Case-based MCQ

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🎈 𝙎𝙥𝙚𝙘𝙞𝙖𝙡 𝙙𝙞𝙨𝙘𝙤𝙪𝙣𝙩𝙨 𝙤𝙣 𝙉𝙤𝙫𝙚𝙢𝙗𝙚𝙧 𝙊𝙧𝙙𝙚𝙧𝙨 📲 ᴄᴏɴᴛᴀᴄᴛ ᴀᴅᴍɪɴ ᴛᴏ ᴏʀᴅᴇʀ ᴘᴜʙʟɪꜱʜɪɴɢ ʏᴏᴜʀ ᴍᴀɴᴜꜱᴄʀɪᴘᴛ: @Mohamm_ADs

- Do you want to publish your paper in the High Impact journal? - Would you like your work to be seen in the best journals? 🔷 We will proceed with the journal publishing process with our professional team on MCU RESEARCH COLLABORATION 🔻 Feel Free to contact admin 👉 @Mohamm_ADs

- Do you want to publish your paper in the High Impact journal? - Would you like your work to be seen in the best journals? 🔷 We will proceed with the journal publishing process with our professional team on MCU RESEARCH COLLABORATION 🔻 Feel Free to contact admin 👉 @Mohamm_ADs

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🧩 Medical Mnemonics Aspirin-exacerbated respiratory disease (AERD); The clinical triad: 🕸 ‌🇦‌‌🇧‌‌🇨‌ ⚡ 🅐sthma (often severe and presenting in adulthood). ⚡ 🅑ronchospasm or nasal congestion following the ingestion of aspirin or NSAIDs. ⚡ 🅒hronic rhinosinusitis with nasal polyposis. #pulmonology   〰〰〰〰〰〰〰〰〰〰〰 ©Medical Mnemonics

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- Do you want to publish your paper in the High Impact journal? - Would you like your work to be seen in the best journals? 🔷 We will proceed with the journal publishing process with our professional team on MCU RESEARCH COLLABORATION 🔻 Feel Free to contact admin 👉 @Mohamm_ADs

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🧩 Medical Mnemonics Five T's of cyanotic congenital heart disease 🍃 5 ‌🇹‌'ˢ ~ 🅣etralogy of Fallot ~ 🅣GA ~ 🅣APVC ~ 🅣runcus ~ 🅣ricuspid valve abnormalities (tricuspid atresia, stenosis, and displacement) #pediatrics   〰〰〰〰〰〰〰〰〰〰〰 ©Medical Mnemonics

- Do you want to publish your paper in the High Impact journal? - Would you like your work to be seen in the best journals? 🔷 We will proceed with the journal publishing process with our professional team on MCU RESEARCH COLLABORATION 🔻 Feel Free to contact admin 👉 @Mohamm_ADs

- Do you want to publish your paper in the High Impact journal? - Would you like your work to be seen in the best journals? 🔷 We will proceed with the journal publishing process with our professional team on MCU RESEARCH COLLABORATION 🔻 Feel Free to contact admin 👉 @Mohamm_ADs

🧩 Medical Mnemonics O’Donoghue’s Unhappy Triad: 🎗 ‌🇲‌‌🇦‌‌🇲‌ 〰 🅜CL rupture 〰 🅐CL rupture 〰 🅜eniscal damage (medial and/or lateral) #orthopedics 〰〰〰〰〰〰〰〰〰〰〰 ©Medical Mnemonics

Superior mesenteric artery syndrome (SMA) (choice B) is the correct answer. This rare, but life-threatening condition must be considered in any patient with a history of rapid weight loss presenting with gastrointestinal symptoms. SMA syndrome describes the compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery (see image below). Retroperitoneal fat and lymphatic tissue normally serve as a cushion for the duodenum, protecting it from compression by the SMA. This cushion effect is lost in cases of rapid weight loss. The resulting duodenal obstruction causes symptoms of epigastric pain (especially postprandial), nausea, vomiting, and early satiety. Abdominal CT scan is the modality of choice to make the diagnosis however signs of duodenal obstruction (gastric distension) may be present on radiographs. ⚠ Viral gastroenteritis (choice A) can have the described symptoms, but would typically be accompanied by lower GI tract symptoms as well (diarrhea). In addition, given this risk for SMA syndrome in this patient, a viral illness would be a diagnosis of exclusion. ⚠ While appendicitis (choice C) could be a possibility in any patient with nausea, vomiting and abdominal pain, the fact that she lacks fever and has a normal white count make it less likely. In addition, appendicitis would not explain the findings of stomach distension on the radiograph.   ⚠ Nutcracker syndrome (choice D) describes compression of the left renal vein between the aorta and the SMA. Symptoms are typically left flank pain and hematuria due to venous hypertension. This is an anatomical entrapment syndrome and, unlike SMA syndrome, is not related to sudden weight loss.  ⚠ Renal colic (choice E) typically presents with lower back/flank pain radiating to the groin. Most urinary calculi develop from the age of 20-40 (peak from 35-45 years), making it less likely in this adolescent. 🔖 Key point: Superior mesenteric artery syndrome is rare, but life-threatening condition that must be considered in any patient with a history of rapid weight loss presenting with gastrointestinal symptoms. SMA syndrome describes the compression of the third portion of the duodenum by the abdominal aorta and the overlying superior mesenteric artery.

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