u/Glittering-Remote254

What are must do things in the last 2 weeks? I’m going to do AMBOSS HY plans. And maybe a few cms based on my recent nmbe incorrects. DIP RF + NBS + free 120 review. Does anyone have any advice? Last 2 NBMEs were mid 250s. I wanna try to touch 260 in nmbe 16 and UWSA2 for confidence on exam day

29. A 21-year-old man comes to the emergency department because of a 3-day history of moderate, diffuse abdominal pain and constipation. During this time, he also has had episodes of nausea and bilious vomiting. He has not had fever, chills, cold intolerance, or skin or hair changes. One year ago, he sustained a pelvic fracture during a motor vehicle collision. His only medication is daily oxycodone; he says he had to double his dose 1 week ago because of worsening pain. He appears uncomfortable. Vital signs are within normal limits. Abdominal examination shows diffuse tenderness to palpation with no rebound or guarding; bowel sounds are decreased. Rectal examination shows normal sphincter tone and brown stool in the vault. Which of the following is the most likely diagnosis?
    A) Drug-induced constipation
    B) Hypothyroidism
    C) Midgut volvulus
    D) Pudendal nerve injury
    E) Small-bowel obstruction
    Correct Answer: A

Can someone pls explain this Q?
Why is the answer not E. This patient has Hx of abdominal surgery + bilious vomiting + dec bowel sounds + abdominal pain. This sounds like classic SBO d/t opioid use.

Opioid constipation doesn’t have bilious vomiting as far as I’m aware.
I also sent this Q to AMBOSS AI it said the answer is E. I sent the explanation + E explanation and it said the answer is still SBO. It said opioids are the cause but the diagnosis is SBO.

Can anyone shed some light? This q made my head hurt