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 +3  (nbme22#35)

Is this saying there is vesicoureteral reflux? I could have sworm this same image was on form 20 or 21 and the answer was Wilms tumor

hello  Yes, it was. I think in both vignettes, the picture was basically irrelevant. Or another possible clue -- but definitely not needed to answer the Q.
presidentdrmonstermd  My school uses old "retired" NBME questions for exams and I've also seen this exact same picture multiple times...w/ different scenarios I think. I tried remembering what the questions were but I guess it's mostly irrelevant.
hyperfukus  SAME
hyperfukus  I also put wilm's tumor bc it felt really familiar wtf

 +1  (nbme22#18)

Is the grey supposed to be a suture? If not why would this not be wound healing therefore granulation tissue?

asapdoc  If you look at the picture you can see the epithelioid and giant cells. I only picked granuloma because I remember seeing a similar picture in Uworld.
dentist  granulation tissue is a part of the normal wound healing process, and happens within the first week.
castlblack  I agree I looked at that grey blob and thought foreign body --> granuloma

 +1  (nbme22#44)

The wording of this question confused me. This is asking "which of these vessels is the high pressure system" right? So the high pressure superior rectal is causing increased pressure into the inferior rectal?

welpdedelp  Superior rectal comes from the inferior mesenteric vein which comes from the splenic vein --> portal veins Thus, this dude had cirrhosis so it would "back-up" into the superior rectal vein. FA 2018: p360
nc1992  Superior rectal not superior mesenteric. Took me a minute
hyperfukus  ugh am i ever gonna get these right EVER
titanesxvi  why not the inferior mesenteric, since the superior rectal drains there
thomasburton  @titanesxvi think it is because question says direct which is why superior rectal
lilyo  thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein.
thomasburton  Yes exactly, so they do eventually reach IMV but not 'directly'
pg32  Also worded poorly because the varicosities are connections between the superior rectal and the middle/inferior rectal veins of the systemic circulation. So the blood could be in both the superior rectal vein and the middle/inferior rectal vein as that is what a varicosity is.
snripper  You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding.
jesusisking  @titanesxvi DrDoom explained it pretty well below: "Defining tributary: https://i.imgur.com/2zDxPbW.png Nice images make the term easier to recall. Smaller streams "pay tribute" to larger rivers (by flowing into them)"

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