‘1.45 yoar-lé woman undergoes endoscopic otogradocheangiopanceatotapy (ERCP for svokation of suspected bil strictures The ERCP ienofes 2 ducts n ‘the pancreas a smal venta ct and larger dorel duc, A logos ota congentalpanceat anomaly mado, Whi of ho folowe satoments Best everest anomaly? | Most of the tnt wth his condition present in ath hdd with abdominal symp {sae congorta anomaly ofthe panctoas Patents with recent episodes of pancreas et this ‘ondtion donot requre any iterventen 1. Magn resonance cetangooancrestography (MRCP) scanning ofthe abdomen is the mst senstive noninvasive lagnestc tecmique forts condition £ Endoscopc utasonogiapy reveals 2stck sgn patents with Bsc h e‘1.45 yoar-lé woman undergoes endoscopic otogradocheangiopanceatotapy (ERCP for svokation of suspected bil strictures The ERCP ienofes 2 ducts n ‘the pancreas a smal venta ct and larger dorel duc, A logos ota congentalpanceat anomaly mado, Whi of ho folowe satoments Best everest anomaly? | Most of the tnt wth his condition present in ath we hdd with abdominal symp {sae congorta anomaly ofthe panctoas x Patents with recent episodes of pancreas et this % ‘ondtion donot requre any iterventen 1 D.Megnete resonance chelangopancreatceraphy MRCP] scanning 45% ‘ofthe abdomen the most sontive nen nveeve diagnose tectique orth conction| £ Endoscopc uasonogiapy reveals astck sein patents wih 13% Resul B bsctto ttExplanation: ‘Comet answer D: Finding 2 ducts inthe pancrssa small vena duct anda larger dorsal dc ssuggostno of pancreatic isu s00 mage Dolow. neroaie dvsum fs tho most common congenital anomaly of the pancreas. Pancreatic dvs s usually asymptomatic and identid cinta at wich ‘me veatment snot necessary. Symptomate patents present wth ect episodes of pnceats, clon pancreas, cron abdominal pal. sich pent, endoscopic or sugialintventn is Benfica Endoscopic etogrde cholanlopanceatosipty (ERCP) tbe mest usta ‘modality fo dagress, bit ERCP iwoiv seca cause comple mos Magnet resonance cholagiopancestogropy MRCP fe nceasngy ulzed Larasound (US) sugges te possbaly of pancreatic evn. CT scanning of ‘the abdemen may isettyataton ofthe dorsal duct and changes consistent wan pancreas, bu CT scanning is ot snstvo enough oennypancteate oli eal} Related Videos: © Lae Pee: ns sme First Aid References: Fst Afr the USMLE Stop 12019, 20h 0: 354 Fst Ad forthe USMLE Step 12018, 25 ea: 353 Fst Ad forthe USMLE Step 12017 27 dh 345‘Option A: Most ofthe patents wth panczentc dsm are asynptomt ot ‘the anemaly is dlagnesd incidentally; however panceatie visu con resent cicaty with reaurert pisses of panceatts,elvonicpancats, fd eran sbdomin! pan ‘Optom B:Panezeate vim fhe most commen congental anomaly of the [antes Parenti diem acces in 10% of he papstion, ae on trent autopsy sors ‘Option c: An mpotant cause of symptomatic pancreatic dvs nceesed [esvac‘Option A: Most fhe patents wth parent dsm are asyptomat an ‘the ancmalyislagnesed incidertally howeve pancreatic visu con present cicaly with reaurert pisses of panceattselvonicpanceatt, fp tron socom! pn ‘Option B: Pancreat cvs the most commen congental anomaly of tho [panes Parenti isum acces in -10% ofthe popultion ea on trent autopsy sos ‘Option c: An mportant cause of symptomatic pancteat dvs nceased ‘minor pila ica decomprersion cn he achioved by endorcopc mar apa sphncetotomy wither wanout steran,o anor pap Sphinclercomy ond aphinclropeay. ‘Option nna win norma enatmy of he pancreas, ring pancrencobiioy imaging by endoscopic urasound (EUS. stack ig’ may be veuaized, in which thee and panceate ducts canbe seen tun pati ‘trough the head othe pancreas. Ths signs uualy absent patnts wth 2 panerente dvs Looming objective: Nogretic reconsnce cholagopaneestogrnty WACP) > the peteednon invasive agnor technique for agreeing panerete re‘8 2year.o1d boys bought oe emergency department by his mother fr ‘valuation of sovere abdominal pan that bogan one hour ag. On examination. the Pent ble ana nae ote rebound tandemess uth sete epigete pn & Stool uaia test postive A smal owe poreationsuspectod Whats tbe ‘mbryetogc suche thats the undering cause ofthis patents presentation? © A Vermiorm appendix © B.Analmembrane © D.Mitine duct © Eclosca Bsc h e‘8 2year.o1d boys bought oe emergency department by his mother fr ‘valuation of sovere abdominal pan that bogan one hour ag. On examination. the Pent ble ana nae ote rebound tandemess uth sete epigete pn & Stool uaia test postive A smal owe poreationsuspectod Whats tbe ‘mbryetogc suche thats the undering cause ofthis patents presentation? ii 8 Anal merbane a © Dov dct om E-cwsca von Resu @ Comect Explanation: ‘corect answer D: This patent i presenting with pefraon ofa Macias Related Videos:: : Gonect " * Explanation: Related Videos: orc newer : This patos presen wth peeraton ota Meas manana ‘ivereiom The vetne dt enemas tom he teu aureg development ot) Nan ‘tho gu Ts duct usualy ogressos completly (S00 mage Deow Pech Meckels Deru oH First Aid References: Fst Ad fr the USMLE Step 12019, 20h: 378 Fst Ad forthe USMLE Step 12018, 28h od 378,600 Fst Afr the USMLE Sep 1 2017, 27h ed 357,585. Howover 3 remnant may pest. which Ishnown a6 Meck Gericom land satu dvetialum. Mary rmnants may have ectopic funciona gastric ‘or pancroatictissue, which wl eventual