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3/8/22 Small Int 3/3

Total questions: 11

Worksheet time: 6mins

Name
Class
Date
1.

The following are the causes of acute mesenteric ischemia, except:

a)

Arterial Embolus

b)

Venous thrombosis

c)

Arterial thrombosis

d)

Occlusive Mesenteric Ischemia

2.

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?

a)

Esophagus

b)

Stomach

c)

Ileum

d)

Duodenum

e)

Jejunum

3.

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...

a)

Serologic workup

b)

Surgical resection of mass, mesentery, and regional LNs

c)

Endoscopic biopsy

d)

PET CT

e)

Contrast study

4.

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?

a)

NET

b)

GIST

c)

adenoma

d)

adenocarcinoma

e)

lymphoma

5.

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?

a)

Serum chromogranin A level and 24-hour urine 5-HIAA level

b)

Serum 5-HT and chromogranin A

c)

Serum chromogranin A and 24 hour urine vanillylmandelic acid

d)

Random urine 5-HIAA level and serum norepinephrine

6.

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?

a)

Endovascular aortogram with possible intervention

b)

Ex lap

c)

IVF resuscitation

d)

Heparin gtt

e)

ASA/Plavix

7.

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?

a)

Resection, primary anastomosis, closure

b)

Resection, anastomosis, loop jejunostomy, closure

c)

Resection, leave in discontinuity, second look laparotomy

d)

No resection, abdominal closure, NGT until ROBF

e)

No resection, second look laparotomy

8.

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?

a)

Afib

b)

Sepsis

c)

Pancreatitis

d)

PAD

e)

CHF exacerbation

9.

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?

a)

Normal healthy bowel

b)

Ischemia of jejunum and ileum

c)

Ischemic D3/4, jejunum, and ileum

d)

Ischemic distal jejunum, ileum, and ascending colon

e)

Ischemic transverse and descending colon

10.

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?

a)

TTE

b)

bilateral LE duplex

c)

TEG + PMU

d)

CTPE

e)

Aortogram

11.

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?

a)

Anterograde bypass with the internal iliac artery

b)

Retrograde bypass with the common iliac artery

c)

Retrograde grade bypass with the supraceliac aorta

d)

Anterograde bypass with the inferior mesenteric artery

e)

Retrograde bypass with the left renal artery