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NBME 21 Answers

nbme21/Block 4/Question#19 (30.7 difficulty score)
A 45-year-old woman comes to the emergency ...
Hepatopancreatic ampulla🔍

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 +6  upvote downvote
submitted by hungrybox(770),
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kaa umallpa fo eaVrt ro het trnhicaacetpeopa cdut

hungrybox  tripped me up cause I didn't know the names :( +11  
sympathetikey  @hungrybox same +7  
angelaq11  omg, same here! I thought, well, I don't know of any duct that connects the pancreas to the liver, so...2nd part of the duodenum it is :'( :'( +6  
alimd  actually Ampulla of Vater is located in the 2nd part of the duodenum. +  
mtkilimanjaro  I think 2nd part of duodenum could be viable if the ampulla was not an option. The ampulla is way more localized/specific to this scenario +  

 +0  upvote downvote
submitted by tamey(0),

im a little confused isnt blocking ampulla of vater(hepatopancreatic ampula) would cause obstruction of both pancreatic duct and common bile duct and in this case the patient would have cholangits too, not only pancreatitis!!!

divya  true but none of the other options cause pancreatic duct dilation. options a, b and c would cause obstruction above the level of pancreas. +1  
lilmonkey  It doesn't say ONLY pancreatitis, but just enough information to choose the correct answer. Maybe, in the test writers mind if they mention cholangitis and jaundice that would be too much hints :). +2