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NBME 22 Answers

nbme22/Block 2/Question#1 (48.5 difficulty score)
A 29-year-old woman is brought to the ...
Avulsion of hepatic veins from the inferior vena cava🔍

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submitted by humble_station(62),

This is another question testing the concept of spatial anatomy. If the surgeon is lifting the liver and then the bleed went from a small amount to a sudden massive hemorrhage, clearly this is implying the bleed is occuring behind the liver.

What structure is behind the liver? IVC

What connects to the IVC from the liver? Hepatic veins

Also the idea that the patient has been bleeding for 6 hours because thats how long it took until the exploratory laparomaty was prefromed means the bleed is most likely from a low pressure system... venous system.

submitted by haliburton(192),
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anlraytepp this si a conomm aeleuseq fo lboiamadn aa.rmtu

rf(mo inlk olwe)b wo-wteTytn fo het 25 tdeahs ewer eusdac yb olbod sosl. Tow setrpnat of ehapitc nsoevu uijnry pearaepd ot ndeprm:iatoe lniavuos fo hte trnuk of the irtgh petahic neiv rfmo the rfeniroi vane acva nda naisoulv of het erpup rbnahc fo het grith ceaphit


submitted by thepromise(53),
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sGeeuds no hsti et buon fi yuo kool tino gp 554335- FA 91, y'uol cioent hte rtucserut of het ICV reapocmd ot hte VC erli1I:v si lneat errotp2eroi: fi ectednta,sr li(airms to na aiomnbdal traao) bolod aectlcsuamu hndibe het uoireemtnp dan aucses everse yhvoloiapem 3: all othre arswens rae trihee oot ar,f ro iihntw teh itmneureop

submitted by alexb(43),
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tsI' salo ustj het nlyo onptio tht'as e""dbhin eth ielvr.

submitted by darthskywalker306(3),

I think it's more of a general type question. When a surgeon tris to slide his hand behind the liver; it gives traction to the liver and thus can stretch the hepatic veins and thus excess traction can even avulse the hepatic veins from UVC. That makes sense.

submitted by monoloco(125),
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nnAyeo slee frugie otu owh a seorugn tseg shi dnha iidens eht taeipnt dpee ugenoh ot ueaslv the ptceiah neivs mrof hte IVC ungidr a OARYOMT?LPA eBflsfa .me

mesoform  I think this one was pretty easy if you just know the regional anatomy. That was the only answer choice that could remotely have that presentation, so I think it was just testing your knowledge of the structures listed relative to the description. +2  
kimcharito  aorta is also behind of liver... +1  
medguru2295  I also didn't realize the surgeon's hands would so deep in he could touch the IVC on a Lappy....kinda eliminates the point of a Lappy.... +  
iwannabeadoctor2  "A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity." Exploratory laparOTOMY very different than LaparoSCOPY, which is what I think you may be confused about. One is a gaping hole from which you can observe everything, and the other uses tiny incisions and scopes. Even still, a hand port used during laparoscopy can allow for digital manipulation of organs as needed. +2  
bbr  I dont think the physician caused the avulsion, I think it was there already and he grazed the area. Causing it to fully avulse and break what ever clotting was going on. +  

submitted by angelaq11(58),
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I htnki seebids goinnkw abics onmytaa I( scuk IGB etim no na,ymota) we dluco mreo or lsse layies rleu otu mots fo teh hSe is ni ,ianp ubt ehs is awake dan hwti elasbt tvail nsisg n(vee tafre 6 souh)r os I nhitk liarerta gaamde duwlo eeditiyfnl lade ot a remo pirda ttoneodiearir. athT avelse us thwi eht toprla nevi dan het pechtai snvi.e The trploa niev (fi knoiwng orez amytoa)n sgbrin umch orem dbloo to het livre anth the phieact yatrre (if mI' tno n)amek,its nda so hatt aelevs ouy ihtw ylon the epcatih ev.sin