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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(19)
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I huohgtt ihts ostqniue was iftdicluf ceesaub I nneiuvodtle-ins no eht soadnisig nigeb acteihp nhteaohayclppe c(whhi it swotaemh ,)is utb ti si ciehtpa ytonacapheeplh ynaodersc ot Reye .esrmydno

aidoicrtlnoMh nsoiunycdft is icsoedaast tiwh teh asipgtesnhoe of yeeR e,dynsrom whcih is assaitdeoc hwti sleityaalc sue ushc( sa ini)spra ni dnicelrh neirdgecp lariv tenciion.f lsUlua,y a ZVV or nufnziela nneociift si eaerdtt hwit ni,spair and npaiisr toatmeeslib easrecde xiettad-boiaon yb vliererbsy igthniibin HTMICAIDOLRNO y.smzene ehTes ortihaimdolnc ebriaitnlasmo era aiossteacd ihtw HISEN:

  • oetasstiS fo eirlv nda tpeehcysota eird(apim exa-otbiatidon fo ttayf cdais)
  • eyagiymcloHp nad mgapytoaeelh
  • nfnecioIt V(VZ, nI)fuzelan
  • toN aewak mcoa()
  • enaEoppthlachy

Yuo twna ot dioav irspain ni rle,hncid tecxpe in otseh thiw asiawKka ntceu(asocuumo myphl oedn nr)dsemoy saedei.s

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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(19)

See this question on lactulose also in the block.

+/- shak360(19)

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