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NBME 23 Answers

nbme23/Block 4/Question#39 (55.9 difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprue🔍,📺

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submitted by masonkingcobra(346),
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In itodniad to teh osepiuvr oln:ipatenxa

ehS si roin iicnedfet adn lieacc efsctfa the oamprilx .dduounem I" cduFke yBniratt" = ,nrIo Fo,elta 21B rof eudnDuo,m uJumjne nda mIlue

krewfoo99  Great analogy lol. But just a correction, First Aid states that Celiac Disease affects distal duodenum and proximal jejunum. But you are right, it would still cause iron deficiency anemia as it affects the duodenum. +3  
fexx  OR you could just remember 'Iron Fist Bro' (F includes folate and fat, B includes B12 and bile salts) +5  

Y'all ignoring the osteopenia also. All those questions on celiac sprue fat malabsorption --> decrease Vit D

+7/- mdmikek89(-1),

submitted by seagull(1583),
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im' tlsil voinccdne tshi si irlrbaeti olbwe sdyemrno. aghenC my nm.di

mousie  haha I picked this too bc she's 44.... isn't celiac something that would present much younger?? but I don't think IBS would cause an iron deficiency anemia is the hint they were trying to give us. +2  
sympathetikey  If it was IBS, they would have mentioned something about them having abdominal pain, different stool frequency, and then relief after defecation, me thinks. +4  
aknemu  I was between celiac sprue and IBS but what pushed me towards celiac's was a few things: 1. The Iron deficency anemia (I think that would be unlikely in IBS) 2. Steatorrhea (which would also be unlikley in IBS) 3. Osteopenia- I was think vitamin D deficency 4. Lack of a psychiatric history +5  
catch-22  IBS is a diagnosis of exclusion. If you haven't excluded Celiac (and this can't be excluded based on epidemiology alone), you can't diagnose IBS. +13  
arcanumm  I think you may have confused it with IBD, IBS would not present like this. +3  

submitted by notadoctor(159),
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Cecail rspue is a mapsbtolraion dyseronm tath ulsesrt ni estheraorat dan esrtlus in oirn ifyneceicd sA arf sa mI' ar,ewa noen fo het hetors rutsle in noir ieyedcfcin nea.mai I( had taBlreica oevrrohwgt as a losec decson tbu I o'ntd eelebvi atsht' esdotacsia htwi rnio eyiccie)d.fn

yb_26  bacterial overgrowth is associated with iron deficiency, but also with Vit B12-deficiency, so I guess pts will have macrocytic anemia +3  
nor16 Vit B12 is key here, moreover, no bloating (IBS and bacterial overgrowth with bloating). bacterial overgrowth is a close one! +1  
covid2019  I wrongly chose bacterial overgrowth, but that is wrong because Small Intestine Bacterial Overgrowth (SIBO) must be instigated by something. Commonly, anatomic abnormalities (like surgery causing blind loop syndrome, strictures, or motility disorders that allow the poop to ~fester~). +3  

submitted by axsa19(9),
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Teh sestm oasl stesta htta eatarll ehcst xrya- owshs ildm soena.ipoet clCaie sisaeed cna dlae to aniortbslomap ude ti's oyahgplot nifgetcfa tsinaborop of itnurt.en Ccelai adeisse si fneot a eausc fo lwo bnoe dneyist dan pnsettai htiw ccieal siesead aehv an icdransee rarcefut .rksi Tihs is thuohtg to eb eud ot klac fo tasbiroonp fo niavmit D adn amlcicu signuac a cedanroys rehytpmr.isiapdraoyh


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kngTai onit ccntoau eht lwonf,logi asbde on rhe bal uslaev ehs sah ccmiyirtco naemai nivge her ehoonlgmbi velel of 6.9 dna reh CMV fo 74 ihhwc si ;lt& 08. bLa evaslu fo a tp /w onIr eeinfiydcc dulwo :eb daerscede in􏰄r􏰂o, hhgi I,TBC eaesdrcde 􏰄􏰂fternii,r eacnidsre free yroerteyhtc hrrop.opropytni

AF 0271 apge 963.