Usmle Gi Questions

Front 1

Most common location where volvulus occurs:

Back 1

* Sigmoid colon

Front 2

What is the Charcot triad and what is it indicative of?

Back 2

* Charcot triad = fever, jaundice, and RUQ pain

* Indicative of cholangitis (infection of biliary tree proximal to an obstruction)

Front 3

What is the window period of hepatitis B?

Back 3

* Period where HBsAg nor HBsAb is found

Front 4

Viral family to which Hepatitis B belongs:

Back 4

* Hepadnavirus -- dsDNA virus

Front 5

Parasite that can cause megacolon, megaesophagus, and cardiac failure:

Back 5

* Trypanosoma cruzi (Chagas disease)

Front 6

A pt with high levels of gastrin will probably have high levels of:

Back 6

* Secretin

Front 7

Pt's with pancreatic calcifications due to pancreatitis are at risk of developing what secondary disease:

Back 7

* Diabetes-- due to islet cell destruction

Front 8

Type of hernia where the gastroesophogeal junction is above the esophageal hiatus of the diaphragm:

Back 8

* Sliding hiatal hernia

Front 9

Progesterone derivative drug that is good at stimulating the appetite

Back 9

* Megestrol

Front 10

Most frequent cause of intrassusception in kids:

Back 10

* Hyperplasia of peyers patches

Front 11

How do adults usually get intrassusception?

Back 11

* Tumors or polyps caught in peristaltic action

Front 12

What causes malrotation?

Back 12

* Failure of the cecum to descend to its normal position in the RLQ

Front 13

The use of these drugs can lead to melanosis coli:

Back 13

* Anthracene laxative abuse-- accumulation of brown black pigment in macrophages in the lamina propria

Front 14

Most commonly infarcted areas in the colon due to hypovolemia/hypotension:

Back 14

* Watershed areas such as the splenic flexure and mid-rectum

Front 15

In what GI layer does a "mural" infarction occur?

Back 15

* Muscluaris propria

Front 16

Acquired dilitation (telangiectasia) of the thin walled veins of the superficial lamina propria in the cecum:

Back 16

* Angiodysplasia

Front 17

What are internal and external hemorrhoids covered with?

Back 17

* Internal = rectal epithelium
* External = anal squamos epithelium

Front 18

Most common clinical characterisitcs of tropical sprue:

Back 18

* Steatorrhea and folate-deficiency anemia

Front 19

These immunoglobins (in the intestinal mucosa) are increased in Celiac disease:

Back 19

* IgA and IgM

Front 20

Characteristic finding in the lamina propria of the small bowel of a patient with Whipple disease:

Back 20

* presence of macrophages filled with PAS-positive, diastase-resistant granules

Front 21

Disorder associated with ulcerative colitis, its characterized by alternating strictures and dilation with "beading" on ERCP. It is inflammation and fibrosis of bile ducts:

Back 21

* Primary sclerosing cholangitis

Front 22

A patient with "tinkling" bowel sounds probably has:

Back 22

* Bowel obstruction-- don't give these pt's prokinetics such as metaclopromide

Front 23

A kid with hypoglycemia, coma, elevated liver enzymes, and elevated ammonia levels probably has ingested:

Back 23

* Aspirin-- Reye's sydnrome

Front 24

A 1 wk old infant who develops GI bleeding, GI perforation, abdominal distress, and sepsis probably has:

Back 24

* Necrotizing enterocolitis

Front 25

Tumors from the penis, vagina, and anal canal all drain where?

Back 25

* Medial side of the horizontal chain of the superficial inguinal lymph nodes

Front 26

The type of E. coli that produces travelers diarrhea:

Back 26

* ETEC (enterotoxigenic E. coli) increases cAMP resulting in a secretory, self limiting diarrhea

Front 27

What clinical lab test is used to confirm candidiasis?

Back 27

* Germ tube test

Front 28

What would predispose a patient to a highly vascular tumor of the liver?

Back 28

* Exposure to vinyl-chloride-- an angiosarcoma

Front 29

Organism that can cause a life-threatening watery diarrhea in a patient who eats raw oysters:

Back 29

* Vibrio vulnificus

Front 30

In acute cholecystitis, where is the occlusion?

Back 30

* In the cystic duct

Front 31

Organism that can cause pigmented gallstones:

Back 31

* Clonorchis sinesis (Oriental liver fluke)

Front 32

A fungating esophageal mass with glands that extend into the muscular layer and have large, hyperchromatic nuclei is probably:

Back 32

* Esophageal adenocarcinoma (major risk factor is GERD)

Front 33

Pancreatic adenocarcinoma has a bleak survival rate which is similar to what other GI adenocarcinoma:

Back 33

* Similar to esophageal adenocarcinoma

Front 34

When treating a kid for diarrhea and you give Pedia-lyte, what is the purpose of the glucose?

