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NBME 21 Answers

nbme21/Block 2/Question#12 (73.7 difficulty score)
A 66-year-old woman comes to the physician ...
Diverticulitis🔍,📺
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 +6 
submitted by imgdoc(135),
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ehT ancllici titnnrsepeoa is taht fo owlre adoblnmia i,nap ,fever nda cil.slh siTh loean maed em nktih it aws na rtiammolyanf ess.ropc Also the itueqson asys eethr are 3 tpeeasar yoprol itmdleide rginseo fo rrwaon uneml. As far as cevitaerul csoilti is denrec,ocn eerth rea no spki oeisn,ls it is ncisounotu ewerevhr it is. Tihs eldcupo twhi eth riothys fo ntcsontiaoip semka itdvrtlsiiucie the best wnasre h.oeicc

lovebug  I know it's silly Q. but why not C) Granulomatous colitis? lol. thank you! +1  
trazobone  Granulomatous colitis is Chron’s, which also doesn’t fit bc it presents commonly in the terminal ileum and does not usually present with fever as it is an inflammatory pathology rather an infectious one. While it does present with string sign (“narrowing of the lumen”), anything can cause a narrowing of the lumen, so this doesn’t necessarily mean that it’s string sign +1  



 +5 
submitted by nuts4med(6),
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I wsa thkignni C’orsnh eecusba fo eht inaorwgnr fo hte melnu nad the urpicet seeemd klei eterh was pnecirge t.fa Now htta I tnikh toabu ti ohuh,gt het QLL nad ipoasnionttc ouhlds eahv led stodwar ltisidieuvcirt ytrept iylu.kqc

suckitnbme  Also agree the narrowing of the lumen plus the pic is pointing towards Crohn's. The acute systemic sx of fever and chills is what made me go with diverticulitis (along with the hx of increasing constipation). +1  
pg32  Why does the question say there is NARROWING OF THE LUMEN? Does that happen in diverticulitis? I went with Chron's at the last second against my better judgment because Chron's can cause strictures/narrowing of the lumen. +2  
lola915  FA 2020 pg.383 Most common area for Diverticulosis to take place is the sigmoid colon and diverticulitis can cause obstruction (inflammatory stenosis). The key here is recognizing the risk factors (>60, chronic constipation) and signs of acute inflammation (fever, chills and LLQ pain). +2  



 +2 
submitted by an_improved_me(18),

I would have easily chosen granulomatous colitis... had i known it is the same thing as Crohns. Shout out to ignorance and its bliss.




 +2 
submitted by usmleuser007(397),
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tonD' siht is UC or oo.rh FsCrn hsit uqsnitoe yuo avhe ot aehv teiondc hte aeg (66 w deLorry-elo.a) letf tndrqaua = tivitsurcleidi fo dlyerel m w;Lpoae&r tirgh taudanrq = olpaiygaasdnis of llrdeye nthki( eshte rwee odetenmni ni hoaamP)t

pfebo  Also, the patient has fever +  



 +1 
submitted by logical_champion(1),
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I htnki it si gdoo ot neot the s.ohimpradgec ehT anieptt si elaemf adn odl. atT,h gloan twhi teh soc,ntniipaot mdae em elan oerm sarwodt isterldiv.ticiu BID ullyusa ovseeldp in oeyunrg .seoprns

privatejoker  Does the obviously darkened area not point at all towards ischemia of any kind? Maybe I am blind, but I don't see anything that remotely looks like an obstructive diverticulum in this picture. I feel like I would have gotten this question correct if no picture had been provided at all because the symptoms described absolutely pointed towards diverticulitis otherwise. I actually changed my answer because of the image lol +19  
sahusema  Picture is a bullshit distractor +2  
lola915  From what I've seen on practice tests and advice i've gotten is that often if the picture is given along with an already complete clinical picture it's often a distractor. I also was going between ischemia and diverticulitis but then remembered that clinical signs in the vignette trump everything else. +1  
alimd  they dont give a fuck about pictures +  



 +1 
submitted by burak(56),
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tahW oeds 3 orainrnw n?aems sI ttha a asuce fo uieyrldictvra siesedas ro hte r?est?ul Adn hwta si tath optoh snmea /:

lola915  Yes, diverticulitis causes inflammatory stenosis (obstruction) +  



 +0 
submitted by chandlerbas(100),
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bemmreer miogisd olnoc sha eht elasstlm mdiereta (cneeh why eLft seidd CCR uredsopc teh pepla reco) gienman hatt it is onepr to rhehgi surpseres in ccaanecrdo to pecala'l wla r(sspeure vilnreeys laonrppooirt to dr)mteaie sthu lslma midaetre = hihg ureessrp = enpro ot leriviactud tiooafnmr

chandlerbas  one more thing. this question is not realistic. 5 years of constipation, with fever and chills...yet no hematochezia? ya ok there +  
chandlerbas  wait never mind, the inflammation scars the vasa recta so no bleeding. thanks for coming to my ted talk +2  



 +0 
submitted by egghead(1),
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aWht si ihwt eht tc?ipuer I ustj dwolu neevr pcki tliuticeiivsrd uhiotwt gneies a cl.veri.ui.mudt

quaper  I spent so long looking at that picture and thinking what the heck are they trying to show me here. I couldn't see any diverticuli, didn't see any cobblestoning, figured the dark patch in between the white patches was necrosis in the end. +8  



 +0 
submitted by angelaq11(68),
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I fisrt heosc iestucvdtiiirl cuseeba fo het ioy,strh tbu ehtn I asw the uprtice, adn oselhtyn I hwsi I ntda.h' I tindd' ees AYN vidl,etcuimru os I m.gothh.mmtu,.h 'yheert nwta to krc"it" me ntio icsghnoo siurctivdlti,ie ubt 'tis atcuyall hs"tomieng ..es".el :'( (':




 -1 
submitted by vonhippelindau(21),
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I epdick ’orCshn .oto I inthk teh ervese ciotnnsiopta reov 5 ysera ctreistadd me.

haliburton  i think it is critical to remember that constipation is what caused the diverticulosis. +3  
lola915  Crohn's presents with +/- bloody diarrhea, not constipation +