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Retired NBME 18 Answers

nbme18/Block 3/Question#11 (reveal difficulty score)
A 3-week old male newborn is brought to the ...
Single primary development defect ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cbreland(195)
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A 3-week old male with a firm mass in near where the stomach should be. Seems like pyloric stenosis. From First Aid:

  • Occurs at 2-6 weeks old with non-bilious vomitting
  • first born males
  • no mention of a syndrome, sequence, or other associations

Just a stand alone defect

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j123  I was thinking it was annular pancreas. The question stem said vomiting after feeding since birth" whereas pyloric stenosis usually doesn't present until usually week 4 or so. I think annular pancreas presents very similar to the question stem and may also show a mobile mass in the same area? Not fully sure about the mobile mass part (since their description does sound like pyloric stenosis for that one). Either way, still "single primary developmental defect" as the answer +5
utap2001  Sequence describes the pattern of multiple anomalies that occurs when a single primary defect in early morphogenesis produces multiple abnormalities through a cascading process of secondary and tertiary errors in morphogenesis [17]. When evaluating a child with multiple anomalies, it is extremely important from the standpoint of recurrence risk counseling to differentiate between multiple anomalies secondary to a single localized error in morphogenesis (a sequence) and a multiple malformation syndrome. In a sequence, recurrence risk counseling for the multiple anomalies depends entirely on the recurrence risk for the initiating, localized error. The words malformation, deformation, disruption, and dysplasia sequence are used if the nature of the initiating error in morphogenesis is known. +1
utap2001  VATER syndrome refers to several birth defects that frequently occur in conjunction with one another. The letters stand for the areas of the body impacted by these defects: Vertebrae Anus Trachea Esophagus Renal (or kidneys) +1
kcyanide101  please is VATER the same thing as VACTERAL??? Also i think it is pyloric stenosis. If it were annular pancreas, wouldn't it present with a double bubble similar to duodenal atresia? It is important to note that a clear distinction between pyloric Stenosis and the other 2, would have been made if they informed us on the type of vomitus (bilious or non-bilious) +
agurl1000  VATER syndrome, also known as VACTERL association, is a term used when a child is diagnosed with birth defects in three or more body parts. The acronym stands for: V โ€“ vertebral abnormalities A โ€“ anal atresia (absence or closure of anus) C โ€“ cardiac (heart defects) T โ€“ tracheal anomalies in which the esophagus and the trachea (windpipe) donโ€™t connect correctly E โ€“ esophageal abnormalities R โ€“ renal or kidney problems and radial (thumb side of hand) problems L โ€“ other limb abnormalities +1



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