lead to peroraon. a occured in {hs patent Meck vertouam can be recognized ning thee of 2° 82k ec e acecal ale 2a es aT bectucioHowever a rennant may persist. which Isknown as. Meckesericuum and sa we dvetcuum Mery rermante may have ectopcfunctona astic ‘or paneoate tissue, which wil vertu eadtoparoraon as occured in {hs pert, Mec vert can be recognized ing thee of 2¢ {within 2fet posal tothe Heocecal vale, 2 inches in lng, symptoms ‘sual present by 2 yous af age, alocts 2% oho populaten a 2 kinds of ‘cto issue). Ths patents presentation of perforation wih diss ledeminal pan suggests a Meckasavertclum, ‘Option A: The venom appenicea ingerte ects tat bud fhe coaum near te foococal vv. The enbryeteg eign ofthe vermtrm appends the cecal mucosa, which buds off and olngates as the gu forms ‘This rts hae an uranoin facto humans ta common ake of jpatnelogy, Aopen cuts most ten when the appendix: Backed by appercts present wih migrating abdominal ai bein atthe umbicus and mitates ote ewer quadont at McBurney’ pot, noted vet, and laukoeyios. Append can progres to prfration andr ina. abdominal abscess fomatonn some patent. This patents pet ebsng ‘Sons ot appends oer than cedorana pan. Addtonaly.appenaiats is falas commana M5 ag2 buts more Maly in ssescanea ‘Option B: The anal membrane ayo f cutaneous tissue covering the ana ‘opening, Thismenirane regress ding the devlopmet of he ‘geavoinestalsystom; however the anal membrane may pert. causing an sbroraltes hat resemble the lock of on anal openings snot crested In tmayy manner the cis wil not be able ta defecate, seu lest 9 Vai of complicates. Including toc megacson and feclet vot. Ths Ewa —ota commen atti age buts more lyin adlesconce ‘OptonB: The anal membrane lye f cutaneous tissue covering the ana ‘pening. his montane rgieses dung to devlopmar fhe ‘sles systom; however the anal mernbrane may perc. cauing a Umparerte ani or ann siren The wil rent taal anatomic lbnormaltce thet resemble ho lack oan anal opening te isnot cnectod In atimoty manner, the eid wil ot be able to defecate, wich il ead to 9 ‘arity of completo, nding tox megacoen and feculet vert. THe ‘may ao cause a perforation: however, would occur eer iif ana ower ‘nth Glvet (ost oon inthe elon) making Us on ural ogra ‘Option: tore ho fomaton othe abdominal al the ombayalgic bowels ave a physcogichemiaten trough the abdomen as they rotate 1 thet fal pesto. As the abdominal wa ferns, any atlachnent pont between he gu fd the abdominal wal may frm Hxeus cord. Ths canoer, expec in ‘he formon of Meck vereki, These cores can cause malotaton of ‘the gutand possibly vohadus wth subsequent bowel btu, This patient's ‘rorefaton fenct consistent wn bowel abtucon, making th an unlly agnosis ‘Option EAs on ombryo fs devsopig separate urogenital and rectoanal [atnuys, are ra be rn hen thee wo cepa eytem empty to 9 ‘omman chan known as cloaca, This doacal opening can posi, usu In ils, which wl reset with mised substance excretion fom te anus, ‘vagina, ruta, Tis cn present gross, wth obvious eda becemaltes,o may preset wit perma extemal anatomy wth recurent ‘nection or gross mixed errors, Tis pion nol preceding wih ‘Symptoms mica ofthis, making ian unlike anos, Leeming objective: Neca veri ore vertu ofthe lsum Bsc tt‘strolls hn resemble theca an ona opening ts snot cores Ina timely manna the child wi not be able to defecate, wich wi eed to a ‘ai of complicates. nding tac megnesen ana facut vont. his ‘may abo cause a perforation: however, woul occur eae ine and omer Inthe Glect est con nthe colon, making tis an unl lage. ‘Option c:etore the fomaton othe abdominal the embysigic bowels ave physicogichemiaton trough abdomon es toy rota thet tal positon. As the abdominal wal forns any atacmont pont between he gut Spine abdominal wal may form frou core The can ones expec in the gutand possibly vohadus with subsequent bowel obstucon. This patient's rerefaton enc consent th bows obarucon mak the an unesy ‘agnosis ‘Option EAs an embryos developing separate urogenital and rectoanal ‘atnways, eros a bre io when thes wo gan sytem empty i a ormen chamber known asa conc. This doscal oping can persist usualy In gis, wich wl recent with mbed substance excretion tom te anus, ‘vogia, or uta, Ts en present gos, wih abvous oxara orale, o may present wit perma external anatomy wth recurent Infections x gross mixed excretions Ths patent ot preset with ‘symptoms naicatvo of mis, making Ian unikaly agnoss. ‘Loaming objective: Neca voriculum 2 rue vertu ofthe oun thats remnant ofthe vetine dt. Mechs Svercula i arsorlated with _ectople gate ae pancrestic sue, which may ead operoation, mostofen by 2 years of age Bsc‘A Syoarold tis rouge oa medical oe er evaluation of past abdominal pon that has worsened over the past 24 hours, Tho moter tales hat th ofr hoe conetpaton wnch hae verasned overt et cy. The other dni tht ‘the gk nas nad body stots. The gt nas nathad a bonel movement passed fatulnce in72 hous She hos omit 3 mes sine Inst right and refuses to at ‘She has ne sicatmeeleal History, ncuding ne story of surgeries. On exam, tampon. Whal i the met ely nrg caus of the i's pers? A Voratus © 8 Maotaon ofthe gut © € Pye stonoss © P.Duodenal area © E Mocks dericutm Bsc h e‘A Syoarold tis rouge oa medical oe er