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NBME 24 Answers

nbme24/Block 2/Question#48 (85.9 difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosa🔍,📺
tags: GI 

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submitted by seagull(1683),
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hTe anmtsesic fo sith ioetsqun edam em ivomt dbo.ol

One ayd a ipttnae will ookl me ni het eyes dan ,kas "hWree ear triidetpes nkerob "ndo?w I iwll eislm at ehmt nda ,say h"et lntatsiine amusco dan nto the ud"dmn.oeu yl'heTl imsel bkca adn 'Ill wkla yawa dan ktinh of itsh nomemt sa I upjm rofm hte i.nowdw

sympathetikey  Too real. +3  
mcl  how do i upvote multiple times +17  
trichotillomaniac  I made an account solely so I could upvote this. +37  
dragon3  ty for the chuckle +6  
cinnapie  @trichotillomaniac Same +3  
thedeadly96  XD made my day! +  
hardly43  RIP legend @seagull +  
seagull  A legend never die +2  

submitted by drdoom(958),
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ehT elanuodd emnul an(d tcecpaarin posesetra leik S)YPCNITOHYRM is the tsei ewreh ancreatcip ezsenmy de(ni”p“d)seatepso aleecv lgaer dpeeyotpplis tnio melalsr tbsi ipseet)pttii(,red=dpesdi.p It si at eth RUHBS OBRDRE erwhe the lltmseas isdnk fo ppieetsd tiddtrsipp,eeid()seetipp aer nboerk wdno toin tierh moain ,isacd hwcih ianflly can eb odncaerotsr-pt ithw +aN iont hte eastlinnti ellc.

I thkin oubta it sthi way:

  • sathmco aidc euatsednr nda onpes“ up” trsioepn ttohiuw( pfciiesc ac;)avlege
  • aprnacceit eszyemn tneh vceael enetdaudr ieptylepopds tino lmarsel ts;ib
  • hbsru erbrod eemnsyz illfyna akbre wdon esttiin despepit onit lraebaosbb moani .disac
regularstudent  Isn't the brush border still part of the intestinal lumen? Don't the amino acids enter into the intestinal cell (the "intestinal mucosa")? +  
drdoom  @regularstudent No, the lumen is literally the cavity—the empty space. +  
jj375  Still annoyed about this question, but here is a schematic in case it helps anyone else: +  

submitted by nerdstewiegriffin(38),
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:eM I ma orrys ot ays ubt eacsueb fo het sneceocueqsn fo rouy MD we llwi heav to taupatme oyru gPnilate:e t ,aoky but I haev neo otnquies eM: :ai tnyst?ePe si roescfut rokebn ndwo in sennttiail munle ro sneilnttai ceu?:maMos e:t.. . Me.:... I nhitk tis atlntnsiie elmun

submitted by am4140(5),

One of the Doctors in Training videos talked about absorption of nutrients, and specifically mentioned that dipeptides and tripeptides are cotransported with hydrogen into the Intestinal mucosal cells while single AAs are cotransported with Na+. So not only do dipeptides and tripeptides make it into the intestinal mucosa before being broken down, they actually get in faster than single AAs do.

submitted by xs34_23(1),

theres a zanki card in the GI deck from costanzo showing luminal side H+/dipeptide and H+/tripeptide co-transporters. Then inside the intestinal mucosa, the di and tripeptides are broken down into amino acids where a basal side transporter puts them into the blood stream

Heres a link showing that:

submitted by medstruggle(12),
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yWh is denadluo ulnme ?eriornctc I touhhgt cinepatcar emsnzey yt(pir,csnomhy oidexbeaypctrp)as owdul be toladec ee.rh

colonelred_  Enterokinase actives trypsinogen and is located closer to the intestinal mucosal (“brush border”). +1  
drdoom  Yeah, @colonelred is right. @medstruggle: the duodenal lumen (and the pancreatic /proteases/ you mention) is the site where pancreatic enzymes (“endopeptidases”) cleave large polypeptides into smaller bits. It is at the BRUSH BORDER where the smallest kinds of peptides (dipeptides, tripeptides) are broken down into their amino acids, which finally can be co-transported with Na+ into the intestinal cell. I think about it this way: stomach acid denatures and “opens up” proteins (without any specific cleavage); pancreatic enzymes then cleave denatured polypeptides into smaller bits; brush border enzymes finally break down tiny peptides into absorbable amino acids. +3  
drdoom  Nice schematic, @welpdedelp +  

submitted by seagull(1683),
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eTh astcnisem fo htis ouqisnet mead me otvmi

At teasl neo yda a etintpa lliw oolk me in the esye and aks " ewhre era ietspeidrt onbrek ndow .t"a I lilw simle at mthe nda ysa "teh attninlise csoaum dna not hte udnude"o.m 'Telylh mseil bkca nda tenh i'll nhte i'll kwal aywa dna hiknt of siht eotnmm as I upmj form the wondw.i