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NBME 23 Answers

nbme23/Block 3/Question#14 (reveal difficulty score)
A 3-day-old male infant with Down syndrome ...
Duodenal atresia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +11  upvote downvote
submitted by โˆ—sajaqua1(607)
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Duodenal atresia is frequently associated with Down syndrome, and is caused when the duodenum fails to recanalize during development. The infant presents with bilious vomiting, so we know that food is at least making it down to the duodenum where the pancreatic duct empties into the duodenum. This eliminates D (would present with nonbilious vomiting, typically a few weeks after birth) and E (would present with choking and vomiting immediately on feeding).

The presence of bile tells us that bile is getting to the duodenum, so extrahepatic biliary atresia does not seem possible (B). There is nothing to indicate that the child has an omphalocele (C) since the abdomen is distended with food that isn't passing, but the guts are still inside the abdominal cavity.

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 +2  upvote downvote
submitted by โˆ—alexb(53)
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Since there were "small amounts of meconium" I thought it couldn't be atresia. Turns out atresia isn't always absence of lumen, it can also be abnormal narrowing of lumen, allowing just a small amount to pass through...

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adong  I don't think that's true, atresia literally means closure/absence of the lumen. I also got tripped up by the meconium but that could be just GI epithelium that was shed while in utero etc. I wouldn't change your definition of atresia. +2
srdgreen123  one thing i would say is that in the case its due to failure of recanalization and not due to failure of formation like other types of atresia, so its possible that when it was de-canalized, it was not 100% closed allowing for some meconium to pass +



 +1  upvote downvote
submitted by sushibear(1)
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Question mentioned that pregnancy was complicated by polyhydramnios. I focused on that. According to first aid 2020 " Polyhydramnios: Too much amniotic fluid. Often idiopathic, but associated with fetal malformations (eg, esophageal/duodenal atresia, anencephaly; both result in inability to swallow amniotic fluid), maternal diabetes, fetal anemia, multiple gestations"

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