Great job everyone - Drs. Dey, Lazarow, Bulzan, and Trace got 12/13 possible points. Dr. Bonney got 11/13 points. Also congrats to @hopeforfuture3 who got 11/13. Thank you for your work and dedication! The current standings - 1. Dey (24/26), 2. Dr. Bonney (23/26). 3. Dr. Hampton (13/26). Everyone else is still in the hunt! On the nonresident hunt - Congrats to @hopeforfuture3 with 11/26 points.
1. C - per the article regarding Acute Mesenteric Ischemia- "The imaging findings are similar to and indistinguishable from acute superior mesenteric arterial thrombosis" that throws out option D. "Typically, patients over 60 (female predominant) with postprandial pain" - that rules out B and rules in C. Notice - B has preprandial pain
2. D - per the above article - "The severity of the injury depends on the extent of reduction of blood flow, number of vessels involved, the duration of the ischemia, and the development of collateral circulation".
3. A - per the above article - "Emboli...often enlarge the SMA...the diameter of the SMA is often larger than that of the SMV...relationship is reversed in normal healthy individuals"
4. C. - at multiple points in the above article - it is listed as a finding associated with irreversible ischemia.
5. B - per the Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury - Shearing forces are most pronounced at locations where the bowel is fixed, including the Ligament of Treitz, the ileocecal valve, and sigmoid colon. This rules in option B but excludes A, C and D.
6. C. - Granted this is tricky - but A is out as you could have pneumoperitoneum from penetrating injury in addition to blunt and many other options as described in the article; B is retroperitoneal; D is extraperitoneal and unless air was present in the bladder at the time of injury shouldn't have air to track to the peritoneum - intraperitoneal rupture in the setting of a Foley in bladder is associated with pneumoperitoneum as per article; Therefore C is left over as mentioned in the article as an acceptable answer.
7. D. - fluid should be simple to be possibly normal. It is only normal in 3% of normal males. Morrison's pouch is between the liver and kidney - it is a place to look for abnormal fluid in setting of trauma or other etiologies.
8. C - per the article - "When diffuse small bowel wall thickening of more than 10 mm is seen, it should be considered a sign of shock bowel"
9. D. Per Emergent and Nonemergent Nonbowel Torsion article - "Although ovarian torsion occurs in women of all ages, it most commonly affects the reproductive age group". I realize, there is a discussion of torsion of the normal ovary is more common prior to puberty - but abnormal ovaries torse more commonly than normal ovaries etc.
10. C. per the article, ovaries are usually greater than 4 cm, string of pearls increases specificity, endometriosis decreases the likelihood of torsion. "Pregnancy, particularly in the 1st trimester, is a risk factor for ovarian torsion."
11. A - Per the article - It is associated with elderly women with kyphoscoliosis and cystic artery calcification. No mention of obesity or fertility. Porcelain gallbladder and gallstones are not mentioned as associated per the article.
12. A - long ureteral length is associated with torsion as are the other listed items.
Bonus - D. Mad World by Tears for Fears
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