GI- uworld

Question 1

spleen embryology

• derived from which embryologic later
• what is special embryologic features

Answer 1

• mesoderm
• derived from mesoderm, but receives blood supply from foregut derivates. splenic artery is coming out from celiac trunk

Question 2

63-Q5. Greater omentum vs. lesser omentum: attachment site to stomach?

Answer 2

greater omentum: greater curvature -> travels inferiorly to cover whole surface

lesser omentum: lesser curvature -> to liver

Question 3

63- Q14. Diphenoxylate

• MOA
• indication
• another drug in same class?

Answer 3

• u opioid receptor agonist
  => decrease motility: anti-diarrhea
• diarrhea
• loperamide

Question 4

63- Q16. Buzzword for arsenic poisoning? what is treatment for arsenic poisoning?

Answer 4

• buzzwords: insecticides, garlic odor, diarrhea

treatment: dimercarprol (also used for lead chelator)

Question 5

63-Q19. Mast cell positive for KIT (CD177). What does this mean? possible GI complication?

Answer 5

KIT :tyrosine kinase -> excess histamine release from mast cell -> excess gastric acid

• Even though I don’t know what KIT means, don’t panic. Go through answer choices, and think about it. In this question, I could derive an answer because I knew mast cell releases histamine, and parietal cells has H2 receptor for gastric acid release

Question 6

Three functions of bile salts

Answer 6

• anti-bacterial: membrane disruption
• Fat soluble vitamin absorption
• dissolve/excretion of cholesterol

Question 7

Pertechneatate study: measuring what? for what abnormality?

Answer 7

ectopic gastric mucosa

For Mecekl diverticulum

Question 8

Pathophysiology of dysphagia in CREST syndrome?

Answer 8

esophageal SMOOTH MUSCLE ATROPHY & FIBROSIS
-> loss of Ausrbach nerve plexus -> dismotility

• this makes sense. autoimmune condition -> attacking esophageal smooth muscle

Question 9

postprandial epigastric pain: three differential diagnosis? how to differentiate these?

Answer 9

• biliary colic: pain comes and goes -> ultrasound for gall stones
• gastric ulcer: abnormal GI endoscopy finding
• chronic mesenteric ischemia: normal GI endoscopy, normally given with history of MI, stroke, DVT, or things like that.

Question 10

63- Q35. long standing GERD. Two possible complications? How to differentiate them?

Answer 10

• ulceration: pain with swelling

- malignancy: progressive dysphagia. First solid then liquid after

Question 11

64- Q2 . Describe hepatic abscess in CT. Two infectious microrganisms for hepatic abscess?

Answer 11

fluid filled abscess

• Staph aureus
• Entamoeba Histolytica

Question 12

64- Q 7. Compare pathophysiology: gastric ulcer vs. duodenal ulcer

Answer 12

gastric ulcer: decreased mucosal protection

duodenal ulcer: increased gastric acid or decreased mucosal protection

• gastric ulcer is NOT NECESSARILY associated with gastric acid secretion. Which makes sense as gastric mucosa is designed to bear with gastric acid, while duodenal mucosa is not.

Question 13

64- Q 12. macrocytic anemia, constipation, person work at construction. Diagnosis?

Answer 13

lead poisoning

• ALWAYS pay attention to OCCUPATION.
  Construction environment is classic example of lead poisoning.

Question 14

64- Q 13. site of bile reabsorption?

Answer 14

terminal ileum

Question 15

64- Q 15. What is initial presentation of HepB acute infection?

Answer 15

serum sickness:

fever, arthralgia, rash

Question 16

64-Q 39. What is silent GERD? clinical manifestation?

Answer 16

GERD with absence of heartburn

• chronic esophagus irritation can lead to extraesophageal symptoms such as nocturnal cough or hoarseness

Question 17

65- Q8. Mechanism regarding how opioid exacerbates biliary colic

Answer 17

contraction of SMOOTH MUSCLE in SPHINCTER OF ODDI

Question 18

65- Q 13, Lower esophagus is associated with what type of esophagus cancer?

Answer 18

adenocarcinoma

upper esophagus -> squamous cell carcinoma

Question 19

65- Q 15. histologic finding of alcoholic hepatitis?

Answer 19

mallory bodies- intracytoplasmic eosinophilic inclusions of damaged keratin filaments

Question 20

65- Q 15. Necrotizing enerocolitis

• affected population
• pathophysiology
• complication? How this complication is represented in abdominal x-ray?

