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NBME 20 Answers

nbme20/Block 2/Question#28 (28.0 difficulty score)
At a postnatal checkup, a 6-week-old female ...
Annular pancreasπŸ”

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submitted by monoloco(132),
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nAaurnl ncperasa is the lnyo wernsa ttah ccotunsa rfo eht beli ni eth o;tvim of eht eh,csoci ti si hte olny icootsbtrun idltsa to erhew ilbe rsntee hte IG t.rtca

ergogenic22  Meckel diverticulum also occurs distal to the CBD but less likely to be associated with bilious vomiting +  
sympathetikey  Correct. Might cause pain due to ectopic gastic tissue. +3  

submitted by strugglebus(163),
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,Aosl cslkMee wdlou heva cerbdise ateeozmichah or ueirfla ot spas nmemoicu

sugaplum  I believe failure to pass meconium is Hischsprung's Meckels don't present within the first few days of life, so meconium wouldn't be a factor FA 2019 378 +1  

submitted by gabriela(3),

Also may help: Even though they are not DIRECTLY saying that there is difficulty feeding, the loss of weight indicates it in this case.

Causes of early feeding difficulties: + Annular pancreas + Tracheoesophageal fistula + Duodenal atresia

Causes of late feeding difficulties: + Congenital pyloric stenosis

submitted by draykid(21),

I have a hard time understanding how annular pancreas can cause bilious vomiting when I'm seeing many sources say it is either bilious or non-bilious.

draykid  Ok, so after doing a little research. It can cause both, but if the annular pancreas wraps around the duodenum distal to the ampulla of Vater then you get bilious obstruction. +5