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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.
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.
I also put wilm's tumor bc it felt really familiar wtf
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.
granulation tissue is a part of the normal wound healing process, and happens within the first week.
I agree I looked at that grey blob and thought foreign body --> granuloma
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
Superior rectal not superior mesenteric. Took me a minute
ugh am i ever gonna get these right EVER
why not the inferior mesenteric, since the superior rectal drains there
@titanesxvi think it is because question says direct which is why superior rectal
thomasburton, so are they asking what vessels do internal hemorrhoids directly drain into? The order is Superior rectal vein--> Inferior mesenteric vein--> portal vein.
Yes exactly, so they do eventually reach IMV but not 'directly'
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.
You just gotta know indirect vs. direct hemorrhoids. In this case, it's an indirect hemorrhoid (superior rectal vein) because of the rectal bleeding.
@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)"