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Comments ...

 +9  (nbme21#15)

best way to approach it is to ask which one has a portal circulation and a systemic circulation ( You DONT need to know the procedure to answer this question.

example: cant be superior epigastric and inferior epigastric because those are both systemic also cant be superior rectal (inferior mesenteric branch) and superior mesenteric because those are both portal system

when you narrow it down, then its a 50/50 guess.

charcot_bouchard  Not 50/50. u can rule all 4 out with this. U have described it perfectly. they are wanting a portosystemic anastomosis. Both hepatic vein and inferior phrenic vein drains into IVC. I was nt sure abt inferior phrenic but was sure abt renal and splenic. so picked that

Subcomments ...

submitted by hayayah(603),

Catheter placement:


Recall that the lung apex extends above the first rib.

hungrybox  His expression is so blissful. U can tell they're shootin up some full u-opioid agonist codeine type of shit and not some shitty partial u-opioid agonist buprenorphine type of shit or some shit like loperamide that doesn't even act on the CNS +16  
rerdwins  even better, if you recall that the esophagus is RETROperitoneal ( its in like half the answer choices). hence, to get to it you have to go WAAYYYYY deep ( like rick and morty smuggling shit). after that, the lung option makes the most sense. +8  
hello  Also, pulmonary artery is way too far away to be damaged by internal jugular vein catherization. +  
makinallkindzofgainz  @hungrybox my mans just slipped in 3 high yield facts within a joke +  
makinallkindzofgainz  @hayayah, I have an issue with that picture unless I'm missing something. In every other source I have, the internal jugular vein lies LATERAL to the common carotid artery. The picture you provided shows the internal jugular veins medial to the common carotid artery. +1  
cmun777  Look at the other side... I think it must be the manipulation of turning the head to the opposite side that better exposes the jugular for catheterization purposes +