Case-based MCQ

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🧩 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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⏳ Case-based MCQ | #Case_465 〰〰〰〰〰〰〰〰〰〰〰〰〰〰 A 14-year-old girl is brought into the ED by her mother as she is worried about her daughter's weight. On history, she has lost 13.5 kg in the last six months and admits to fatigue, dry skin, hair loss, constipation, and poor concentration at school. Upon hospital admission, the patient is started on nasogastric feeds to meet minimum caloric requirements. A few days after being admitted, the patient starts complaining of nausea, "stabbing" abdominal pain as well as vomiting without diarrhea. An abdominal radiograph shows a distended stomach but is otherwise normal.

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⚠ 🔔 𝐒𝐀𝐕𝐄 𝐓𝐇𝐈𝐒 𝐋𝐈𝐒𝐓 𝐅𝐎𝐑 𝐀 𝐑𝐀𝐈𝐍𝐘 𝐃𝐀𝐘 ! ⤵ 1. 🧩 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗠𝗡𝗘𝗠𝗢𝗡𝗜𝗖𝗦 (𝗟𝗘𝗔𝗥𝗡 𝗘𝗔𝗦𝗜𝗟𝗬) 2. 𝗖𝗔𝗦𝗘 - 𝗕𝗔𝗦𝗘𝗗 𝗠𝗖𝗤𝗦 💯 3. 🇨🇦 𝗠𝗖𝗖𝗤𝗘 𝗣𝗥𝗘𝗣𝗔𝗥𝗔𝗧𝗜𝗢𝗡 4. 🩺 𝗘𝗗𝗟 𝗠𝗘𝗗𝗜𝗖𝗢𝗦 (𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 𝗔𝗡𝗗 𝗟𝗜𝗡𝗞𝗦) 5. 📚 𝗘𝗗𝗟 𝗣𝗛𝗔𝗥𝗠 6. 🏛 𝗢𝗡𝗟𝗜𝗡𝗘 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗦𝗖𝗛𝗢𝗢𝗟 7. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗚𝗘𝗥𝗠𝗔𝗡𝗬 🇩🇪 8. 𝗣𝗥𝗔𝗖𝗧𝗜𝗖𝗘 𝗜𝗡 𝗔𝗨𝗦𝗧𝗥𝗔𝗟𝗜𝗔 🇦🇺 9. 𝗠𝗕𝗕𝗦 & 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗜𝗧𝗔𝗟𝗬 🇮🇹 10. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗨𝗞 🇬🇧 11. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗨𝗦 🇺🇸 12. 𝗥𝗘𝗦𝗜𝗗𝗘𝗡𝗖𝗬 𝗜𝗡 𝗖𝗔𝗡𝗔𝗗𝗔 🇨🇦 13. 𝗙𝗥𝗘𝗡𝗖𝗛 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 🇫🇷 14. 𝗚𝗘𝗥𝗠𝗔𝗡 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗕𝗢𝗢𝗞𝗦 🇩🇪 15. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗥𝗘𝗦𝗘𝗔𝗥𝗖𝗛 🎓 16. 📸 𝗗𝗘𝗥𝗠𝗔𝗧𝗢𝗟𝗢𝗚𝗬 𝗔𝗧𝗟𝗔𝗦 17. 𝗢𝗘𝗧 𝗣𝗥𝗘𝗣𝗔𝗥𝗔𝗧𝗜𝗢𝗡 🔡 18. 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗠𝗔𝗭𝗢𝗡 🌐 19. 𝗠𝗘𝗗𝗜𝗖𝗖𝗢𝗨𝗡𝗧 - 𝗠𝗘𝗗𝗜𝗖𝗔𝗟 𝗔𝗖𝗖𝗢𝗨𝗡𝗧

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🧩 Medical Mnemonics Ranson's criteria for prognostic indicator of mortality in #pancreatitis during first 48 hours 🦧 C - HOBBS ➕ Serum Calcium < 2 mmol/L ➕ Hct drop > 10% ➕ Arterial PO2 < 60 mmHg ➕ Base deficit > 4 mmol/L ➕ BUN rise > 1.8 mmol/L ➕ Estimated fluid Sequestration > 6L #gastroenterology #surgery 〰〰〰〰〰〰〰〰〰〰〰 ©Medical Mnemonics

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