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Old 04-14-2011
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Question Why Iron causes Gastric Ulceration?

Hi,, does any1 know the concept behind ingesting high quantity of iron tablets and that resulting to gastric bleeding.
I know it might be a dumb question but for some reason I can't get to the answer.
It's a question from NBME Form 1, section 3, #34.
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Old 04-14-2011
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Stop Know why they ask the question

That NBME question did not ask you why Iron causes gastric bleeding, they just wanted to know that it's a feature of Iron poisoning and they wanted you to know that metabolic alkalosis, polycythemia, respiratory depression, and urinary retention are not clinical features of Iron poisoning.

You have to understand the reason why they put the question so that you can adjust your reading and know what to focus on.

I guess the most expert pathologists or cell biologists or gastroenterologists do not know the exact mechanism by which Iron causes gastric bleeding.

There are details and depths that you don't need to waste your time with.

On the other hand, there are high yield info that you need to know, for example why Aspirin causes gastric ulcer (because it block the cytoprotective prostaglandins while Type CO inhibiters do not block and hence cause no gastric bleeding).
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Old 04-14-2011
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The primary mechanism for iron-induced tissue damage is free radical production and lipid peroxidation.

Local toxicity of iron (manifested as abdominal pain, vomiting, diarrhea, and gastrointestinal bleeding) develops from iron-induced damage to the gastrointestinal mucosa. Systemic toxicity occurs as the result of injury to the cardiovascular system and liver. The cause of death from iron poisoning is usually shock or liver failure

@laithbv: If we know the mechanism, it is much much easier to remember manifestations. Instead of memorizing a long list which is easily forgettable, if we understand the concept behind diseases, we can answer difficult questions. With this question, its a lot easier to remember that iron causes free radical induced damage to mucosa than to memorize the 5 different clinical manifestations of Iron poisoning (which can be forgotten among the thousands of other things we have to know)
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Old 04-14-2011
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Quote:
Originally Posted by apx85 View Post
@laithbv: If we know the mechanism, it is much much easier to remember manifestations. Instead of memorizing a long list which is easily forgettable, if we understand the concept behind diseases, we can answer difficult questions. With this question, its a lot easier to remember that iron causes free radical induced damage to mucosa than to memorize the 5 different clinical manifestations of Iron poisoning (which can be forgotten among the thousands of other things we have to know)
ps. didn't mean to be argumentative, just my opinion. We all learn in different ways.
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Old 04-14-2011
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Default Nothing personal

Quote:
Originally Posted by apx85 View Post
ps. didn't mean to be argumentative, just my opinion. We all learn in different ways.
Definitely, nothing personal

However, the NBME question did not ask what is the mechanism by which Iron causes gastric bleeding, that's the whole point, you should focus on what's being asked.

If you try to memorize how Iron cause local damage, and how potassium chloride cause pill esophagitis, and how irradiation causes cancer, ..etc you will need couple of decades before you can take Step 1 exam.

Hopefully, I made myself clear this time
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Old 04-14-2011
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Yea i agree, it does take more time/effort. But unfortunately, that's how I learn best
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Old 04-14-2011
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thanks guys for the response.
@ apx85- makes alot more sense. thank u for the explanation
@ laithbv - yes, definately we should focus on what being asked n cross out options that dun make sense. i knew the other options wern't correct n i was just left with "gastric bleeding." of course i picked that n moved on n got it right but at the end i didnt know the reason behind y its the correct answer.
but yea, if things go like this it will take ages to prepare for step 1 n i do tend to over think alot when doing questions (which does mess me up) but i think this was an easy concept which i should have known.
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