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NBME 24 Answers

nbme24/Block 4/Question#50 (23.2 difficulty score)
A 47-year-old man comes to the physician ...
Superior rectal veinπŸ”
tags: FA18p360 FA19p359 

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submitted by m-ice(340),
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sThi ittneap hosws ngiss fo icsh,roisr hiwhc is lkyeil aticseasdo htiw raplot eynpsnrh.tieo oPalrt nthsnepyeior llwi asuec esdirance ssrueepr in lal siven ginadnri toin teh porlta nei,v dan nac uesca inubggl fo eshte vesni at asera ewher etyh mtee osteh ttha drnia ot eth vena .vaca enO eaar is teh utrcem dan ans,u weher het ouireprs rltcea neiv (mofr the atprlo e)mstys esemt pu ithw the dleidm and onirierf actler nives ichw(h ndrai to eth calav es.tysm) Iardceens ruesespr in het ruiorpes crtela niev will useac mroohiredsh at tihs cntiaoo.l

submitted by ihavenolife(69),
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Pg 360 itsrF iAd 1029

ltrnenIa ohmsdrieoHr

liV-csare ntvnienroia (no pani le,ft) opeSrrui elatcr ,.a irSrupoe lterca vnie dsrain( to ,IVM) trInalen icail mhply deson


trxelEna hrersHomodi

tSm-coai iaentoinvrn yt(eh ,ru)ht nrfIrioe lrceta a., Iirfnoer elrtca neiv isr(dna ot tailnnre napldedu e)vi,n aSurcifilpe ainunlgi hlmpy odnse

kateinwonderland  Above pectinate -V:sup. rectal v -> inf. mesenteric v. -> splenic v. -> portal v -internal iliac LN Below pectinate -V:inf. rectal v -> internal pudendal v->internal iliac v->common iliac v->IVC -superficial inguinal LN (FA 2018 p360) +1  
sherry  Venous drainage above pectinate, most to the portal vein, some to internal iliac v via middle rectal vein. I think the real solid key here is that the clinical vignette suggests hepatic cirrhosis. +1  
moxomonkey  internal hemorroids are not related to portal hypertension β€Ί pmc β€Ί articles β€Ί PMC4691702 also FA 383 anorectal varices are. now if you check FA it say Pg 359 First Aid 2019 Anorectal varices Superior rectal ↔ middle and inferior rectal all of them include in the answers options so? +1