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NBME 17 Answers

nbme17/Block 1/Question#14 (10.7 difficulty score)
A 21-year-old man comes to the emergency ...
Inferior rectal veinπŸ”
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 +5 
submitted by lfcdave182(30),

Pg 366 FA 2020.

  • Below pectinate line: External hemorrhoids: Painful if thrombosed: Inferior Rectal Vein.
neovanilla  Note: pg 365 FA 2020 states: anorectal varices: portal <--> systemic: superior rectal <--> middle and inferior rectal. Not sure if that's correct, but definitely the info cited in pg 366 is correct +  
cheesetouch  FA 2018 p360 +  



 +5 
submitted by lpp06(26),

Hemorrhoids are dilatations of arteriorvenous plexuses in the rectum. Blockages on the arterial side will not cause the plexus to fill while venous thromboses will cause a back up of fluid.

Clues for hinting which vein are the location at the anal margin and that he was in extreme pain. External hem's will be painful, pointing towards inferior rectal as the answer since it drains below the pectinate line where external hem's are found.

skilledboyb  anyone know how to rule out middle rectal vein thromboses? +  
prostar  it is just that when both are in option go for inferior rectal vein. this is more apt. or else both are correct. +