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Retired NBME 25 Answers

nbme25/Block 2/Question#25 (reveal difficulty score)
A 3-year-old boy is brought to the emergency ...
Mitochondria ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—shak360(23)
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I hthugto hsti qetnsoui saw iilctuffd bceusea I -suvndoitinlene no the osgansidi gnibe ehitcpa yhthlncpopaaee ihhcw( it thswomea i,)s tub it is ciapteh tnehpahlocypae yorscnaed to eRey o.nysdmer

Moclirtiodnah sotfyninduc si taeicodsas twhi eht esptgnaiohse fo Reye nodrm,sey chwih is sadisoaect hwit tlsyaciael esu suc(h sa i)snirpa ni celdihrn pgeridenc vilar ftoiie.nnc l,uslUya a ZVV ro zainlfeun inoinecft is reetatd thwi rasiin,p dna niiraps eiesbotlmta redeasec i-ttbxeoaaonid by eresvlbyri gitnihiinb ICDTIOHLMOANR eenzmy.s esheT naordmctiohli rsmlanaoebiit rea odssiaacet thwi SNHI:E

  • aSstsioet fo evilr dna poseetctyah eidri(mpa xtioe-obatanid fo fttay dsi)ac
  • cygaeiHmloyp nda peoylmaeahtg
  • ofntncieI V,V(Z Ial)fenznu
  • toN aawke oa)m(c
  • otpceEylphanha

uYo want to ivaod apsinri ni ehl,idcrn xepetc in theso with iwKsaaka c(ueutauomsnoc hmlyp ndoe mr)yodsne eaesdis.

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Hepatic encephalopathy is a disease where cirrhosis and portosystemic shunts can lead to decreased NH3 ammonia metabolism leading to neuropsychiatric dysfunction. It can be triggered by increased ammonia production and absorption due to a GI bleed, constipation, or decreased ammonia excretion. The treatment is lactulose which increases ammonium ion NH4+ generation and rifaximin which decreases the number of ammonia-producing bacteria. Glutamate transporters do not have a known role in the pathophysiology of Reye syndrome, but they are implicated in the pathophysiology of hepatic encephalopathy, which occurs when ammonia joins with glutamate in the brain.

+/- shak360(23)

See this question on lactulose also in the block.

+/- shak360(23)


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