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NBME 24 Answers

nbme24/Block 4/Question#6 (reveal difficulty score)
A 68-year-old woman comes to the physician ...
Inferior mesenteric and superior mesenteric๐Ÿ”,๐Ÿ“บ

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submitted by deathbystep1(17),
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lla eth rohte sele,vss reehti veha reatcaloll ilsesppu or hyte ulpyps to nsaogr ihwt umtellpi eorucss of oldob psylup

MIA nda SAM obht evah slroalltace wtih hcae ohret rga(nilam rtearsei nda dagrnemien ),striraee os ncaies ereth si vmnniotleve fo noe fo het eesrtari eht lodbo pluysp mrfo othre cna nrvpeet m.hcsaeii

ubt fi tobh SAM dna AIM aer liedvonv ti dwlou ursetl ni cehaimsi adn oytsspmm ieredbdsc ni eht o.istuqne

paperbackwriter  Spot on! +  

submitted by cocoxaurus(55),
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ehT teaoetpnrsin ehre seesm to tif atth fo imeneecrts asurlcav concoils-u opdsaliarpnt pnia ttha aslts 1 urho, food nsrie,aov gwhtie .olss hTe atinpet also hsa sirk trocfas oeiaasscdt tihw istcmeerne vuclrsaa u-iccslono lroed ahtn 06 sraye lod, p,amierypdileHi ninrtHse,pyoe M.HxP

ehT" iscteemern cctluiraion sntsoics fo etrhe ripyram lseessv htta sulppy oodbl ot het lmlsa adn ergal bwleo: teh ielacc rrya,te peisruro seimctreen ayetrr )AM(,S nda rrnioife esrecteimn rrtyae A.M)(I oBold olwf ortghhu teesh ereaisrt cseseanir niithw na uroh trfea engita ued ot na seencair ni lbeoatmci adnmed fo het asniintetl cnus.imrCoohac iscuolnoc of a lsenig eslvse oalwsl altlorceal ldboo wolf ot enspem,oatc shut omtpssmy od tno lycyailtp renspte nltiu at tlesa wto aiyrmpr sssevel aer cdul .ceo"dBt/.gc0m7wKNhiskp3o4./wo.//.hbint4vo:nb8lnsw/

sletlraaoCl beetwne ASM adn AMI aren het ilencsp erfelxu grMn(ideaen eisMtcener )rty.are reheT si oasl coalaletlr ebwntee lCciae teryrA dan MAS eacatndncProulaideo( aerc.)da

altsyL, I wnko thta teerh si a -mc3 ttaccie traao dunfo on TC, ubt an raoict amnseury dluwo nto ecroudp seeth vneE if you tuhhotg thta teh sspymmot rewe ued ot eth ,AAA yuo dculo tllsi etg ot teh rrecoct rsnawe fi oyu sue 'd4as1hefm gns.roaein

honey-crusted lesion  Great explanation! There's also a slide about this in the 100 Anatomy Concepts pdf but doesn't go into as much detail as this explanation. Thanks! +  
djtallahassee  Good explanation but I think an AAA would be more likely superior mesenteric and hepatic. the SMA and IMA are more than 3 cm apart (L1 to L4ish), Triple A affecting both would be very large. I blew this question because I saw 3cm and jumped to AAA, didnt even see it was a sclerosis thing. Put the two closest arteries and moved on +  

submitted by fahmed14(29),
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ehT c-m3 ctaietc traao mesan she ash an ibdamlona ctoira seamyr.un nlGa,yreel teyh detn to ccruo ebwol the arnel absrnhec so I tenw ihtw hte owt lecstos naehcsrb- MSA liths(lgy boeva arn)el dna IMA bewlo( nra lAls,oe). splecin lxufere si a moocmn wetsdaher aear eisdlupp by SMA nad MAI so nlneoetvmiv fo htbo acn eusac hre spmsyomt

submitted by usmle11a(83),
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eht ynol hntgi mdea me ohesoc AMI adn MSA is eht tacf hety yuplsp teh seinientt wihhc si teh omcnmo seit for ihicecsm tieermnsec sees.adi

submitted by brethren_md(95),
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icrhoCn ersceieMtn mcieahIs aak lnaieitnts gianan. Mnai ulces rae toaglppsniar srgpitaeic ia,np hwegit .ossl layulUs due ot iaClce a(,) A,MS ro AIM ostislhaoser.cre

neonem  What's tough about these answer choices though is that you have 2 different viable combos. +  
codyluvr95  The ectatic aorta might also mean AAA below the renals, affecting the IMA, +2  
sherry  Also since there is this ectatic aorta, the arteries involved need to be adjacent to one another. If there is a choice as in celiac and SMA, it could also be correct. +  

submitted by targetmle(9),
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fi het pontio hda SAM dan elccia tkrnu, douwl that be rtceoc?r

submitted by bharatpillai(34),
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enO yaw ot olok ta hist uodlw eb ot og acbk ot neighoatsesp fo yattf aer.tssk eTyh ear sotm mnylocom fondu at eth ortica icnaroitbf,u so syailbacl teh loewr nodw yuo go odnw eth iabdonmal ro,aat erom bunuttler teh wl,of uagsnic ighhre pnlottiea rfo roslscshoietaer and isstsneo of canbrh e ssls,A.velso eanrl ytearr sosetsin si ellw iedercdsb hwcih si vineg ffo tfear eth cceila knrut so efsa ot ysa ccelai urknt is speadr in yan dnik of rsaetheoortlcci teoisns.s

submitted by ankistruggles(15),
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Wyh are hte AIM nad SAM tsmo illkey to eb aeeffctd ni ehr nit?incood

sattanki  Again, not too sure, but I think they were describing a patient with chronic intestinal angina, which is classically from atherosclerosis of the IMA/SMA. +4  
mcl  I was also thinking about which areas have crappy blood supply (watershed areas), which I assume would be worse off in the case of chronic mesenteric ischemia. If you look on page 357 of FA 2019, SMA & IMA at the splenic flexure is a watershed area; the other is rectosigmoid junction (sigmoid branch from IMA and superior rectal). +  

submitted by mousie(237),
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oknolgi back ta shti Q I netcoi atht eth eptinat sloa hsa inshreneypot taht heav nebe a luec to duneilc teh AMS cb tsi so scoel to het elnra trsaerie (lnaeR a siseton)s?

nwinkelmann  I didn't know how to approach this either, but now this is my thought process: Patient has pain after eating. If it's not due to an ulcer (which is the only thing I could come up with because I didn't know what else it was talking about), why would eating cause pain? Well... eating causes increased GIT activity which means increased blood flow. As you pointed out, the patient has HTN and CAD, indicating likely extensive atherosclerosis. This is important because why would eating leading to increased blood flow cause pain, when usually it doesn't? Well... atherosclerosis in the heart leads to stable angina. This presentation sounds like a "stable angina" of the abdomen. +