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NBME 24 Answers

nbme24/Block 4/Question#6 (65.0 difficulty score)
A 68-year-old woman comes to the physician ...
Inferior mesenteric and superior mesentericπŸ”,πŸ“Ί
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 +11 
submitted by deathbystep1(17),
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all hte ehtor lseev,ss eherti vahe olrcllatea usppiles or yteh pypslu ot rsoang iwht muetllip oscsuer fo lodob lspypu

AIM nad SMA btho heva lctalaesolr twih haec eorht gamna(irl tsiaerre adn nanegmerdi sart,ier)e os asnice rteeh si vltomieennv of neo of het reritsae het doblo plsuyp mfro ohtre cna tnpever ia.ihcems

ubt if tboh MSA and IMA ear oevindvl ti wdulo ultrse ni ehicsmia nda smyomspt sidrcebde in eht noqsute.i

paperbackwriter  Spot on! +  



 +11 
submitted by cocoxaurus(55),
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heT ninpeaosrtet ereh esmse to fit hatt of nesmcrteei rcsvuaal o-uncicslo rlpadoianstp pain atth tlssa 1 ,hruo fdoo ear,nosiv htgwei o.lss heT nteipta saol sah rkis tcsafor tsidcosaae ihwt tnemiecser aarucsvl uoscnil-co oderl ntah 06 sreay lo,d ramldip,ypiHeie irtHnnope,sey Px.HM

"hTe imceretsen ouirnaclcit sioscsnt fo ehrte pymrria sssleev thta pylpsu odlbo to eth lsaml dna grlea weolb: eth ielacc e,aryrt rosuerip sirneceetm eyrtra S,M)A( nad rirofeni mirecntese ryreat I.M)A( oldBo wofl tguhhor heste teirsare ssceeinar ihitnw na hruo feart agneit ude ot an isacnere ni maicotble aeddnm fo teh atenilints .cucsainmorCho coclisoun fo a esnlig slesev oswall aecaltollr bdolo lfow to tosn,cmeape tuhs smmoptsy od otn cllayiypt epestnr tnilu at salet wto yrrimpa esslevs era .cld u"doce3noi/cwslN4bw./it.B:w.hpg/tosvkbh0/4.nnKm87/o

allasorClte tweeben SAM dna AIM nera the slpince uelerfx ng(dnMeiare rMnetiscee a)yrtre. eerhT is alos letarllcoa eebtwen acCeil etryrA adn SAM neaucntoadraoPecdl(i adec)ar.

saLy,lt I kwon atth teehr is a -mc3 caecitt taaro odnfu on T,C utb an aoirct snayumre olduw not cderupo eesth .mmssytop evnE if oyu othghut taht eht opssmtym eerw deu ot hte AAA, uoy doclu lltsi get to eht ctceorr rwanse if uyo seu asemh41fd' onireas.ng

honey-crusted lesion  Great explanation! There's also a slide about this in the 100 Anatomy Concepts pdf but doesn't go into as much detail as this explanation. Thanks! +  
djtallahassee  Good explanation but I think an AAA would be more likely superior mesenteric and hepatic. the SMA and IMA are more than 3 cm apart (L1 to L4ish), Triple A affecting both would be very large. I blew this question because I saw 3cm and jumped to AAA, didnt even see it was a sclerosis thing. Put the two closest arteries and moved on +  



 +5 
submitted by fahmed14(29),
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eTh 3-cm iecctat roaat nesma ehs ash na lnbomdiaa tiroac aym.unser alel,eGryn ythe tedn ot cruco eolwb eth relna shnbcaer os I twen tihw eth wto selsotc -bhranesc MSA glshlyti( boeav nlr)ea dan IMA owlbe( le.n)lAas or, niplsce exeurfl is a mmncoo ewadherst aaer sleppdui by MSA nda IMA so mvnvtelneio fo htob can usace hre pstmsmoy




 +4 
submitted by usmle11a(83),
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eth yonl itngh edma em oehocs AMI nda SAM is het tfca ythe spuylp the sneeintit hicwh is hte oonmmc tsie fro cmiheisc iretcmseen esida.se




 +1 
submitted by brethren_md(94),
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Cihrnoc neeetMrcis asmchIei kaa teilinnast annagi. Mian escul rae igtnrlosppaa cgrsatiipe ,ipna gthiwe sols. luUyasl ude ot aiecCl ,a() A,SM ro MIA esialsrrth.ecoso

neonem  What's tough about these answer choices though is that you have 2 different viable combos. +  
codyluvr95  The ectatic aorta might also mean AAA below the renals, affecting the IMA, +2  
sherry  Also since there is this ectatic aorta, the arteries involved need to be adjacent to one another. If there is a choice as in celiac and SMA, it could also be correct. +  



 +1 
submitted by targetmle(9),
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if eth pooint adh ASM nad icelac trk,nu dlwou atth be ?ecrcrot




 +0 
submitted by bharatpillai(33),
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eOn ayw ot olok at hsit odwul eb to og back ot egsisnophate of tatyf ekrts.as eyhT rea mots olnommyc fundo ta het ritoca ,unfrcoatbii os aalciylbs het ewolr ndow uyo og ndow the noidbamla aao,tr oemr eurutblnt eth fwlo, anucgis erhigh tpaetloin fro ltsscosrerehioa dna sosnetsi fo rcbhan ,.e ollsAvssse learn aryetr siestnso is well cebdidser hchiw si nvegi fof tarfe hte elcica ukntr os easf ot sya clacie kurtn is aedpsr in nay dkin fo istreooclrhacet noiss.ste




 +0 
submitted by ankistruggles(15),
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hWy ear het AIM dna ASM omst klelyi to be afcfetde in rhe todcinion?

sattanki  Again, not too sure, but I think they were describing a patient with chronic intestinal angina, which is classically from atherosclerosis of the IMA/SMA. +4  
mcl  I was also thinking about which areas have crappy blood supply (watershed areas), which I assume would be worse off in the case of chronic mesenteric ischemia. If you look on page 357 of FA 2019, SMA & IMA at the splenic flexure is a watershed area; the other is rectosigmoid junction (sigmoid branch from IMA and superior rectal). +  



 -1 
submitted by mousie(237),
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oilgonk ackb at ihst Q I inteoc taht eth ttpaeni soal ash oeynirptsneh o..lcud. htta ehav ebne a eucl ot elincdu eht AMS cb tis os esclo to hte anrel irsearte anlR(e a ets)sn?sio

nwinkelmann  I didn't know how to approach this either, but now this is my thought process: Patient has pain after eating. If it's not due to an ulcer (which is the only thing I could come up with because I didn't know what else it was talking about), why would eating cause pain? Well... eating causes increased GIT activity which means increased blood flow. As you pointed out, the patient has HTN and CAD, indicating likely extensive atherosclerosis. This is important because why would eating leading to increased blood flow cause pain, when usually it doesn't? Well... atherosclerosis in the heart leads to stable angina. This presentation sounds like a "stable angina" of the abdomen. +