nbme q - jlx

[ArchivalUser]

2. A 56-year-old man with alcoholism comes to the physician because of a 2-month history of increasingly severe stomach pain and increased volumes offoul-smelling
stool; he also has had a 9-kg (20..Jb) weight loss during th is period. He has a history of multip le visits to the emergency department because of severe abdominal pain.
He has consumed one bottle of red wine daily for 5 years. His temperature is 37"C (98.6"F). Physical examination shows epigastric tendemess. His fasting serum
glucose concentration is 150 mgfdL. A CT scan of the abdomen shows pancreatic calcifications. The most likely cause of th is patienfs current symptoms is a decrease
in which of the fo llowing?
o A) Bile acid synthesis
o B) Colonic bacteria
o C) Duodenal pH
o D) Fecal elastase
o E) 7a-Hydroxylase activity

[ArchivalUser]

i'd say c

[ArchivalUser]

Do you mind explain? c is the given answer

[ArchivalUser]

i see a patient with chronic pancreatitis, who develops a fatty diarrhea, due to malabsorption. i assume that the secretin secretion is also impaired, which normally increase the duodenal ph, for the pancreatic enzymes to work. since there is no option for "decrease pancreatic enzymes", i'll pick decrease duodenal ph

[ArchivalUser]

Good explanation, thanks.

[ArchivalUser]

C - decrease in ph denatures pancreatic enzymes, they don't work

[ArchivalUser]

wow what a good question.

I just learned that the pancreatic enzymes need to be in a basic state in order it to function. Acid is bad for the pancreatic enzymes..

Thanks for this post.