evaluation of past abdominal pon that has worsened over the past 24 hours, Tho moter tales hat th ofr hoe conetpaton wnch hae verasned overt et cy. The other dni tht ‘the gk nas nad body stots. The gt nas nathad a bonel movement passed fatulnce in72 hous She hos omit 3 mes sine Inst right and refuses to at ‘She has ne sicatmeeleal History, ncuding ne story of surgeries. On exam, tampon. Whal i the met ely nrg caus of the i's pers? A Vvohatus 258 8. Mattaton ofthe gut om © .Pyere stonoss ws .Duodena ares om Meckatsaertcitim We Result: B bsctto ttExplanation: Covet newer ste midgut fons nenbolgk development Arcdegoee dengetonadroaton afore tmnt al suche the wet Th gene occ before foraten te donna yaa ho teem contents oe pysclogeaty het The songon orton ston tthe carat ope towel at frm oad geen, Ae voces ore ne utean nearly resect tneion noma of te gt sich es matoiaon bee nage below Related Videos: © essen ‘ros neste! Makotaton First Aid References: Fst Ald forthe USMLE Step 1 2018, 28h ed): 379 Fst Ad forthe USMLE Step 1 (2017, 270 eh 367 B bsctcho ttFirst Aid References: Fst Afr the USMLE Step 12019, 20h o@: 379 Fst Afr the USMLE Step 12018, 2h: 379 Fst A forthe USMLE Step 12017 27th dh 367 a fon ‘Many patons wih mattaton of gut have no symptoms. noe ‘matotaton ofthe out generay noted when the ent hos inaging ofthe ledemen for another eaEen Some patents vl develop a bowel bstucton, ‘specaly et an cet age. Ts patent presented vith aymetoms ot bows! ‘obstruction. most kay a smal bowel obstruction. Due to this paints age and lack of pthelogy smal bowel obsructon du to malotation ofthe guts the most key cognoss. ‘Option A: Vlas oceus when a loop of tstine ists around sa or he motentery causing cbatnuon and necoss othe lop andary other ‘truce ewppled bythe blood vests involved Vota most olen occas In chlen othe ede. In chen, volvulus usualy duet martaton ot ‘ho ut tne megocelon, of Rous cor Termin tom abdonal wa Reis‘Option A Vlvus occurs when aloop of tctne nists around ator he masonry, causing cbstucion and necoss othe op and ary other sructires supped bythe blood vessels involved Vos most often occas In chen or the ler. In cen, volves usualy duet marotaton ot ‘he gut tse megacclon, of Rous co fermion tom abdonal wal rermraes Symptoms clad at severe adominal pain wth bloody curant Jey soo. Patients may also presentwh mptoms of sma bows! ‘bsuucton such asthe plesontaton nts pais. The abdominal pat willbe sudden, not radu as inthis paint. (Option C: Porc tenors duo to ieopathichypertophy ofthe plo phic leading obstruction, Porc stenosis sume in that occurs 2-6 weeks ater bith Pyle stenosis occu na chld who had nomal feeding ‘abi at tor eens pojecto, on teu vonzing, The cd vl xasent th characters ‘ve mass inthe abdomen, which represents the yperophic pyloric steno, Continuous voting of gaetc acd can progress temetabole alkalosis and volume conracton. Tes patents age and _sympoms are not consistent wth this sease, mang pylori steno Uy ‘OptonD: Duodenolaoxinis flue ofthe duodonum 6 recanaze afer fotaten of tha weartnal cers cing inautnin development Theis ious voriting ean fe; bko enters to asacenam but Toad cannot ‘roars trough tho smal morte The prox dodenam aed stomach Decome dnt ith ingested materi ending to 9 ‘Sule bubble sign on ‘maging ae abdominal dstonsin.Ouodenal aves assocaea wth Down ‘syndrome, Whae venting early in te artocted wits duodenal obi, he age of he patent and presenting symptems ako duoeral atresia an urchy dagnoss. ‘Option E The eine dct exten fromthe Seum dung the development of tn gut The duct usualy greases completa nowover a ronan ay [esvac‘smptoms fe not consistent wth this sease,mikng pyri senoxs uri, ‘Option: Duodenal atresia is afalire of the dodenum 0 reconaize afer rotaten ofthe eestnal viscera dung ivauterie development TREresuts in ious woritig ey info; bke enters to auacerrn but Toad cannot ‘proms trough the santos The proxtalduodonam ae stomach become dst it ingested materia ending to 9 ‘Sule bbl’ sign on ‘meaing ane ebdominal dstonsion.Oucdenal aves assocaed wth Down _5nrome. Who vortng ex in fe associ wit cuodonal acl, tho ‘ge of he patent and presenting sytem make duodenal atresia an unicly agnosis. ‘Option E: he wetne ct extends om the Aeum dung the development ot Ja Tae gga ay eae eral rh erst whichis known as @ Meck dvericulan andi 3 tue vertu ‘Many emarts may have ecopl functional gst or pancreatic sue which \wtlevertuay cade portation, as occured Ns pation Mockars ‘lvertclum can be recognized sing thereof 2 2 fet proximal ‘the leacecal alo, inches in lngth, symptoms usualy present by 2 years of age, eects 2% othe ppusaton and 2 kinds of acta su) Medals ‘vertu can cause a mail owe ston ce to 9 Rous cord emant attached othe abdominal wal: however. th pln dd net present leh symptoms of Mocks voriulam. makng Han elk cause oth patents bowel obsturton Looming objective: Natotaon ofthe gut caused by inopropiate “embrylogirotnon ans slongton oth gt The ea ess to era bows ‘ebstucton but may aso be a benign conan. Bsc‘42 you.la woman presents tothe emergency department in actve aber Se has hod no pron care ads uae of the gesatona age. Labor progresses aptly nd pontansovs vagina diver fa Baby boy oeere hore ae preeatston (hints oram, to ehiais 19g (218th a smal head andaw. Thora protrusion from the abdominal wal that sa stk tte containing infesting a5 ‘an be sen nthe cir, What comple aton fe closely ecocatecwth the 8 Lack abdominat wal muces (¢ Detyeraton and necro of bowel Thang ofthe bowel round tot‘42 you.la woman presents tothe emergency department in actve aber Se has hod no pron care ads uae of the gesatona age. Labor progresses aptly nd pontansovs vagina diver fa Baby boy oeere hore ae preeatston (hints oram, to ehiais 19g (218th a smal head andaw. Thora protrusion from the abdominal wal that sa stk tte containing infesting a5 ‘an be sen nthe cir, What comple aton fe closely ecocatecwth the 8 Lack abdominat wal muces (¢ Detyeraton and necro of bowel Thang ofthe bowel round tot‘42 yoar.l8 woman presents tothe emergency department in ache abot Sho hos had no prenatal core and is wns of the geta¥onal age Labor poxresees ‘ply 2 spontanscu vagina eluery of» Baby boy occur 3 ovr afer prseaten. Of itl ex the chi 19 kg (2B) wh asmat oad ae ow "There potion em the sbdomina wal hat ck suc containing Intestine, canbe sen inthe pcre, What completion lee aesocited wth © 8 Lack of abdomin wal miscles 20% (¢ Detyeraton and necro of bowel 8 Thang ofthe bowel round tot 20% Result:Explanation: Comat answer: This pants presenting with an omphslocale, an bina wal dofect chracterizd by protrusion ofthe abormina cay Content ns peroneal ae trough an umlea deck una at devscgment here i tine mn wich a physiol hemi ofthe outs outside ofthe abdominal cary. This allows fr elongaton and rotation of {ho natna. this doesnot ppropratolyrecade with nema tao, an ‘mphnlocele wires, Babies bern older women ave at her rk for ‘developing thie conplicalon ae wel as babies wth genetcabnonmates, Such 6 Eawar' syne sony 1) and Pata syeome sony 13, ‘The most commonly associated mbryologi abnormal Isa heart detect. CCerdac nome ae the most common cause of dost in these patents and shouldbe seoened tor mmeditey This patent's presentation Is constant wih an omphaocae, makng cardiac defects te mest commen ad pont lethal compiiation, ‘Optom Ac Duodenal aesia isa congenital synckeme cheraterzedby complete cosue or a ind pouch ofthe duodenum Tis ead tothe cbse “double bubble’ sign on Xa, asthe pouch ofthe duodenur and stomach Eats Related Videos: © steers onste First Aid References: Ft Be forthe HEME Sep 1 0H0, 2h 259 Fst Ad forthe USMLE Step 12018, 28 oa: 352 Fst Ad forthe USMLE Stop 12017, 270 e340,‘Opton A: Duodenal atresia sa congental syndrome characterzedby camplte desu and pouch ofthe duodenum This oad tothe caste “double bubble sign on say. athe pouch ofthe dodenu and stomach ‘become sweden wth ingested contents, but are separate byte pyloric Sphincter Duodenal aesta present win stous vorstng and per f2eang tates no area net fetines, Ths conden thy esa’ wh Down syrome trisomy 2 bt has no assocaton wth abdominal wal {elects oan omphelecse,mokng tan urikely dagnoss ‘Option B: Compete ak of abdomina wall msclesis associated wih pune Daly syndrome. his synatemo hes 3 charactors feats: ack af addons wall muscles: ryptrchesm: and un tact anomaes. Exel, he skin of the abdomen is wrinkled thea prune, dueto the ay to visualize the ‘contents of ho abdomen. Ths condition rate and eimoe oxcusoly occu Inmols. The most serous completion ofthis syome i associated wth ‘rnary Senora tat cn eee shea bladder amon, ‘Option c:Gaetroscne ie ave abla wll cect haratzed by ptatusen of he zestnestaough to abominl wal Th tstns aro not covered by 3 portonea zc ad donot pete trough an umbilical defect. “meena coms of Bland einer ere ee ‘ate of gastosenkis in younger mothers ana hase who use alchal tobacco cure pregnancy. Becaute tho intstines erent covered by 3 ayer of peritoneum, the netines can become cy ad necote lading to destruction ‘ofthe associated intestinal loop This condtion wa ead to death ie Latent. This patient is prosenng wih ntosta rofruson with he presence ofa peroneal sac. making this ages uke Option: Volks occurs when oop of intestine tts around Hse rhe resetn, oun eben an nttaofeep an ay ber eas‘rary abrermaliies tat can led to Keney and adder mone, Option: Gastoschins is nave abominal wall defect characte by rotusien ofthe testes hough te abdominal wal Te tetnes are not {covered by a pottonel sac an donot pete tough an unbaeadetoct “The undoing cue of is condo surkrewn,ahcugh thro ia higher rate of gastroschise nyounger mothers ana those who use aleaelotobaeco ‘ung pregnancy. Bocause ho tastnes er at covered by a ayer of pettonoum, the netics can become dy and nocote leading to destruction ‘ofthe associtd inten oop This contin wl ead to ath ie \unvecta. This patent's prosensng win ircsta promusion with a ‘presence ofa peritoneal sac, making this agneis unio pon: Vols occurs when soap finlsino tite wound se othe mesentery, causing obstruction and necrosis ofthe op andary other Sructures supped byte blood vessels involved Vos most often occurs In criten ote ly. In cen, vv usualy duet maton ot the ot ose megoclon, of Rous cord fermion fom abdonal wa ‘remnants, Symptoms clude acite severe abdominal pain wh bloody “carant {el ston, Patios may als present win symtoms of smalbowel ‘bstucton There are no extn signs of vows ad an onhalocele not ‘lovely assole with