Back 34

* To aid sodium absorption via the intestinal glucose/sodium co-transport mechanism

Front 35

Provide vascular circulation to the lower anal canal:

Back 35

* Inferior rectal artery and vein

Front 36

Typical labs in a young patient with Gilbert's disease:

Back 36

* Elevated indirect bilirubin with a normal direct bilirubin (glucuronyl transferase deficiency)

Front 37

A woman who is vomiting up bile could have this congenital anomlay:

Back 37

* Annular pancreas which is compressing the duodenum (d/t failure of the ventral pancreas to migrate normally)

Front 38

What does vaso-active peptide do?

Back 38

* Stimulates GI fluid secretion and can cause a secretory diarrhea

Front 39

Triad of symptoms often seen with hereditary hemochromatosis:

Back 39

* Cirrhosis, diabetes, and skin bronzing

Front 40

Where specifically does tylenol cause hepatic necrosis?

Back 40

* Causes centrilobular necrosis around the terminal hepatic vein

Front 41

Extraintestinal manifestations of ulcerative colitis

Back 41

* Pyoderma gangrenosum and primary sclerosing cholangitis

Front 42

Relatively specific lab finding in alcoholic cirrhosis:

Back 42

* AST:ALT ration > 1.5
"your to-AST-ed in EtOH hepatitis"

Front 43

Common lab findings in viral hepatitis:

Back 43

* ALT > AST

Front 44

How does hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) typically spread?

Back 44

* Hematogenous dissemination

Front 45

Prostalandin E1 drug that is used to prevent NSAID induced ulcers:

Back 45

* Misoprostol -- pregnant women should avoid this, as it can induce labor

Front 46

How does gemfibrozil affect HDL, LDL and Trigs?

Back 46

* slight decrease in LDL, slight increase in LDL, LARGE decrease in triglycerides-- best for high TRIG's

Front 47

The most likely location of a cancer patient who has macrocytic anemia d/t B12 deficiency is where?

Back 47

* The stomach, chronic atrophic gastritis (affects parietal cells) can lead to B12 deficiency and cancer

Cancer of the Ileum is uncommon

Front 48

Stress ulcers will often cause an increase in these 2 gastric products:

Back 48

* Pepsin and gastric acid

Front 49

What type of change occurs in Barret's esophagus?

Back 49

* Non-keratinized squamos to NON-CILIATED columnar cells

Front 50

Only GI hormone that is stimulated by fats, proteins, and carbs:

Back 50

* Gastric inhibitory peptide (GIP)

Front 51

Risk factors for gallstones:

Back 51

* 5 "F's": Female, fat, forty, fertile, and flatulent-- Native Americans are also at a greater risk

Front 52

Old patient with RLQ pain and fever probably has:

A young adult/kid with RLQ pain and fever probably has:

Back 52

* Think diverticulitis (acute appendicitis doesn't usually occur in the elderly

* Think acute appendicitis

Front 53

Features of achalasia:

Back 53

* Failure of the LES to relax d/t loss of myenteric plexus-- dilated esophagus with distal stenosis ("Bird's beak on barium swallow)

Front 54

Degradation of heme (such as in Sickle cell) will produce what type of gallstones:

Back 54

* Calcium bilirubinate stones

Front 55

1st test done on someone with suspected achalasia:

Back 55

* Barium swallow-- although you would need to do an endoscopy to rule out cancer

Front 56

A nearly complete blockage of blood flow in the hepatic veins or IVC is:

Back 56

* Budd-Chiari syndrome

Front 57

Levels of this protein are often elevated in hepatocellular carcinoma:

Back 57

* Alpha-fetoprotein (AFP)

Front 58

Tumor markers that are often elevated in pancreatic cancer are:

Back 58

* CEA and CA 19-9

Front 59

Extraintestinal manifestations of Crohns disease include:

Back 59

* Migratory polyarthritis, uveitis, ankylosing spondylitis, erythema nodosum, and other immune disorders

Front 60

Alcoholic hepatitis differs from viral hepatitis in that it has this finding in the liver:

Back 60

* Mallory bodies (these aren't seen in viral hepatitis)

Front 61

Barrett's esophagus can transform into what cancer:

Back 61

* Esophageal ADENO-carcinoma

Front 62

Extrapyramidal effects can be seen with this prokinetic:

Back 62

* Metaclopromide

Front 63

Complications of Crohns disease include:

Back 63

* Strictures, fistulas, perianal disease, malabsorption, and nutritional depletion

Front 64

Antidiarrheals (such as loperimide) are contraindicated in kids with diarrhea because:

Back 64

* Can cause a toxic megacolon

Front 65

What causes Cholestasis and what lab value is elevated?

Back 65

* Cholestasis-- caused by DRUGS that interfere with bilirubin conjugation will have NORMAL AST/ALT but ELEVATED Alkaline Phosphate

Front 66

What type of steatosis is caused by drugs (especially Aspirin in Reye's)?

Back 66

* Microvesicular-- fat globules don't displace the nucleus

Front 67

How is aspirin typically handled in the liver (what metabolic path)?

