NBME Step 2 CK Form 6 Intramural hematoma of the proximal small bowel (NBME Answers)

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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#30 (reveal difficulty score)
A 67-year-old woman is hospitalized because ...
Intramural hematoma of the proximal small bowel 🔍 / 📺 / 🌳 / 📖
tags: GI marked

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submitted by ∗jlbae(159)

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↑ INR (↑ risk for bleeding)

drop in hemoglobin from 13 → 7.8 in 24 hours and tachycardia (signs of acute blood loss)

epigastric guarding (signifying proximal location of the bleed)

negative FOBT/rectal exam (blood is not making it out the back end)

vomiting (partial/full obstruction from hematoma)

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submitted by ∗beeip(141)

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A precipitous drop in Hgb effectively rules out malrotation. Overaggressive anticoagulation is associated with intramural hematoma.

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submitted by ∗step_prep7(71)

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Patient recently started on anticoagulation with a severely elevated INR (therapeutic range is 2-3) and rapidly dropping hemoglobin

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