vols although thi isa posable compleaton. ‘Leaming objective: An omphalecle san abdominal wal detect caused by ‘marotaten oft gut ing dovelepmert. The presentatloninckses proen of etestines in 3 pertoneal oe rough an unteal defect. An ‘Sriplocsle else seecernted wth cade defo ne genic Bsc‘8 2ayct boy ast pas mecontun ortho st AB how's off, Ho was bom a ‘mo. heathy 8 sarod woman after on uncomplicated pregnancy. bith, Ns ‘wolght was 39 (8.6 nj athe time of presentation, he weighs 28k 841) His al sins ate 2 otows: bod pressure TSO mn Hg, hear ata BOM, respratery rate 33min ane temperature 320°C (G86). On pysial xainaton hes sy ae appears iy dehyerated Bowel sounds are acive.on ‘useltaton Hs abdomen lly distended and.no masses can be detec on ‘ato. Th pins ors patent. Peeper patos std wih oral ‘onrastderonsatesnommal aratony lower gases sels wth baron enema eveasa lage amount feted botun contest wih a dated sigmotd beyond 24 hear ter admstaton, Wich a he follwing best deecoos te cause ofthe patients symgtons? © A Fatur otnewal ost cts to mate caudal oteetna val rig eminyogeness £8. Derupton of apoptotof esti alls (© Hyporropny of te muscular ayer ofthe ower sigma con © D.Prepoting eta poly daly by presale © E Decreates blood suppy o developing teste nthe embryo patedLeave ‘8 2ayct boy ast pas mecontun ortho st AB how's off, Ho was bom a ‘mo. heathy 8 sarod woman after on uncomplicated pregnancy. bith, Ns ‘wolght was 39 (8.6 nj athe time of presentation, he weighs 28k 841) His al sins ate 2 otows: bod pressure TSO mn Hg, hear ata BOM, respratery rate 33min ane temperature 320°C (G86). On pysial xainaton hes sy ae appears iy dehyerated Bowel sounds are acive.on ‘useltaton Hs abdomen lly distended and.no masses can be detec on ‘ato. Th pins ors patent. Peeper patos std wih oral ‘onrastderonsatesnommal aratony lower gases sels wth baron enema eveasa lage amount feted botun contest wih a dated sigmotd beyond 24 hear ter admstaton, Wich a he follwing best deecoos te cause ofthe patients symgtons? | Fale of noutal ot cts to migrate caudal to testinal wall 76% rig eminyogeness £8. Oerupton of apoptoof asta alls oo © CHypeopty ono muscular layer ofthelowersgmoxicoion OK © Propoting ofa polyp distally by portals ~ £ Decreases blood suppy to Sevelopingnostne nthe embryonc 6% patedExplanation: ‘Comec answer A: This 2ay- patent presents wih the absence of ‘meconium passage a abdominal stanton. The dfrentalineides Cyc ‘roe, aden or nal siren, meconium tes, and Hracheprina deere, ‘Duodenal evesia'stuled out ar anormal upper gastrointestinal study. The subsequent lower gortrointestnalzorioe with barium enema showed dation ‘ofthe sigmoid colon wih normal rectum. whieh is highly suggestive of Hischsprung disease This flndng must be confirmed with eps Hiachaprang douse sone ofthe most common causes of pela bowel ‘batucton Ives om th absence of gangiain tho asta ean whieh lends to action obsrcton. na normal bowel wal here re two neural ploxuses: myenteric or Auerbach plus} and submucesal(elsener ples). ‘These pluses can function axtonomcaly duo to the presence of pacomakar «alls (os koown a Cala cols). They rove the proper pertaic muscle ontracton to pass the bowel content rrough Neurons of these pluses come ro he vagal an soca segments ofthe earl ces. which isa group of ectoderm-deved cals located between the otel neural tbe an overing ectoderm Call ofthe now rest undergo Related Videos: Pec Hrechspung Diese © [isos Dee comomanepcoen First Aid References: Fst Ad forth USMLE Sop 1 2019, 20h od: 378 Fst Ad forthe USMLE Sop 12018, 28h od) 378 Fst Afr the USMLE Stp 1 (2017, 270 357Fst A forthe USMLE Step 12017, 27th ed 357 Nourans of thos ponuses come rm ho vagal and sera agents fhe neural crest. which sa group of ectoderm-detved calls oated botwoon the {oral neural tbe and overyng ectoderm Cals ofthe newal rst undergo Intuonce by induce signals suchas Wnt praton. bone mesphogenctic reins and Raxeblot grow factor and gradual seperate (or doling) ftom terest © migrate rosally or aut Hrschspran disease results om fle of hese cel to migrate othe «sta arto the colon. Te segment lacking nawons [egangoie) becomes ‘constictd,causng he pronal bowel sogments te itond de 10 fecal, secumtion ‘The dsease usally monfests eal finfncy vith constipation of even ieence of meconium afr bith. Any case of cerenpation nan ifn should De evaluated or Hisctspring dsease and bo consioredas Such unl proven ‘tres, The golden standard or diagnosis is suction blopsyof the ‘lstaly narrowed segment, wth a Nstloge examination that sows ack or absence of ganglion cal. reatmorts sual ‘Option B:Disuoton of apoposs ypc leads to he development ot entrant tein ad te phen far af Mecha, Sees. Option: Hipentonty doesnot cccurin Hschspnng dees ‘Option: Propeting a pel dal by peristalsis con led to intussusception lanienie an emergency sustonchoracterzed by blogg inthe toot, a pabamle ‘naabdeminal mass yng and ans veo pan nd vemtng Gapencaing ‘on te level of obstruction Contos ener woe evel an oclug mace ‘roping nto te lumen, ging thecaled sprig’ appearance tic uty 10 ‘ote cause of bstucon nis pat. B bscteto ttjen Tho sognant aking ne ge consited, causing he proximal bowel sognent to dstond de to fecal sesumulton ‘The senso usally manos