Answer 20

• premature, formula fed-kids
• immature immune system -> bacteria invades into bowel mucosa -> inflammation
• perforation. will be seen as pneumatosis intestinalis: radiolucent lumen of bowel

Question 21

66- Q 19. Past history of Crohn’s disease, multiple bruises and ecchymoses. What is going on?

Answer 21

damaged terminal ileum -> impaired bile reabsorption

• > loss of vitamin K -> less coagulation factor
• > bleeding

Question 22

66- Q27. Symptoms of fever, jaundice, abdominal pain. What should I suspect?

Answer 22

acute viral hepatitis

Question 23

67- Q4. What mediates increased gastric acid secretion in Zollinger-Ellison syndrome?

Answer 23

increased gastrin

Question 24

67-Q4. What is a diagnostic test for Zollinger-Ellison syndrome

Answer 24

secretin stimulation test

- gastrin levels remain high even after administration of secretin

Question 25

67- Q28. Frequency of colorectal cancer location among ascending colon, descending colon, rectosigmoid colon?

Answer 25

rectosigmoid colon > ascending colon > descending colon

Question 26

67- Q28. Describe different presentations of colorectal cancer in ascending colon vs. rectosigmoid colon

Answer 26

- ascending colon: big mass, iron deficiency anemia (more like to bleed) - rectosigmoid colon: smaller mass (more like infiltrating mass), obstruction, hematochezia * this makes sense. ascending colon is big. so bigger one can grow well. while recosigmoid colon is close to anus, so bleeding poop

Question 27

68- Q1. Duodenal atresia vs. jejunal/ileal atresia - etiology - clinical finding

Answer 27

Duodenal atresia - failure of recanalization - Down syndrome, double bubble sign on x-ray Jejunal/ileal atresia - ischemic necrosis - apple peel blood vessel (spiral shape of jejunum and ileum around blood vessel)

Question 28

68- Q4. Infectious esophagitis: morphology of each - HSV-1 - CMV - Candida

Answer 28

- HSV-1: punched out ulcer - CMV: linear ulcer - Candida: white pseudomembrane

Question 29

68- Q5. buzzword: mushroom - name of toxin - inhibition of what molecule?

Answer 29

- Amatoxin (mushroom is called Amantia phalloides) | - RNA polymeraseII -> impaired mRNA synthesis

Question 30

68- Q8. End stage renal disease patient who received kidney transplant, complain progressive worsening dysphagia, chest pain. Esophageal endoscope reveals linear ulcer. What will be seen on esophageal biopsy?

Answer 30

Intranuclear inclusion : owl-eye appearance of CMV *This is fucking good question * buzzwords 1. organ transplant -> immunocompromised 2. linear esophageal ulcer -> CMV

Question 31

68- Q16. Patient with severe septic shock and respiratory failure showed blood in nasogastric suction. what is going on?

Answer 31

stressed induced acute gastiritis * buzzword - hypovolemic shock -> when shock and some GI manifestation is going on. Always think about stressed induced acute gastritis. Classic example is Curling's ulcer (burn-> hypovolemia -> ischemia-> ulcer)

Question 32

Recent travel history to Mexico, with some liver thing going on. what should I suspect?

Answer 32

acute viral hepatitis Mexico is endemic region for HepA

Question 33

68- Q 23. Anal fissure - what is it? - clinical presentation - location? why?

Answer 33

- tear in anal mucosa - Painful Pooping, blood on Paper - Posterior below Pectneal line: due to less perfusion -> more susceptible for ischemia * notice all Ps

Question 34

68- Q 24. sign of obstructive jaundice? With obstructive jaundice + non-painful distended gallbladder: what should I think?

Answer 34

- obstructive jaundice sign: pale stool, dark urine * bilirubin doesn't get excreted fecally, but it can still get to urine via blood. - obstructive jaundice + nonpainful distended gallbladder -> should think about adenocarcinoma at HEAD of pancreas

Question 35

68- Q 26. hepatic vein vs. portal vein: to where does left gastric vein (esophageal varices) drain into? esophageal varices is sign of obstruction at what vein?

Answer 35

- PVC - PVC * Thus, Budd-Chiarri (hepatic vein thrombosis) is not associated with esophageal varicies

Question 36

69- Q3. What is most common benign tumor of liver ? Histologic finding?

Answer 36

Cavernous hemangioma - multiple bloody spots: vasculcar malformation * check image FA p.368