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NBME 20 Answers

nbme20/Block 4/Question#44 (54.3 difficulty score)
A 45-year-old man comes to the office for ...
Starchy foods🔍

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submitted by thepacksurvives(14),
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I hintk htis oen sah ot od ihtw ltae" dunpmig eso"-rmyn-d csa,blyial ytarcsh odsfo ausec hyamerlecgipy ;t-&g- eeaesrl of usiinln &t;--g lcoteaienhcam sureg ;t&g-- ,rahaderi te.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. +2  
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) +  

submitted by beeip(124),
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utgTohh isht ouwld be ngstehiom nigergrad aia"rbtric sgrrye,u" but n,poe ujts "no hactyrs osfo,d sueeacb oueyr' "b-idteeairc.p

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.. +5  
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? +  

submitted by strugglebus(165),
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I adh upt a"s"etsrch c/b tps thta rnougde rtabicrai ryesugr rae noyl peosudsp to tae xmelpoc bsrac uvirf/(steas)tlegeb nad vdiao lepmsi rascb .e(i. rabkafset eldacekrea/b sogod)

submitted by topgunber(18),

damn, i was way off. i put green leafy vegetables thinking the increased folate content can cause bacterial overgrowth. pretty sure i had a uworld question that said something like that.

submitted by garima(14),

Because of the starchy nature of bread, rice, and pasta, after your surgery, they can form a paste in your throat that is hard to swallow without liquid. In some cases, they can block the stoma, the hole to the pouch that is your new stomach. You don’t have to completely reject these high-starch foods, but it’s best to avoid them in the beginning. When you do eat them, try to have very small portions and make sure that you only eat small bites of each.

submitted by humble_station(68),
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I nktih it ash to do hitw the eGinttg a tasgcri sbpysa or tbairacri erysrug mneas yuo no ogreln lianwgol nntsecto ot psas ghouthr teh e.undudmo So tath dowul eman if uoy had a sartcyh aeml ouy owldu not be laeb ot eesrael teh parptearopi menzesy frmo eht cnasreap to wallo ofr getsndiio.

slaPee cetorrc em fi m'I ron!wg