oly infancy wth conepaton of even absence of meconium alr bith. ny case of consupation han ian sould ‘tres, The golden standard or dlagress is 2 suction bons of the Does ‘Te pancreas develops flor two enbryone foregut buds venta and dre ‘duct dovelos witin each bu, buat the ducts fuse together W det ‘usin aso occu aclasial pancroai vsum wh wo separate ducts develops. The fs may bo Be incomplete Paneronticdvsum can be asymptomatic or manifest as recuront acute ot eats‘duc dovolos wn ch bd, bala the ccs fo togethoe Meck fusion fas to eccur 9 clasial panereati sum Wn wo saparate ducts velop. The sion may abo bo comple Pancreatic ais can be asymptomate of mantest as recutent acute oF bressre win he accessory duct that rans Secretens fom te mar potion ofthe pancreas. yet opens wth lave sal minor duodenal apie. ‘Option A: The ambyonic pancreas has two sap dicts which then fie, ‘Option B: Magnetic resonance cnotanglopancoategapry shows neal blo ‘et anatomy, Pancreatic andver bus develop eos proxi, ord ‘ceasenally thor cane variants efile dct opening ectopy. ‘Option D: There are two pancreatic bu th wo ducts which nomiy evel inthe embryo, anit faue of rope fusen tat ests n anton nomatea. No doptcaon tas place nthe cuvent cose ‘option Emproperrtaton of ha anor pancostebud causes anatner _natomic anomaly annua pancreas) wich surrounds the descending prt of the duodenum, Lamingobjaciv: Pancreat aise a anatomic vant of the developing pancreas n whch theto ata two Separate pancreae duc, Pancroatic sum resus fom ncompet fin of the dorsal and vera pancroae dict rloges and may predepose a parson recent acter chronic Bsc‘4 3. yoar.old boy presonts wth abdominal palo tt started nearly Gus ago. Tho pins lected inthe perumblcl area and rates othe ight ower avdrart. “There was no vet or passage of tel ince the onset of pain, The patent ropers tat be pasod sols wi bland several tinos uring he past orth, Te il signe inde ood pressure 1170 mm Hg eat rate BY, respite rae {imi ae terperature 375°C 995°). The physeal examination revels abdominal ‘tenderness and quarang nthe petunia avea. An abdominal uasouna does notrevel an appendiceal abnormal The pation! undonwont an cxplratny Taparescopy. tthe tine of laparoscopy. 22cm wldoinfamed dverictu found 40 cm panimal te tececalvave. The dvericuum resected an set fx oterents te? ‘A. tecsuted fom bacon by embryonic pettoneal adhesions. ‘5. The most probable causo of is dvericuum Sneoasoa rivloninl presse, isan nbineatas emryoni ble et (© 0.nsaremnant othe embryonic omphalomeseneic det eae}‘4 3. yoar.old boy presonts wth abdominal palo tt started nearly Gus ago. Tho pins lected inthe perumblcl area and rates othe ight ower avdrart. “There was no vet or passage of tel ince the onset of pain, The patent ropers tat be pasod sols wi bland several tinos uring he past orth, Te ial signe inde ood pressure 1170 mm Hg eat rate BY, respite rae 16imin an trperature 375°C 995"). The physical examination reveals abdominal tenderness and ganang inne penanbica area. Ar abdoninal tuteazound dooe not reve! an appendices! abnormal The paint underwent an ‘exploratory apaosecpy the te oflparoscopy. 32cm wie flamed ‘verscuu found 40cm proximal. the leoceclvave. The dertcuben 5 resected and sont ft hetolage evaluation Thoreau shown ene aba Which ofthe fotoning statement str? ‘A. tecsuted fom bacon by embryonic pettoneal adhesions. ‘5. The most probable causo of is dvericuum Sneoasoa rivloninl presse, ison anebineratas emoryoni ile dct 1. afemant ofthe embayonic onphomesertatic duct.Result: Explanatio Ccomact answer : The described strcture is 8 Mecho iverteuum. 9 remnant ofthe embryonic ompalomesentei uct tline duct) which ‘connects the yok stato the midgut. Ta vetine dt proves nn the digestive sy:tom drng embryenic development. The wane duct appears dug eh wock and sappearsin the Sth- ath wooks of ‘embryonic development n pater with a Meckelavericaum. the posal purtothe volino dct fat abiterata A Mecel deren haste own ‘lod sori rom the superior mesenteric ary, which deed fom the ht vine ater soa Mechel dhvertcdum ssuseptble to niet Mockel avorculum can aso contain ecopeunetening gst of panceatc tere ed cn etter even perfor ‘The features of» Mecelivertcukm canbe descr by there of 25 2 {eat (40-60 cm) prnal othe deocecal valve, 2 em wide, 2 inches [3-5 cm ‘ong, atecs 2% oho population, a maletomao atl of 7, and fen presents before te age of 2 yours) Tho presentaton icudes orkid bominl pan that lat to height lower abdominal quart and can mimic appenaics. Torta, ding an appendectomy tis necesatyto ‘ei the leu 1m prone tothe eorsel ang to ase thre sno Infamed or perforated Meckel dvrtcuum, eae} Related Videos: @ Me eten Pocttre Mockols Derek First Aid References: Fst Afr the USMLE Step 1 2019, 20h oh: 378 Fst Ad forthe USMLE Step 1 (2018, 28h od 378,600 Fst forthe USMLE Step 1 201727 ed 357,585.Se SSF ee aca cre "tis true divorce, which moans that te walls composod of 2 layers (waco, submucosa and musculrs propria In conios false vertu are composed of one yer ony fhe mucosa which prude through anole ‘ermal ay ‘Option A: Embryonic abdominal adhesion te relatvey are and moe ey ‘rosin testinal sanguin ledge intsina eben rather han ‘ractondveredn natn, adhesions woud be reveal ing