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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 3/Question#2 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Malabsorption ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: GI

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 +2  upvote downvote
submitted by โˆ—jlbae(159)
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What's going on here? Thought this was lactose intolerance โ†’ secretory process??

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lubdub  Yea, this one made me think more than I'd hope lactose intolerance would have. If the lactose can't be broken down (by the lactase in the brush boarder) then it stays in the lumen (malabsorption) letting all the gut bugs digest it (make gas) and allowing for osmotic diarrhea. Osmotic =/= secretory +5
jlbae  Ah ok, ty. That makes sense. It's kinda coming back to me from M2 GI lectures now lol. So then an example of secretory would be a viral gastroenteritis where electrolytes are being actively secreted into the GI lumen. +1
notyasupreme  I think of secretory diarrhea like secreting alllll the time, so they have to shit in the night time too.. as opposed to lactose which is osmotic diarrhea, with some acidic ass bullshit going on in the bowels. Anyways, if you're too pedantic on this question, you may get it wrong +



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submitted by โˆ—step_prep7(71)
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  • Presentation most consistent with lactose intolerance (bloating, abdominal pain and intermittent diarrhea that have worsened with increased dairy intake) which is a form of malabsorption because lactose cannot be broken gown into glucose and galactose monomers
  • Impaired intestinal motility would lead to decreased bowel sounds
  • Inflammatory process would likely lead to fever +/- blood in stool
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