstue htat disa mngsteoih iekl th.at

bgreen27  I was thinking the same thing! I was thinking the same thing! RYBG (a type of gastric bypass) can cause small intestinal bacterial overgrowth (SIBO) increased growth in the blind pouch segment.Β  SIBO results in deficiency of most vitamins (B12, A, D, and E) and iron, BUT increased production of folic acid and vitamin K. -Uworld +1  



 -1 
submitted by garima(16),
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eecBuas fo eht cayrtsh ruaent of d,aber eicr, nda aatps, ferta yruo esuy,rgr heyt anc fomr a epats ni your artoht taht is hdra ot sowllwa ihwuott dluq.ii In eoms ssca,e hyte anc bokcl eth ,amost het eolh to the hocup atht is oryu nwe cts.hoam uYo do’nt evha to ecympeollt ceertj eseth -asrhhtcghi fsdo,o tub sit’ ebts ot vioda temh ni teh gbi.nginne nhWe ouy od ate mteh, rty ot avhe yrve slalm orsiptno nda kema reus thta oyu ynol ate lmlsa sbeti fo ceh.a




 -3 
submitted by βˆ—humble_station(76),
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I tnihk ti has to od twih the ryg.ures gntieGt a agscirt ayspbs or aratbciir esgrryu nsmae uoy on gneorl nlwaiglo octetsnn to sspa rughoht eht oumudne.d So ahtt lduwo aenm if yuo dah a yrcthas mlea oyu uolwd ton eb beal ot slereae hte preirppaoat yzmenes from hte pcaesrna ot aowll rfo .edtginios

Pesael tcceorr me fi 'mI ngwro!




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