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  • Air in retroperitoneum and mediastinum
  • Fluid and air dilated duodenum, readily connected to the pylorus on all views. All jejunal loops normal size.
  • Duodenal mechanical obstruction
  • Pneumomediastinum and pneumoretroperitoneum; cause indeterminate (presumably Macklin effect from severe vomiting)
  • Surgical emergency (based on signalment, neoplastic causes are very unlikely, so staging the abdomen unnecessary)
  • Stage causes of pneumomediastinum with thoracic radiographs
  • Candidates consistently misdiagnosed the duodenum as the colon.
  • 50% of candidates never mentioned the word “duodenum” and stopped at testing for causes of pneumoretroperitoneum and pneumomediastinum
  • 25% of candidates discussed the challenge of differentiating between duodenum and colon and tested appropriately for differentiating between colon and duodenum (pneumocolonogram, Abd US) receiving partial points.
  • 25% of candidates labelled the dilated loop as duodenum, therefore proceeded to surgery to receive full points.