need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

Retired NBME 16 Answers

nbme16/Block 4/Question#35 (reveal difficulty score)
A 68-year-old woman comes to the physician ...
Superior mesenteric ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags:

 Login (or register) to see more


 +4  upvote downvote
submitted by โˆ—cassdawg(1781)
get full access to all contentpick a username

This is mesenteric artery stenosis causing postpranidal intestinal ischemia/angina. I definitely did not know this answering the question and I personally got to the answer by attempting to logically think through the symptoms:

  • Weight loss and abdominal pain in general pointed to intestinal ischemia of some sort and since most absorption of nutrients happens in the jejunum, ischemia there would cause weight loss. Jejunum is supplied by SMA
  • Bruit to me meant a larger vessel was blocked since to be able to hear it it has to be a pretty large vessel, SMA is one of the larger arteries listed
  • No liver symptoms (i.e. jaundice) so eliminated hepatic artery

If anyone has a better explanation please offer it.

get full access to all contentpick a username
deathcap4qt  great explanation for not knowing the answer! You're right in that it has to do with a vessel of a larger size. Generally Celia, SMA or IMA. pt hx of atherosclerosis should be a big hint. FA 2019 pg 380. +3
nbmeanswersownersucks  SMA is the MOST COMMON vessel involved in ischemic bowel disease. +2
baja_blast  I reasoned this out by remembering that the Abdominal Aorta was the most common place for atherosclerosis and picking the only option that branches off immediately from there. Not sure if that's what they were going for but it got me to the right answer. +1
topgunber  i think thats a great explanation ^, namely because its possible obstruction at the other vessels may not cause symptoms due to collateral circulation. SMA on the other hand, if stenosed, would have a number of regions with ischemia- not to mention its involved in a watershed area. +
an1  I thought because this said severe pain after meals, it was hinting at gastric ulcers which was cause for the weight loss :( +



Must-See Comments from nbme16

bingcentipede on Cerebral edema
zincy7 on Gastrin
cassdawg on Kidney
medninja on Lysosomes
cassdawg on Sildenafil
cassdawg on Feces-contaminated soil
cassdawg on Presence of an internal ribosome entry site
cassdawg on Peutz-Jeghers
hungrybox on Induction of cytochrome P450 enzymes that ...
andro on Antagonizes VLDL-cholesterol secretion
bingcentipede on Decreased function of Na+โ€“K+ ATPase
bingcentipede on Glyceraldehyde-3-phosphate dehydrogenase
cassdawg on 46,XXY
bingcentipede on Grade 4/6, holosystolic murmur heard best ...

search for anything NEW!