laparoscopy,i true diverticula, which means that he walls composed of eyo (cosa, submucosa and muscularis propria} In conast aleve are composed a ne ayer any the mucosa} whieh prtudes rough a nae ‘Option A: Embiyoniesbdominal adhesion ta eletvoly rar and moo ely toresutin testinal svanguaton, leading intestinal cbsrcton athe han ‘vation vere. nadlion, adhesions would be revealed ding, laparoscopy, ‘Option B:ncteasea intaurina pressure can cause propuson ofthe Intstint wall and dovelopmen of dori, bt hs cave describes a pla Meckel voriculum vt very characte features. ‘Option: The beac develop fom the hepa vei of the ms “The desinnve ucts form without pay precursor. ‘Option: A Meckel dvercubm sa tue dvertculam which hes mucous, submucous, an proper muscular ers. Leamingsbjectv: A Mechs eran este Hon ncomplt esron ‘ofthe wine dict whieh connects the yok so mth themida ing lembyegenese Mecka tvericnim enue cuercukim whieh hae thee layors mucous, submucous, nd muscular propa nematen ofa Mecket 24 hours, abdoninal tani and ‘vomting, Colonic ives very rate condton associated with vasclt {scckdent ormafomation suchas occhaon ofthe Hero mesentery. ‘Tis esuRsn bowel farcin wah subsequent atntogaton. eabSompon ot ed sue, aed sing of bow ends Looming objective: Newsome an fonts vont and hs oxpocted Howove, any 20 of excessive bios vorfing could be considered tresut for 3 igh mesial obsvucton ut ts preven ethers andthe patient should ‘be evaluated for duodenal asia, Duodenal areas a congenital order ‘hat este om lire of he uodonum fo recenaze caring ambryon‘A 2menh.cld boy has mslodorous until charg hat devoloped shorty atar Lniblical cor separation, He was veatedforomphatts wih 3 doses of anbcis, “ie val egne are fol: ood presse 70!40 mm Hs, Rest 125i, respratay ate Mimi, ard tamperature 362°C (98.2. On pysicl examination, he appears act and wel ouished. The sin the porambica region red and macerated. There a slght green yolew cechage om the ambi which resembies ace. The rernant of whi stucure moa ety causing the patir’s A Urctus 8 Right umbical atery Lemuel atery .Ompholomesener dct E Unbacaivein‘A 2menthcld boy has # malodorous until charge at doveloped shorty ‘or unbical cord separation. He wos teat for omphalts wh 3 oss of Sntioten, The tal signe ae 98 folour: blood presrre 70.40 mm Ho, Restate 12a rspatry ate 34min, and tmpetatute 368°C 8.27) On pysical ‘xamination he appeers active and well oud. The skin inthe primes region red and macerated There ea ght reen-yelow decharge rom te Umble which esemes feces, he vera of which stuctre ls most ay causing he pation symptoms? A Urctus 28 3. Right umblical artery » © CLomumpiical atoy * _.Omphomesentrc duct 50% E Unbacaivein * Result: © trcoect aExplanation: Ccorect answer 0: A patent omphalomesentei {stn tis the most ‘hay cause ofthe present case. The onphalomesantei uct appears ding te dt week of gstaton and connect the yk sac to the midgut to prods ‘ures unt the placentas completly devon ‘The dic shoul completly dsappor bythe St wesk of gestation. the duct ‘alo senppasy cover! anomie tndnge ean oreur \C K€ Related Videos: © Mes Oven © Rome vectts Orca First Aid References: Fst Ad forthe USMLE Step 12018, 28h ed 378,600 Fst Ad forthe USMLE Step 12017, 270 dh 367,585,Ft the obliterate duct ean remain nonrsorbac and deulop nt a fxoue ‘ord which can eauso infos struction do ta nestnalsengation.The mile poron rene ae ald onphalomosentorc oss Uy. ho [Shlteted et ramaineconnacta othe aero acorns vi nhs ‘tum wh thous suo, so may cause tho samo camplcation testa! ‘pst e proximal end port, Becomes @ Meck © GertcUUM, # {he midle potion renmns non obra, bal polyps can develop, ‘ch can cause a serous umblcal charge and is prone tact, Wineno whole dt persists, the ptentomphalomesentei duct connects ‘he lau tothe umbiicus and causes fecal discharge. Treatment equres surgeal resect. pon A: The wach remnant of he alontok which rains xine rom the ‘orang agar the umes rd Noval the ache obMeatad an Fst A forthe USMLE Step 1 (2018, 2th ea: 378,600 Fst Ad forthe USMLE Sop 1 2017, 27h ed 367 595, a‘obliterated diet emsine connactd tothe ater adorn wl dhe ‘tum th thyous issue, 0 may cause te same campleation testa! ‘bstuction) the protimal end port, it becomes s Necks divertculum. {he midcle pononremne nom obese. ba otps can even, ‘whic can cause a serous umblcal charge and is prone taco, Wineno whole duct persists, the patent emphalomesentei duct connects ‘he lau tothe umbiicus and causes fecal dscarge. Testment equres (Opton A: The uactssa emnant ofthe alontok, which ans rine rom the ‘orang blader the umes ert Nowra the ache eobMeatad an oament Prastence ofthe urochus causes ue leokage not fea acharg, Opbone 8, A paton ofboth unbis ‘medial unbiea igamentAncterporton neal remains pen as part of ‘Option: The unbitea oi wavetses the umbical cord and enters he porta vai Tho uel eins obtaate, forming he rou gamers wes | ‘courses fom the bic the ver. The umbieal ven can reopen in atonts with peta hypertension, Leaming sbjectv: The witelin orpnalornazenter cit conc th yok seco the midgut cing woke <8 of embryogenesis Subeccuenty, he ‘toting dct shoul obese. obleroton does nt occ hepato ‘riplonissertrie ct conteeto Inthe auto Umble esng fe Lumbica dscharge fans‘A