NBME 20 Starchy foods (NBME Answers)

You must be logged in to vote!

Retired NBME 20 Answers

nbme20/Block 4/Question#44 (reveal difficulty score)
A 45-year-old man comes to the office for ...
Starchy foods 🔍 / 📺 / 🌳 / 📖
tags:

+4 upvote downvote
submitted by ∗thepacksurvives(21)

get full access to all content ⋅ pick a username

I think this one has to do with "late dumping syndrome"-- basically, starchy foods cause hyperglycemia --> release of insulin --> catecholamine surge --> diarrhea, etc.

get full access to all content ⋅ pick a username

smc213 https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=107 +

merpaperple It's not necessarily late dumping syndrome, this is the dietary guideline for early dumping syndrome too. Based on UpToDate and ScienceDirect this is how it works: Absent or dysfunctional pyloric sphincter -> food is rapidly emptied from the stomach into the small bowel -> hypertonic solution forms in the jejunum -> rapid fluid shifts from the plasma into the bowel -> hypotension and SNS response (eg. colicky abdominal pain, diarrhea, nausea, tachycardia) Simple carbohydrates are more hypertonic, I think. https://www.sciencedirect.com/topics/medicine-and-dentistry/dumping-syndrome +5

j44n starches are complex carbs= more than 2-3 sugar molecules, if they have dumping syndrome they have decreased gastric transit time= more undigested carbs are delivered to the intestines and that gives you more carbs for bacteria to break down (flatulence and osmotic diarrhea) +

This video makes sense https://www.youtube.com/watch?v=mXhNYj_oqEU

+/- uasid(68)

You must be logged in to vote!

+4 upvote downvote
submitted by ∗beeip(141)

get full access to all content ⋅ pick a username

Thought this would be something regarding "bariatric surgery," but nope, just "no starchy foods, because you're pre-diabetic."

get full access to all content ⋅ pick a username

hello Yep, seems that because the patient has prediabetes, he should avoid eating excessive starchy foods. +

yotsubato such a BS question IMO +7

yotsubato such a BS question IMO +

breis I put nuts thinking of "fats" and that with a bariatric surgery they may have problems with absorption.. +6

teetime This isn't right because the bariatric surgery will cure the prediabetes. It's dumping. +2

dr_jan_itor Why should he avoid eating excessive starchy foods? To avoid gaining weight? It doesn't matter what macronutrients he eats if they are calorie controlled. +2

dhkahat yeah but he's prediabetic. you want someone like that to shove a bunch of starch down all the time? +

You must be logged in to vote!

+1 upvote downvote
submitted by ∗strugglebus(189)

get full access to all content ⋅ pick a username

I had put "starches" b/c pts that undergo bariatric surgery are only supposed to eat complex carbs (fruits/vegetables) and avoid simple carbs (i.e. breakfast cereal/baked goods)

get full access to all content ⋅ pick a username

You must be logged in to vote!

+0 upvote downvote
submitted by ∗brise(86)

get full access to all content ⋅ pick a username

https://www.pennmedicine.org/updates/blogs/metabolic-and-bariatric-surgery-blog/2020/january/foods-drinks-to-avoid-after-bariatric-surgery#:~:text=Diet%20after%20Bariatric%20Surgery&text=After%20protein%2C%20focus%20on%20non,may%20not%20be%20well%20tolerated.

get full access to all content ⋅ pick a username

brise "Starches such as fried potatoes, rice and pasta may make you feel bloated or gassy and may not be well tolerated." +

You must be logged in to vote!

+0 upvote downvote
submitted by ∗topgunber(67)

get full access to all content ⋅ pick a username

damn, i was way off. i put green leafy vegetables thinking the increased folate content can cause bacterial overgrowth. pretty sure i had a uworld question that said something like that.

get full access to all content ⋅ pick a username

bgreen27 I was thinking the same thing! I was thinking the same thing! RYBG (a type of gastric bypass) can cause small intestinal bacterial overgrowth (SIBO) increased growth in the blind pouch segment. SIBO results in deficiency of most vitamins (B12, A, D, and E) and iron, BUT increased production of folic acid and vitamin K. -Uworld +1

bfinard1 Any idea why this isnt the case? +

You must be logged in to vote!

-1 upvote downvote
submitted by ∗garima(21)

get full access to all content ⋅ pick a username

Because of the starchy nature of bread, rice, and pasta, after your surgery, they can form a paste in your throat that is hard to swallow without liquid. In some cases, they can block the stoma, the hole to the pouch that is your new stomach. You don’t have to completely reject these high-starch foods, but it’s best to avoid them in the beginning. When you do eat them, try to have very small portions and make sure that you only eat small bites of each.

get full access to all content ⋅ pick a username

You must be logged in to vote!

-3 upvote downvote
submitted by ∗humble_station(85)

get full access to all content ⋅ pick a username

I think it has to do with the surgery. Getting a gastric bypass or bariatric surgery means you no longer allowing contents to pass through the duodenum. So that would mean if you had a starchy meal you would not be able to release the appropriate enzymes from the pancreas to allow for digestion.

Please correct me if I'm wrong!

get full access to all content ⋅ pick a username

You must be logged in to vote!

Must-See Comments from nbme20

amorah on Cytomegalovirus infection
masonkingcobra on Contact with parakeets
hayayah on Capillary hydrostatic: increased; ...
hayayah on X chromosome-linked isoenzymes
medbitch94 on Mannose 6-phosphate
hello on Capillary hydrostatic: increased; ...
hayayah on Osteoblasts
imgdoc on Hypophosphatemia
hayayah on Missense
celeste on 50%
justgettinby on Omeprazole
andrewk1 on Cold, dry air
yotsubato on Jugular venous pressure of 12 mm Hg
strugglebus on Drug effect