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NBME 16 Answers

nbme16/Block 2/Question#20 (5.2 difficulty score)
A 28-year-old woman, gravida 2, para 1, comes ...
Venous hypertensionπŸ”

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submitted by aakb(2),

what is the lesion/picture? not really sure what to even google for this.

skilledboyb  I got the feeling that this was some type of a hemorrhoid. The reason why is because they speak about constipation (risk factor for hemorrhoids) and the bigger give away is that this patient is pregnant. The uterus can compress the IVC when it gets large enough and lead to blood stasis behind the obstruction. +3  

submitted by topgunber(10),

its an external hemorrhoid, pic is of an anus with a hematoma round the 7 o'clock position. there is pain and bleeding with wiping which points me toward an external hemorrhoid. with the other answer choices being infectious causes the only two left were venous htn and lymphatic obstruction. because increased straining and increased pressure on the inferior and middle rectal veins went with venous htn. (not to be confused with superior rectal vein which is linked to portal htn and internal/ painless hemorrhoids)