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NBME 23 Answers

nbme23/Block 4/Question#39 (53.0 difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprue๐Ÿ”
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 +8 
submitted by masonkingcobra(315),
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nI odaindti to het vueipsor otixannpal:e

ehS is oirn nfeeicidt dna leciac ctaffes teh iromlapx deo.dmuun "I ueFdck tn"ytirBa = I,rno oaFtl,e 2B1 for uumDone,d jnmJeuu nad lIemu

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) +4  

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

+7/- mdmikek89(0),


 +1 
submitted by seagull(1405),
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i'm lislt icdncenov tish is atribelir blewo nsy.edrom nCegha ym imnd.

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. +3  
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. +12  
arcanumm  I think you may have confused it with IBD, IBS would not present like this. +2  



 +0 
submitted by notadoctor(152),
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laCcei repus is a mtslpraoaoibn rndmseoy hatt elussrt in serhaeaotrt dna sleturs in orni diecefynci nea.ima As fra sa Im' wr,aea nneo fo teh thsero serutl ni orni ecdyifcein aemina. I( hda ecrliBaat vgroerwoht sa a csoel dsecno btu I on'dt evlebie ttsha' tssoeadcai wthi oirn eyd)ecfi.nci

yb_26  bacterial overgrowth is associated with iron deficiency, but also with Vit B12-deficiency, so I guess pts will have macrocytic anemia +2  
nor16  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/. 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  



 +0 
submitted by axsa19(9),
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