10-21-2008, 10:51 AM
NBME3-block3-Q39
#315134
durham - 07/01/08 23:10
After eating, a 40-year-0ld woman has a vague feeling of discomfort in the right upper quadrant of the abdomen. Ultrasonography discloses several small calculi, believed to be cholesteol gallstones, in the gallbladder. She begins oral therapy with ursodeoxycholic acid. Which of the following is the best rationale for this treatment?
a. addition of bilirubin to the bile
b. decrease in the ratio of cholesterol to bile acids
c. decrease in the concentration of bile acids
d. increase in the ability of the gallbladder to concentrate bile
e. increase in the concentration of lecithin in bile
I am confused between b and c. Need help, thanks.
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* Re:NBME3-block3-Q39
#1366516
mutantmind - 07/01/08 23:50
bbb
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* Re:NBME3-block3-Q39
#1366520
durham - 07/01/08 23:52
I chose b but answer is c, any idea?
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* Re:NBME3-block3-Q39
#1366529
usmled - 07/01/08 23:59
b UDCA reduces the rate at which intestine absorbs cholesterol molecules and dec cholesterol secretion into the bile thereby dec ratio of cholesterol to bile acids.
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* Re:NBME3-block3-Q39
#1366534
durham - 07/02/08 00:03
usmled, you also think the given answer is not correct?
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* Re:NBME3-block3-Q39
#1366540
usmled - 07/02/08 00:07
yes i too think so unless smone gives a reasonable explanation in favour of the given ans
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* Re:NBME3-block3-Q39
#1366564
durham - 07/02/08 00:24
thanks. but if you think that bile is from cholesterol, dec cholesterol also means dec bile, the ratio maybe not changed, so c is correct.
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* Re:NBME3-block3-Q39
#1366572
usmled - 07/02/08 00:34
yes durham u r right, thanks for clearing my concept
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* Re:NBME3-block3-Q39
#1366573
durham - 07/02/08 00:38
let us listen to other's opinion too. good night.
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* Re:NBME3-block3-Q39
#1366592
ultradocmansu - 07/02/08 01:00
b is the answer
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* Re:NBME3-block3-Q39
#1366605
united123 - 07/02/08 01:08
Durham,
Ultradoc is right. Also, the given answer with the answer key is B as well. good luck.
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>>
* NBME3-block3-Q39
#315134
durham - 07/01/08 23:10
After eating, a 40-year-0ld woman has a vague feeling of discomfort in the right upper quadrant of the abdomen. Ultrasonography discloses several small calculi, believed to be cholesteol gallstones, in the gallbladder. She begins oral therapy with ursodeoxycholic acid. Which of the following is the best rationale for this treatment?
a. addition of bilirubin to the bile
b. decrease in the ratio of cholesterol to bile acids
c. decrease in the concentration of bile acids
d. increase in the ability of the gallbladder to concentrate bile
e. increase in the concentration of lecithin in bile
I am confused between b and c. Need help, thanks.
Report Abuse
* Re:NBME3-block3-Q39
#1366613
durham - 07/02/08 01:10
by accident, I switched the choice b to choice c so the given answer b is the choice c here. Sorry united123.
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* Re:NBME3-block3-Q39
#1366639
united123 - 07/02/08 01:19
ohhhhhhhhhhhhh.................lol
i didn't even see that.......i verified it with my answer key cuz i did nbme 3 about two week ago.
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* Re:NBME3-block3-Q39
#1367097
mlegriller - 07/02/08 11:08
Ursodiol is at least as effective as chenodiol (chenodeoxycholic acid) for the dissolution of cholesterol gallstones and is associated with fewer adverse effects. Ursodiol desaturates bile, solubilizing cholesterol from the stone surface. The diameter of the largest stone is the most important determinant of successful dissolution. Dissolution with ursodiol is effective for approximately 30% to 50% of stones smaller than 20 mm in diameter, with the best results for small, buoyant stones. A meta-analysis of randomized trials with ursodiol found that the dissolution rate was 37% for patients treated with ursodiol at doses of more than 7 mg/kg per day or of more than 500 mg/d for at least 6 months. Maintenance therapy is effective for prevention of gallstone recurrence. Ursodiol also improves biochemical markers of cholestasis and inflammation when used to treat cholestatic liver diseases. By displacing potentially hepatotoxic bile salts, it appears to interrupt the cycle of cholestatic injury. It may also exert hepatoprotective membrane-stabilizing or immunomodulatory effects (or both). Improvements in laboratory variables are limited to the treatment period, with relapses after withdrawal of therapy. Pruritus may be markedly relieved in individual patients treated with ursodiol.
