Absite prep for intern year UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Heller myotomy - CORRECT ANSWER - a surgical procedure in which the muscles of
the cardia (lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the
stomach; treats achalasia
Killian triangle - CORRECT ANSWER - Area of potential weakness situated behind the
esophagus at the level of the cricopharyngeus muscle
which vagus is anterior vs posterior? - CORRECT ANSWER - LARP
left anterior, right posterior
what does the right vagus become? - CORRECT ANSWER - posterior vagal trunk, celiac
plexus, criminal nerve of Grassi
what does the left vagus become? - CORRECT ANSWER - anterior vagal trunk, gastric
plexus, liver branches
criminal nerve of Grassi - CORRECT ANSWER - from right vagus, causes persistently
high acid levels post op if left after vagotomy, supplies the posterior fundus
types of hiatal hernia - CORRECT ANSWER - type 1: sliding hiatal hernia (~95%).
type 2: paraesophageal hiatal hernia with the gastro-esophageal junction in a normal position.
type 3: mixed or compound type, paraesophageal hiatal hernia with displaced gastro-esophageal
junction.
type 4: mixed or compound type hiatal hernia with additional herniation of viscera (most
commonly colon).
, phi angle - CORRECT ANSWER - A normal phi angle is ranging between 4 and 58
degrees. The phi angle is a useful measure in assessing of gastric lap band position. This patient
is need to revise the position of the slipped band.
treatment for slipped gastric band - CORRECT ANSWER - plain x-ray (measure phi
angle) or swallow study, deflate the band
ddx: tachycardic, fever, abdominal pain after gastric bypass - CORRECT ANSWER - leak
until proven otherwise (other complications = bleed, PE); if there is any suspicion of leak, go
straight to the OR because swallow studies miss 30% of leaks and CT misses 20% leaks
(imaging not reliable enough)
where does a gastric sleeve usually leak? - CORRECT ANSWER - at the angle of His or
GE junction since those areas are the least vascularized
when do gastric bypasses leak, if they are going to? - CORRECT ANSWER - usually post
op day 3
when do gastric bypasses get internal hernias, if they are going to? - CORRECT
ANSWER - months to years after the surgery, once the patient has lost weight and the
mesenteric closures have loosened up
Peterson defect - CORRECT ANSWER - internal hernia in the mesentery of the roux limb
when it is made antecolic
swirl sign - CORRECT ANSWER - dilated bowl indicating an internal hernia, usually on
the left side after gastric bypass
splenic ligaments and their contents - CORRECT ANSWER - splenorenal - splenic
vessels, pancreatic tail
gastrosplenic - short gastrics, left gastroepiploic
colicosplenic
ACTUAL Exam Questions and CORRECT
Answers
Heller myotomy - CORRECT ANSWER - a surgical procedure in which the muscles of
the cardia (lower esophageal sphincter or LES) are cut, allowing food and liquids to pass to the
stomach; treats achalasia
Killian triangle - CORRECT ANSWER - Area of potential weakness situated behind the
esophagus at the level of the cricopharyngeus muscle
which vagus is anterior vs posterior? - CORRECT ANSWER - LARP
left anterior, right posterior
what does the right vagus become? - CORRECT ANSWER - posterior vagal trunk, celiac
plexus, criminal nerve of Grassi
what does the left vagus become? - CORRECT ANSWER - anterior vagal trunk, gastric
plexus, liver branches
criminal nerve of Grassi - CORRECT ANSWER - from right vagus, causes persistently
high acid levels post op if left after vagotomy, supplies the posterior fundus
types of hiatal hernia - CORRECT ANSWER - type 1: sliding hiatal hernia (~95%).
type 2: paraesophageal hiatal hernia with the gastro-esophageal junction in a normal position.
type 3: mixed or compound type, paraesophageal hiatal hernia with displaced gastro-esophageal
junction.
type 4: mixed or compound type hiatal hernia with additional herniation of viscera (most
commonly colon).
, phi angle - CORRECT ANSWER - A normal phi angle is ranging between 4 and 58
degrees. The phi angle is a useful measure in assessing of gastric lap band position. This patient
is need to revise the position of the slipped band.
treatment for slipped gastric band - CORRECT ANSWER - plain x-ray (measure phi
angle) or swallow study, deflate the band
ddx: tachycardic, fever, abdominal pain after gastric bypass - CORRECT ANSWER - leak
until proven otherwise (other complications = bleed, PE); if there is any suspicion of leak, go
straight to the OR because swallow studies miss 30% of leaks and CT misses 20% leaks
(imaging not reliable enough)
where does a gastric sleeve usually leak? - CORRECT ANSWER - at the angle of His or
GE junction since those areas are the least vascularized
when do gastric bypasses leak, if they are going to? - CORRECT ANSWER - usually post
op day 3
when do gastric bypasses get internal hernias, if they are going to? - CORRECT
ANSWER - months to years after the surgery, once the patient has lost weight and the
mesenteric closures have loosened up
Peterson defect - CORRECT ANSWER - internal hernia in the mesentery of the roux limb
when it is made antecolic
swirl sign - CORRECT ANSWER - dilated bowl indicating an internal hernia, usually on
the left side after gastric bypass
splenic ligaments and their contents - CORRECT ANSWER - splenorenal - splenic
vessels, pancreatic tail
gastrosplenic - short gastrics, left gastroepiploic
colicosplenic
