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NBME 21 Answers

nbme21/Block 2/Question#15

A 48-year-old man is brought to the emergency ...

Splenic and left renal

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 +4  upvote downvote
submitted by rerdwins(8),

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 +1  

 +2  upvote downvote
submitted by yo(21),

they're talking about a splenorenal shunt procedure


hungrybox  be honest did u know that before looking it up +2  
meningitis  @hungry, because you didn't know it, doesn't mean he didn't. This is a forum for answering questions and helping out, not dissing or showing off. Grow up before becoming a doctor. +1  
sympathetikey  Relax @meningitis. Hungry's just messin :) +1  
sbryant6  Looks like somebody needs an enema to get that stick out. +  

 +0  upvote downvote
submitted by imgdoc(18),

Ileocolic (systemic)/inferior mesenteric (portal), and splenic (portal)/left renal (systemic) are the only two portosystemic shunt options. Of which splenic and left renal is the BEST option of the two just based on their proximity to the esophageal varices.

 +0  upvote downvote
submitted by usmle11a(2),

ok i think i have a theory in regards for this:

the whole procedure is done to decrease the portal HTN. which means the shunt should be portal to systemic avoiding the liver.

a) hepatic (systemic) to inf phrenic ( systemic ) ; no B) ileocolic (portal ) to inf mesentric (portal) ; no c) splenic (portal) left renal (systemic); yes d) superior epigastric (systemic) to inferior epigastric (systemic) ; No e) superior rectal (portal) to superior mesentric ( portal) ; NO

whossayin  You’re a legend. Good theory man, makes memorization a whole lotta easier! +