Back 67

* Usually phase II (up to 3 grams) over this it is PHASE I which cause hepatic necrosis via toxic NAPQI

Front 68

Budd-Chiari (thrombosis of major hepatic veins/IVC) which causes pain, ascites, hepatomegaly, etc, is most commonly caused by:

Back 68

* Polycythemia Vera, hepatocellular carcinoma, or possible pregnancy

Front 69

Veno-occlusive disease (collagen developing around the central hepatic veins) is most commonly associated with:

Back 69

* Complications of bone marrow transplatation

Front 70

Components of a hepatitis profile:

Back 70

* HBsAg, Anti-HBs, Anti-HBc, Anti-HAV, Anti-HCV (HB surface, then ANTI-surface, core, A, and C)

Front 71

Hep B marker that is there before symptoms appear:

Back 71

* HBsAg

Front 72

How would you know someone was immune to Hep A?

Back 72

* They would have Anti-HAV IgG

Front 73

What type of virus is Hep C?

Back 73

* ssRNA

Front 74

What would it mean if a pt had anti-HCV IgG?

Back 74

* Their either infected or recovering-- this is NOT a protective antibody

Front 75

Councilman bodies are a sign of:

Back 75

* An acute hepatitis (apoptosis of hepatocytes)

Front 76

Persistent inflammation and fibrosis is a sign of what in the liver?

Back 76

* Sign of chronic hepatits progressing to post-necrotic cirrhosis

Front 77

Pt with pigmented cirrhosis probably has:

Back 77

* Hemochromatosis

Front 78

What drugs can cause:
Acute hepatitis?
Cholestasis?
Fatty change?
Fibrosis?

Back 78

* Acute Hep = Isoniazid, Tylenol
Cholestasis = Oral contraceptives, 'Roids
Fatty change/Fibrosis = Amiodorone and Methotrexate

Front 79

Autoimmune disorder seen in women who have Anti-Mitochondrial Ab's, increased IgM, cirrhosis with portal HTN, hepatomegaly, and jaundice:

Back 79

* Primary Biliary Cirrhosis-- (Granulomatous destruction of bile ducts in portal triads)

Front 80

AD disorder characterized by PAS + red hepatic cytoplasmic granules:

Back 80

* Alpha-Antitrypsin (increased risk for hepatocellular carcinoma)

Front 81

A pt who has Kayser-Fleisher rings has a deficiency of what protein?

Back 81

* Ceruloplasmin (copper-binding protein)

Wilson's disease is AR

Front 82

This complication of cirrhosis results in Asterixis d/t a defective urea cycle and false neurotransmitters (GABA):

Back 82

* Hepatic encephalopathy

Front 83

Most common malignancy of the bile ducts, clinical findings include jaundice and a Courvoisier's sign (palpable gallbladder):

Back 83

* Cholangiocarcinoma -- most common cause is primary sclerosing pericholangitis

Front 84

Cholelithiasisi (gallstones) is the most common cause of chronic cholecystitis which may lead to a porcelein gallbladder and then:

Back 84

* Gallbladder adenocarcinoma

Front 85

Acute cholecystitis is 90% of the time caused by:

Back 85

* Stone in the cystic duct (could be d/t infection or severe volume depletion though)

Front 86

Gold standard to identify cholelithiasis:

Back 86

* Ultrasound

Front 87

A pt with jaundice and a gallstone means the stone is most likely:

Back 87

* In the common bile duct

Front 88

Most common cause of gallstone in women:

Back 88

* Gallstone obstructing the terminal part of the common bile duct where the bile activates pancreatic proenzymes

Front 89

Gold standard for pancreatic imaging:

Back 89

* CT scan

Front 90

A pt with an abdominal mass and a persistent increase in serum amylase probably has:

Back 90

* Pancreatic pseudocyst (persistent increased serum amylase)

Front 91

Most common cause of pancreatic adenocarcinoma:

Back 91

* Smoking

Front 92

Genetic association with pancreatic adenocarcinoma:

Back 92

* K-RAS, mutation of tumor suppressor genes (TP16 and TP53)

Front 93

Gold standard tumor marker for pancreatic adenocarcinoma:

Back 93

* CA19-9

Front 94

How do patients with pancreatic adenocarcinoma present:

Back 94

* Jaundice, light stools, and palpable gallbladder

Front 95

This zone of the liver is most susceptible to ischemic (hypoperfusive) injury:

Back 95

* Zone 3 (Pericentral vein zone) -- is where P450 metabolism occurs

Front 96

Signs of cirrhosis:

Back 96

* Portal HTN, ascites, and bridging fibrosis

Front 97

A pt with a cystic lesion adjacent to the pancreas is most at risk of:

Back 97

* Pt has a pancreatic pseudocysts-- biggest complication is rupture creating a GI HEMORRHAGE

Front 98

A woman with itching, elevated conjugated bilirubin, increased Alk Phoshate, and granulomatous inflammation of the intrahepatic bile ducts has:

Back 98

* Primary biliary cirrhosis -- she will have ANTI-MITOCHONDRIAL autoantibodies

Front 99

A pt with type A chronic gastritis will have what blood finding?

Back 99

* Increased macrocytes (macrocytic anemia d/t B12 deficiency)

Front 100

Parasitic infection that can cause bowel obstruction in an adult:

Back 100

* Ascaris lumbricoides