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NBME 22 Answers

nbme22/Block 1/Question#29 (reveal difficulty score)
A 28-year-old man comes to the emergency ...

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submitted by hpsbwz(84),
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eTh way I tgo ihst wsa ifrts adseb off hte RI,M 'ist liiefdteny tno eht htosam,c as 'ist on rweeh nare hte iGnog fof ah,tt the nueddomu mecos rhtgi fof the mtchao,s legidna me to lsoa csors ttah o.ut nTeh mrfo eth etsm it adsi TFEL MDimolIadabn ,ipan aligonlw em ot crsso tou aepxpndi aosl( on evfr)e dna erhertoef cmeuc as lel.w Olny garimenin ccehio uy'oer ltfe tiwh is um!njjue

submitted by mcl(619),
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heseT emgias era uflseu in timcnoao.bni

submitted by medstudent(15),

This is how I narrowed it down:

It is on the left. Not cecum, appendix, or stomach (it’s the way left on CT and small).

This leaves jejunum and duodenum. It is cut in cross section which means it would have to be retroperitoneal (2nd portion of duodenum). You can see the kidneys and descending colon way behind it. Likely not retroperitoneal.

This leaves jejunum.

submitted by hello(354),
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asleeP hlpe - how are yuo blae ot tlle htta the CT gaeim is tno at eth lleve fo md?ounude

I td'on oknw htaw I'm klgnioo rof ot mpecrao nda constart a TC at hte ellev fo het oueumddn sv teh TC eigvn ni shit .Q

submitted by iviax94(7),
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CT hwsos sasm no teh eltf isde of ihs anomebd and e’oryu ldto ’tis sipiu.cntnosuset ssAk wihch tapr fo het IG tcatr si omts leylki to aescu the ni.ap I matiilydeem dlkeoo for oaiclecel juicnton ... not na warsen i.cohec yWh si teh rawesn jmnejuu sv.( n?umddoue)

liverdietrying  The picture is key here. You’re right that ileocecal is most common, but ileo-ileal and jejuno-jejunal are the next most common (I think I might just know this from having done clerkships already, not sure). Ileo-ileal isn’t an answer, so that rules that out. Look at where the arrows are pointing in the picture as well. Its on the L, ruling out appendix and cecum. And the slice is not at the level of the duodenum, ruling out that answer. So by process of elimination based on the picture you could get this one too. +4  
dr.xx  Duodeno-duodenal intussusception is a rare because of the retroperitoneal fixation of the duodenum. +1  

submitted by lnsetick(97),
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Hwo era oyu able ot letl ttah the TC scile is otn at the levle of euoum?ddn

zelderonmorningstar  I think the small intestine narrows as you go along, so jejunum would most likely intuss into the duodenum. +  
yotsubato  Duodenum is fixed to the retroperitoneal wall, and also has lots of named vessels attached to it, along with the pancreaticobiliary duct and ampulla. It cant really intussuscept. +  
gh889  You should also know that the duodenum is almost purely on the right side of the body +32  

submitted by usmleuser007(419),
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tpsutsunoseIcni si eylealgnr udscea by a aclekgob in eht IG ttarc auceds yb a mtru,o lopyp, cet,ilirdmuvu or jsut iymoltiimb at arpt of eht .ctart

)1 yM gtuhhot wsa tath eth tietanp had a clMeke dcr ueltiimvu yse ti phseanp ni 2 etfe ofrm hte cciaoleel ;avvel tbu ahtt is in abuot 2% of teh ilooptupna

hpsbwz  Meckel diverticulum itself occurs in 2% of the population. Also it would present much sooner rather than in a 28 year old man. +1  
osler_weber_rendu  Meckels is an incidental finding in 98% patients. (only 2% symptomatic) It is a well known lead point for intussusception +2