MISC

Question 1

Describe Bilroth anatomy

Answer 1

Question 2

Discuss location and etiology of aberrant hepatic arterial anatomy

Answer 2

Replaced left hepatic artery off of the left gastric. Found under the lesser omentum.

Replaced Right hepatic artery off the SMA. Found in the lateral aspect of porta hepatis.

Question 3

Thoracic outlet order

Answer 3

Subclavian vein > anterior scalene > subblavian artery > brachial plexus

Question 4

Alpha 1

Answer 4

Vasoconstriction

Question 5

Alpha 2

Answer 5

Vasoconstriction

Question 6

Beta 1

Answer 6

Increases heart rate and contractility

Question 7

Beta 2

Answer 7

Bronchodilation and vasodilation

Question 8

Norepinephrine

Answer 8

Alpha 1 > alpha 2 > beta 1

Question 9

Epinephrine

Answer 9

Low dose Beta

High dose Alpha

Question 10

Dopamine

Answer 10

Dopamine (renal vasodilation) > Beta (HR and contractility) > alpha (vasoconstrictor)

Question 11

Dobutamine

Answer 11

Beta 1 > Beta 2

Useful in cardiogenic shock

Question 12

Phenylephrine (neosynephrine)

Answer 12

Alpha 1

Question 13

Isoproterenol

Answer 13

Beta 1 and Beta 2

Question 14

Insulinoma

Answer 14

Most common, Whipple’s triad: fasting hypoglycemia, Sx of hypoglycemia (palpitations, tachycardia, diaphoresis), and relief w/ glucose.

Dx increast in C peptide and pro-insulin.

Tx enucleate (<2cm), formal resection (>2cm)

Question 15

Gastrinoma

Answer 15

Most common w/ MEN1. Found in gastrinoma triangle: CBD, neck of pancreas and third portion of duodenum.

Sx: refractory or complicated peptic ulcer disease

Dx; secretin stimualtion test gastrin will increase. Octreotide scan to localize

Tx: <2cm enucleation, >2cm formal resection

Question 16

Glucagonoma

Answer 16

Most are malignant. Distal pancreas

Sx: diabetes, stomatitis, dermatitis (rash-necrolytic migratory erythema)

Dx: fasting glucagon lv

Question 17

VIPoma

Answer 17

Most are malignant. Distal pancreas.

Sx: watery diarrhea, hypokelemia (from diarrhea), and achlorhydria

Question 18

Somatostatinoma

Answer 18

Most are malignant. Head of pancreas.

Sx: diabetes, gallstones, steatorrhea

Dx: fasting somatostatin lv

Question 19

BIRADS

Answer 19

0: incomplete
1: negative
2: benign
3: probably benign. Short interval f/u
4: suspicious. Bx
5: highly suggestive of malignancy. Bx
6: Bx proven malignancy

Question 20

Ranson criteria

Answer 20

GALAW & CHOBBS

Glucose, Age, LDH, AST and WBC;

Calcium, Hematocrit, Oxygen, BUN, Base, Sequestration