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NBME 21 Answers

nbme21/Block 2/Question#15 (63.4 difficulty score)
A 48-year-old man is brought to the emergency ...
Splenic and left renal๐Ÿ”,๐Ÿ“บ
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 +14 
submitted by rerdwins(26),
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etsb ayw to chppaora it si to aks hwich noe has a lorapt uirnacoictl nad a ssiytecm iclitrncuoa ( ouY ODNT dnee to kown eht epcdroreu to resawn tshi q.niteous

p:leeaxm tcna be iosurrep arptcigsei dan frniioer ispgcrteia ueeabcs hesot era htob ysmsciet aslo tcan eb ospurrie eltacr ironie(rf ceietrsmne ba)rnhc dna ursreiop mcienetrse esuecab ohtse are hobt latopr msyest

ehnw yuo rrwaon ti n,dwo enht sit a 5/500 ess.gu

charcot_bouchard  Not 50/50. u can rule all 4 out with this. U have described it perfectly. they are wanting a portosystemic anastomosis. Both hepatic vein and inferior phrenic vein drains into IVC. I was nt sure abt inferior phrenic but was sure abt renal and splenic. so picked that +7  



 +13 
submitted by usmle11a(77),
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ko i ikhnt i veha a oteryh in gdarrse fro :hits

eht olhwe cerdepruo si onde to edescear eht laprot NT.H chhiw naems the hunst olsudh eb ltproa ot siystecm gndivoai eht .vrlie

a) achptie (sycsitem) to ifn rpechin ( ssietycm ) ; )nBo oiieoclcl oprlat( ) ot nif ncisremte po(lar)t ; cno ) icnlpes ptl)oar( eltf narle ymse)t;is(c ye sd) rrispoue tigcapsier sesytcim() to rnifiroe gisirtacpe etsi(sycm) ; )N oe puriseor cltear )ra(ltpo to eopriusr mietsnecr ( p)atrlo ; NO

whossayin  Youโ€™re a legend. Good theory man, makes memorization a whole lotta easier! +  
lovebug  2019FA, 359pg. +  



 +3 
submitted by _gkr(3),
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ehT reaipaethxtc vtalracoop hstun ofr eht tertnamet fo ptloar HT is etebewn eth iscnlpe vein dna tlfe enrla ni.ev

Teh aicrhinttpae orptovclaa usnth si eewbnte het ptlroa nive adn ephiatc siven.

hTsi cna be donuf in het 100 cepcnsto nytaoma p.pt




 +2 
submitted by yo(86),
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etyerh' tikganl uaobt a lpasnleenor suthn dpueeorrc

eueltmsis-t9y/mtilch/hate/arvd/nnt/.seg:prs-llao0-.aprocetl5edtenlicah4nnstlhn

hungrybox  be honest did u know that before looking it up +9  
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor. +30  
sympathetikey  Relax @meningitis. Hungry's just messin :) +9  
sbryant6  Looks like somebody needs an enema to get that stick out. +1  
chandlerbas  ya'll are too TP/(TP+FN) lol +12  



 +0 
submitted by imgdoc(135),
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Ieocliloc srtoyimisef(inc)/er rteseeicnm r)l,tpao( and nicepsl /petlt(afor)l realn iecmy(ts)s rae eth noly wto tyorpemisscto tusnh p.notiso fO wichh pciesln nda ltfe earnl si teh ETBS tpooin fo hte wot sujt badse no ierth torxiypmi ot het pseaogaleh a.evscir

msyrett  ileocolic vein is a portal vein, it empties into the Superior Mesenteric Vein +1  



 +0 
submitted by an_improved_me(16),

Just to add another piece that i think may be worth considering.

Endoscopy is showing gastric varices specifically. In the cases I've encounterd gastric varices due to portal HTN, it relates to the connection between the splenic circulation and the epiplogic/short gastric veins (similar path i think for arterial circulation).

Consequently, gastric varices can be treated by altering the splenic (portal) circulation to a systemic circulation. In this case, the answer was l. renal.