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* Re:NBME3-block3-Q39
#1367454
durham - 07/02/08 15:10
thanks, mlegriller.
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* Re:NBME3-block3-Q39
#1408591
wrasse - 08/04/08 13:44
So, what is the answer, B or C???
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* Re:NBME3-block3-Q39
#1408940
goout - 08/04/08 17:58
anyone to clear the confusion? please?
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* Re:NBME3-block3-Q39
#1408949
sweetiful - 08/04/08 18:06
its CCCCCCC.....decrease in concentration of bile acids..........as the mechanism is to desaturate the bile which will cause the dissolution of the stones
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* Re:NBME3-block3-Q39
#1409426
snsb - 08/05/08 01:23
Sweetiful is right .....C
E-medicine Points in favor of ans.
In humans, long-term administration of ursodeoxycholic acid reduces cholesterol saturation of bile, both by reducing liver cholesterol secretion and by reducing the detergent effect of bile salts in the gallbladder (thereby preserving vesicles that have a high cholesterol carrying capacity). Desaturation of bile prevents crystals from forming and, in fact, may allow gradual extraction of cholesterol from existing stones
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* Re:NBME3-block3-Q39
#1420045
medrmtci - 08/13/08 21:57
what do they ask ?about MOA or pathogenesis (what happen in patient )?
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* Re:NBME3-block3-Q39
#1420160
klm25 - 08/14/08 00:13
no right answer is B.
because concentration of bile depends on water rebsorption and cholestrol intake donot forget that bile salt, phospholipid , bile pigment and bicarbonate play imp role too. u cant neglect all those thing and think abt cholestrol only. since the mechanism of action of drug is reduce intestinal absorption of cholestrol ir is more logical to think that it ratio of cholestrol in the bile.
remember decreased concentration of cholestrol do not depand only on chlestrol there are other factors too which i mentioned earlier.
i hope u guys get the point
#315134
durham - 07/01/08 23:10
After eating, a 40-year-0ld woman has a vague feeling of discomfort in the right upper quadrant of the abdomen. Ultrasonography discloses several small calculi, believed to be cholesteol gallstones, in the gallbladder. She begins oral therapy with ursodeoxycholic acid. Which of the following is the best rationale for this treatment?
a. addition of bilirubin to the bile
b. decrease in the ratio of cholesterol to bile acids
c. decrease in the concentration of bile acids
d. increase in the ability of the gallbladder to concentrate bile
e. increase in the concentration of lecithin in bile
I am confused between b and c. Need help, thanks.
Report Abuse
* Re:NBME3-block3-Q39
#1366516
mutantmind - 07/01/08 23:50
bbb
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* Re:NBME3-block3-Q39
#1366520
durham - 07/01/08 23:52
I chose b but answer is c, any idea?
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* Re:NBME3-block3-Q39
#1366529
usmled - 07/01/08 23:59
b UDCA reduces the rate at which intestine absorbs cholesterol molecules and dec cholesterol secretion into the bile thereby dec ratio of cholesterol to bile acids.
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* Re:NBME3-block3-Q39
#1366534
durham - 07/02/08 00:03
usmled, you also think the given answer is not correct?
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* Re:NBME3-block3-Q39
#1366540
usmled - 07/02/08 00:07
yes i too think so unless smone gives a reasonable explanation in favour of the given ans
Report Abuse
* Re:NBME3-block3-Q39
#1366564
durham - 07/02/08 00:24
thanks. but if you think that bile is from cholesterol, dec cholesterol also means dec bile, the ratio maybe not changed, so c is correct.
Report Abuse
* Re:NBME3-block3-Q39
#1366572
usmled - 07/02/08 00:34
yes durham u r right, thanks for clearing my concept
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* Re:NBME3-block3-Q39
#1366573
durham - 07/02/08 00:38
let us listen to other's opinion too. good night.
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* Re:NBME3-block3-Q39
#1366592
ultradocmansu - 07/02/08 01:00
b is the answer
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* Re:NBME3-block3-Q39
#1366605
united123 - 07/02/08 01:08
Durham,
Ultradoc is right. Also, the given answer with the answer key is B as well. good luck.
