Abdomen and pelvis: duodenum and mesenteric vessels: practice question

A Anatomy question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anatomy · Abdomen and pelvis: duodenum and mesenteric vessels

Sample item

A 19-year-old woman with anorexia nervosa has lost 15 kg in 3 months and has postprandial epigastric pain with bilious vomiting. Barium meal shows abrupt cut-off of contrast in the third part of the duodenum, which improves in the prone position. What is the anatomical basis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Reduced aortomesenteric angle compressing the duodenum between superior mesenteric artery and aorta

The superior mesenteric artery arises at L1 and passes anterior to the third part of the duodenum, which lies on the aorta. Loss of the mesenteric fat pad narrows the aortomesenteric angle and distance, trapping the duodenum and causing superior mesenteric artery syndrome. Positioning that moves the artery away, such as prone or left lateral, relieves symptoms.

Option by option

  • A. Reduced aortomesenteric angle compressing the duodenum between superior mesenteric artery and aorta (correct)

    Correct. Weight loss reduces the fat pad and compresses the third part of the duodenum.

  • B. Compression of the coeliac trunk by the median arcuate ligament

    Median arcuate ligament syndrome causes postprandial pain from coeliac compression, but not duodenal cut-off.

  • C. Annular pancreas encircling the second part of the duodenum

    Annular pancreas encircles and obstructs the second part of the duodenum, not the third, and typically presents in neonates.

  • D. Compression of the left renal vein between the superior mesenteric artery and aorta

    This describes the nutcracker syndrome, which gives haematuria and flank pain rather than duodenal obstruction.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anatomy question

What is the answer to this Anatomy question?

The best answer is A, Reduced aortomesenteric angle compressing the duodenum between superior mesenteric artery and aorta. The superior mesenteric artery arises at L1 and passes anterior to the third part of the duodenum, which lies on the aorta.

Why is "Compression of the coeliac trunk by the median arcuate ligament" not the answer?

Median arcuate ligament syndrome causes postprandial pain from coeliac compression, but not duodenal cut-off.

Why is "Annular pancreas encircling the second part of the duodenum" not the answer?

Annular pancreas encircles and obstructs the second part of the duodenum, not the third, and typically presents in neonates.

Why is "Compression of the left renal vein between the superior mesenteric ar…" not the answer?

This describes the nutcracker syndrome, which gives haematuria and flank pain rather than duodenal obstruction.

What concept does this question test?

It tests Abdomen and pelvis: duodenum and mesenteric vessels in Anatomy. Loss of the mesenteric fat pad narrows the aortomesenteric angle and distance, trapping the duodenum and causing superior mesenteric artery syndrome. Positioning that moves the artery away, such as prone or left lateral, relieves symptoms.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Abdomen and pelvis: duodenum and mesenteric vessels?

Learn every nerve by its route, its muscles and what a lesion looks like at the bedside. That one habit answers a large share of questions. Then use the flashcards and the other Anatomy questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.