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NBME 23 Answers

nbme23/Block 2/Question#30 (46.8 difficulty score)
A 21-year-old man is brought to the emergency ...

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submitted by youssefa(141),
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oS utngcti ghhutor teh enntsieti wlil gamdae hte ytrcps fo ekeniLbrhü wcihh naoitcn mtes ellcs taht alecerp eelteeno/scoygtbtr elslc i)dFa(. Thsi kcla fo etanvigrreee tabylii wlli ahev tlaetplse and rtiofmamylna llecs to eb detreircu in erord ot eedatim ignelha (hchwi dne uterls is iissorb)f ehT isltentnai wlal kniacgl yscrpt of kenbühiLer atsc retpyt hcmu elik bstlae cells :(.ge ycc)iytmsrdeaoo ihwch cntaon be eeetgearrdn nad os riisfobs snseeu .e(g: acSr is saaywl end poctdur reatf I).M

youssefa  Correction: I meant Permanent cells instead of Stable cells. The hepatocytes in this case will act as a stable cells which will exit G0 phase and proliferate in response to injury. +1  

submitted by et-tu-bromocriptine(122),
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yAneon ownk owh ot erul out llmsa iensenitt on isth ?one I uhthotg het touemnm peydla a oerl in ghaelni in eth moden,ab btu rlyecal Im' gssinim iteognsmh .rehe

what  Small intestine has smooth muscle in the walls which will fibrose on injury +  
youssefa  So cutting through the intestine will damage the crypts of Lieberkühn which contain stem cells that replace enterocytes/goblet cells (Faid). This lack of regenerative ability will have platelets and inflammatory cells to be recruited in order to mediate healing (which end result is fibrosis) The intestinal wall lacking crypts of Lieberkühn acts pretty much like stable cells (e.g: cardiomyocytes) which cannot be regenerated and so fibrosis ensues (e.g: Scar is always end product after MI) +3  
thotcandy  The way i thought of it was: small intestine PERFORATION repair -> the basement membrane and stem cells were definitely disrupted thus limiting regeneration ability Liver = puncture wound, not necessarily all the way through = basement membranes and stem cells are probably still intact -> regenerate without fibrosis +2  

Liver heals without scarring in response to most acute injuries. Only chronic liver injuries will lead to fibrosis (which then leads to cirrhosis.)

submitted by bigbootycorgi(5),
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oS I tgo sthi one rowng uebsace I ohgutth that sncei he i'tndd hvae gopnshlloaepeymtae nda astisec hsi relvi asw slilt f,ine but I esgsu if eh alerady sha ocan,gsaeiytm opgdiamyoshn and teh reev svboiou erpids miaaatong 'ehs iyietlndef sllit ko

woN htat I kihtn of it, yuo dno't dnee yompealesghtneploa to vhae ilooacclh lvrei ufrieal I eebv.eli

bigbootycorgi  sorry my bad this was the wrong question i responded to but i still got this one (ED one) and the gynecomastia one wrong i think it's liver for this one because they say it has regenerative potential and because even though the small intestine has regenerative potential, it can apparently fibrose? i have no idea, i put small bowel +  
kateinwonderland  @bigbootycorgi : I put small intestine too. From what I've searched after, it says that liver fibrosis reversible -> no evidence of fibrous scarring +  
goodkarmaonly  Just to add to that, a cirrhotic liver is a small shrunken liver so you wont be able to find hepatomegaly anyways. The other signs are the stigmata of Liver disease +