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>>
* NBME3-block3-Q39
#315134
durham - 07/01/08 23:10
After eating, a 40-year-0ld woman has a vague feeling of discomfort in the right upper quadrant of the abdomen. Ultrasonography discloses several small calculi, believed to be cholesteol gallstones, in the gallbladder. She begins oral therapy with ursodeoxycholic acid. Which of the following is the best rationale for this treatment?
a. addition of bilirubin to the bile
b. decrease in the ratio of cholesterol to bile acids
c. decrease in the concentration of bile acids
d. increase in the ability of the gallbladder to concentrate bile
e. increase in the concentration of lecithin in bile
I am confused between b and c. Need help, thanks.
Report Abuse
* Re:NBME3-block3-Q39
#1366613
durham - 07/02/08 01:10
by accident, I switched the choice b to choice c so the given answer b is the choice c here. Sorry united123.
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* Re:NBME3-block3-Q39
#1366639
united123 - 07/02/08 01:19
ohhhhhhhhhhhhh.................lol
i didn't even see that.......i verified it with my answer key cuz i did nbme 3 about two week ago.
Report Abuse
* Re:NBME3-block3-Q39
#1367097
mlegriller - 07/02/08 11:08
Ursodiol is at least as effective as chenodiol (chenodeoxycholic acid) for the dissolution of cholesterol gallstones and is associated with fewer adverse effects. Ursodiol desaturates bile, solubilizing cholesterol from the stone surface. The diameter of the largest stone is the most important determinant of successful dissolution. Dissolution with ursodiol is effective for approximately 30% to 50% of stones smaller than 20 mm in diameter, with the best results for small, buoyant stones. A meta-analysis of randomized trials with ursodiol found that the dissolution rate was 37% for patients treated with ursodiol at doses of more than 7 mg/kg per day or of more than 500 mg/d for at least 6 months. Maintenance therapy is effective for prevention of gallstone recurrence. Ursodiol also improves biochemical markers of cholestasis and inflammation when used to treat cholestatic liver diseases. By displacing potentially hepatotoxic bile salts, it appears to interrupt the cycle of cholestatic injury. It may also exert hepatoprotective membrane-stabilizing or immunomodulatory effects (or both). Improvements in laboratory variables are limited to the treatment period, with relapses after withdrawal of therapy. Pruritus may be markedly relieved in individual patients treated with ursodiol.
Report Abuse
* Re:NBME3-block3-Q39
#1367454
durham - 07/02/08 15:10
thanks, mlegriller.
Report Abuse
* Re:NBME3-block3-Q39
#1408591
wrasse - 08/04/08 13:44
So, what is the answer, B or C???
Report Abuse
* Re:NBME3-block3-Q39
#1408940
goout - 08/04/08 17:58
anyone to clear the confusion? please?
Report Abuse
* Re:NBME3-block3-Q39
#1408949
sweetiful - 08/04/08 18:06
its CCCCCCC.....decrease in concentration of bile acids..........as the mechanism is to desaturate the bile which will cause the dissolution of the stones
Report Abuse
* Re:NBME3-block3-Q39
#1409426
snsb - 08/05/08 01:23
Sweetiful is right .....C
E-medicine Points in favor of ans.
In humans, long-term administration of ursodeoxycholic acid reduces cholesterol saturation of bile, both by reducing liver cholesterol secretion and by reducing the detergent effect of bile salts in the gallbladder (thereby preserving vesicles that have a high cholesterol carrying capacity). Desaturation of bile prevents crystals from forming and, in fact, may allow gradual extraction of cholesterol from existing stones
Report Abuse
* Re:NBME3-block3-Q39
#1420045
medrmtci - 08/13/08 21:57
what do they ask ?about MOA or pathogenesis (what happen in patient )?
Report Abuse
* Re:NBME3-block3-Q39
#1420160
klm25 - 08/14/08 00:13
no right answer is B.
because concentration of bile depends on water rebsorption and cholestrol intake donot forget that bile salt, phospholipid , bile pigment and bicarbonate play imp role too. u cant neglect all those thing and think abt cholestrol only. since the mechanism of action of drug is reduce intestinal absorption of cholestrol ir is more logical to think that it ratio of cholestrol in the bile.
remember decreased concentration of cholestrol do not depand only on chlestrol there are other factors too which i mentioned earlier.
i hope u guys get the point