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NBME 20 Answers

nbme20/Block 2/Question#28 (31.1 difficulty score)
At a postnatal checkup, a 6-week-old female ...
Annular pancreasπŸ”,πŸ“Ί

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submitted by monoloco(141),
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rnalAnu pcsernaa si teh ylno sweran atht snctuaco rof the beli ni hte moi;vt fo eth ,cshoiec ti is teh only otoscrnutbi tdlisa ot erweh bile eretns eht GI t.actr

ergogenic22  Meckel diverticulum also occurs distal to the CBD but less likely to be associated with bilious vomiting +  
sympathetikey  Correct. Might cause pain due to ectopic gastic tissue. +3  

submitted by gabriela(5),
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olAs mya l:hep vEen guhhot eyht are otn DRILCEYT ysgina taht eerth si ufflitcydi enf,igde het loss fo gwetih datsnecii it in hsit asec.

auCses fo layre nefdgei c:iltfsuiedif + aunrAln asn e+apcr sachlohapeorTegea +ul tsaif udnDeola taserai

usCaes fo eatl fgniede ftisdlifei:uc + onaiCltneg ylripoc isesntso

submitted by draykid(27),

I have a hard time understanding how annular pancreas can cause bilious vomiting when I'm seeing many sources say it is either bilious or non-bilious.

draykid  Ok, so after doing a little research. It can cause both, but if the annular pancreas wraps around the duodenum distal to the ampulla of Vater then you get bilious obstruction. +5  

submitted by strugglebus(172),
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,soAl eMelcks ldowu ehav rbdsceei iomcahzeahte ro iaerflu to apss eoincmum

sugaplum  I believe failure to pass meconium is Hischsprung's Meckels don't present within the first few days of life, so meconium wouldn't be a factor FA 2019 378 +2