Worksheets3/8/22 Small Int 3/3
Total questions: 11
Worksheet time: 6mins
The following are the causes of acute mesenteric ischemia, except:
Arterial Embolus
Venous thrombosis
Arterial thrombosis
Occlusive Mesenteric Ischemia
23yoM is diagnosed with FAP and undergoes a prophylactic colectomy. He wants information about the risk of developing other malignancies. Which GI malignancy is associated with the highest risk of death for this patient?
Esophagus
Stomach
Ileum
Duodenum
Jejunum
64yoM is admitted for SBO. A CT of the abdomen reveals an ileocecal mass, partial ileal obstruction, and multiple ileal mesenteric enlarged lymph nodes, but no liver or distant metastasis. The best next step is...
Serologic workup
Surgical resection of mass, mesentery, and regional LNs
Endoscopic biopsy
PET CT
Contrast study
70yoM presents with 6 weeks of increasing abdominal pain, nausea and emesis, and 20 lb weight loss. He has a longstanding history of diarrhea and severe pruritic papulovesicular eruptions of the elbows and knees. Abdomen is mildly tender and distended. CT scan shows a 4-cm mass in the small bowel with some proximal dilation. No abnormality of the liver is noted. What is the most likely diagnosis?
NET
GIST
adenoma
adenocarcinoma
lymphoma
72yoM has a 3-month history of anorexia, pain, and constipation but denies any black or bloody bowel movements. He now presents with NBNB emesis. CT scan reveals a 2-cm hyperenhancing soft tissue mass closely associated with the terminal ileum with surrounding desmoplastic reaction. Which of the following tests would be most useful in confirming the pathology of tumor?
Serum chromogranin A level and 24-hour urine 5-HIAA level
Serum 5-HT and chromogranin A
Serum chromogranin A and 24 hour urine vanillylmandelic acid
Random urine 5-HIAA level and serum norepinephrine
83yoM w/ ESRD and CHF is admitted to the COVID ICU on BiPAP. On HD3, has abdominal pain has had no bowel function with distention and mild ttp. LA wnl, LFTs elevated, mild hypotension 90s/40s. CTA shows no PE and good flow through the aorta and tributaries. What is the best next step in treatment?
Endovascular aortogram with possible intervention
Ex lap
IVF resuscitation
Heparin gtt
ASA/Plavix
67yoF has SMA occlusion is taken to the OR. She is fully heparinized. A 20-cm segment of jejunum is found to have patchy ischemia without frank necrosis and with a faint Doppler signal. An SMA arteriotomy is performed with suction thrombectomy and embolectomy. Which of the following is the best management of the small bowel?
Resection, primary anastomosis, closure
Resection, anastomosis, loop jejunostomy, closure
Resection, leave in discontinuity, second look laparotomy
No resection, abdominal closure, NGT until ROBF
No resection, second look laparotomy
65yoF with h/o 1 pint per day liquor presents with n/v and worsening abdominal pain. She has mild mid-abdominal tenderness with no guarding or rebound. CTA shows a filling defect in a mesenteric vein. Which of the following is most likely to be the reason for the woman's presentation?
Afib
Sepsis
Pancreatitis
PAD
CHF exacerbation
64yoF with afib on warfarin presents with sudden onset of severe abdominal pain and emesis Abdomen is mildly tender without guarding, rigidity, or rebound tenderness, but she describes her abdominal pain as excruciating. HR 112, BP 93/62, lactic acidosis, leukocytosis, and subtherapeutic INR. CT shows emboli in the SMA. She is taken to the OR. On inspection of her bowels, what do you expect to observe?
Normal healthy bowel
Ischemia of jejunum and ileum
Ischemic D3/4, jejunum, and ileum
Ischemic distal jejunum, ileum, and ascending colon
Ischemic transverse and descending colon
68yoM has ex lap for SMA embolus. After embolectomy and inspection of the bowel, his abdomen is closed and he is brought to the SICU. Which test(s) will most likely reveal the embolic source?
TTE
bilateral LE duplex
TEG + PMU
CTPE
Aortogram
62yoF with h/o Afib on warfarin presents with diffuse abdominal pain x6 hrs. CT demonstrates thickening of the small bowel wall and colon extending through the transverse colon with stranding in the mesentery. Intraoperatively, the bowel is noted to be dusky. What must be done to restore perfusion?
Anterograde bypass with the internal iliac artery
Retrograde bypass with the common iliac artery
Retrograde grade bypass with the supraceliac aorta
Anterograde bypass with the inferior mesenteric artery
Retrograde bypass with the left renal artery