nowbaan gis tere vainly tant a heathy 25 yoa-ot IPL The rograncy was vncompleaed.On examination she wos found have ash Inengrtion bit no anal opening Further examination show eet eka ne roymaly developed extornalgertaia Which e the fotowing tatemots about his ‘ondtons come? 1 Such abnormal anatomy formed ater wesk 12 of nautene evelopment 8. The prosonco oan assent porno or vest stl fe more ‘Melvin females th sony 2 {C Thore a fare of he asion ofthe embryonic cloaca it the \ogenaal snus and rectoanal cana Theres flue of the invagation and rupture of te dorsal pomton ofthe closes membrane. cane congenital abnormalities of extemey rain patents wihPerey [a a” G ‘A nowbaan gis tere vainly tant a heathy 25 yoa-ot IPL The rograncy was vncompleaed.On examination she wos found have ash Ineagistion but no anal opaning, Further examination show eet kn {and namaly doveloped ederna gontata, Which of be flowing Saleen about this condition core? | Such abnonmalanstony te formed ater week 12 ofinrautsne 3% evelopment 8. The prosonco tan associat ponoa or vestibular sulals ‘not katy fale wh ecm 2 © There a fature ofthe asion ofthe embryonic cloacae the 40% fogensal snus and rectoanal cana 1. Ther la faire of heinvaghation nd runt ot dorsol 42 orton ofthe loses! membrane. cine congenta abnormalities ote entemely rein patents wih 4%Result: Explanation: Related Videos: ‘Comect newer : The loaca|e he common end ofthe qu tbe and te Ceca ities Hi iowutanmpedicion fexmngwragenital rac. Th daca cored byte doaeal mombrane. First Aid References: Fst Ald forthe USMLE Stop 12018, 29th of: Fst Ad forthe USMLE Step 12018, 28 ea Fst Ad forthe USMLE Step 12017 27th ed Allantols Hindgut Cloacat membrane CloacaPerey = 1. = a Allantois Hindgut Cloacat membrane Urorectal septum ‘Bemeen the 4h and 6th weeks of embryonic development the wort Septum separates the cloaca tothe wrogental sins wertly and the ctu dora, Urogenital sinus Perineal body ‘Anal membrane‘etneen the th and th weeks of enbroiogt development the wort Soptum separates the cloaca toe wrogental sinus erty andthe rectum ora, Urogenttal sinus Perineal body Anal membrane Rectum, ‘Te dorsal portion ofthe embryonic closcal membrane, afer ts duson by the rorecta septs calacto ana membrane rom the oii, the an ‘mambrane i covered by ectodoum; adm the ni, he ana merbrane s ined by endoderm. The ectoderm of the anal membrane iveginates and presto connect the etn othe ena eronment a the an ean se Te Se hte i cho te ode ah i a‘The dora ponton ofthe embryonic cloacal membxane, afer fe duson by the ‘membrane f covered by ectoderm a rom he ini, he anal membrane ie ‘ined by endoderm, The ectoderm of the anal membrane ivaginater a ‘ruptures to connect the rectum othe eternal endonment via the ana cana ‘he anal canal by the pectin ne, Far of his invagination ana rope ‘results nan inparorate anus (or anorectal mfmation). The incidence of anal aeeate in 000 ve hen the US Te aeerder nat 2 wolinown association with ctor congenital aomals:such 35 VACTERL (vertebra sromstes, nal ars, cade maormotons, achcoesophogel ‘eu eophagesl seen ena anomalies rac pte, anc manors) and Townes 802k or REAR (eral ca ana and ada anonakes Syme, "Noonotes wth anal tesla shoul hus be evaluated fer ether congenital Inadton, rogenta anomie ae flequenty associated wh an mperorate ‘snus because the anomalies have common sutures cuang the couse of ‘erin nary bladder orurtrain mines, o wes tbl or vagina a females. ‘The absence ofthe ans i apparent on examination because the anus not patent. Further examraton shouldbe pertamodto expire he anata of ‘roger orgs, a wall aso search for fetus ned congoral abnormalities sesocntcwah other eytone,stot. Furthr exametion shouldbe pefomerdto explore the anatomy of {rogenta organ, ae wel 9 search for etn ed eongenta sbnormalee ‘ssocatd wah other eystone, “Trenment ofthis condone surgical, The completo surgery depends on the severity ofthe anomaly Before surgery nonbome with sn imperforate anus seu nt be fed ray ad shoud recete tavern, ‘Option A: The anal membrane normaly rptresbelore week 8, 50h an ‘anatomic anomaly forms even eater. ‘Option B: The opposite ir. ngs wth tomy 2 he Nesthood ners ‘mathe gi does notrave este ‘Option: The embryonic cloaca s avidedinto a uegental sus and ‘eteaal canal by tho urtecta septum dvsion fas to accu the oaca remain the coron endpant fr to gentoutnary a! dinerve act Such {an anatomic anomaly is indeed accompanied by an inpesorate anus, btn ‘Option: An imperttato ars is associated wth a number af her sbeormlties. The welleonm assocnon ace VACTERL vertebral ‘arise, trachea esophages renal and imb abnormal and REAR ena, ‘or ana andradalabnormales)eyncomos. ‘Loaming objective: An impororate aus a congentalabnarmaty caused by fale ofthe anal membrane to tue. An imperfrato anus often [etocntdweh urogenital abnormalities ce o velopment rom he commen prinaida, aswel as wih adsormates mother systems.Test Results © Comect: 3/12 (25%) ° mm ° 2406 e 208 8 2400 e 2x00 satjere Extyseay boar topo Enbyoeay Eniyaoay @ Incorrect: 9/2 (75%) © Omitted: 012 (0%) Spine estos See (estos Sem° ° es e e 8 8 e e ° e 8 200 satjece tnonotay topo Fnboobay Ennyaoay Exsysteay Entooeny tmonotay tonobay Enyeay Exsysteay Stems este Se estos Sse stots Sem