MEHLMAN HY GASTRO - INFO
310+ (2026/2027) Exam-Style Questions & Answers | 100% Verified
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📋 DOCUMENT OVERVIEW 311 Qs
This document, "Mehlman HY Gastro - Info," covers various gastrointestinal topics, including abdominal
imaging, esophageal disorders, gastroenterology, and parasitology, as well as specific infections and
treatments. The document provides 311 questions with correct answers, along with diagrams and
images, serving as a comprehensive review of gastrointestinal concepts. Students can use this
document to study, review, and understand complex gastrointestinal topics, facilitating their preparation
for exams and enhancing their knowledge retention.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 1
MRI shows satellite nodule of HCC that grows next to the larger, initial growth
CORRECT ANSWER
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, QUESTION 2
Perioral impetigo
CORRECT ANSWER
- Often confused with herpes
- If they show you image of young kid in particular with lip lesions, it's usually impetigo caused by S.
aureus or Group A Strep (S. pyogenes).
- Can lead to PSGN (if caused by Strep), as discussed in the HY Renal PDF
QUESTION 3
Esophageal manometry
CORRECT ANSWER
- Answer for achalasia after barium swallow shows bird's beak.
- A pressure study of the esophagus
QUESTION 4
Trypsin
CORRECT ANSWER
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, - Secreted by exocrine pancreatic acinar cells as the zymogen trypsinogen.
- Converted by enterokinase at the brush border into trypsin.
- Trypsin is a protease that breaks down protein.
- Once active trypsin is formed, it activates other zymogens (e.g., chymotrypsinogen) into active
proteases.
- USMLE will ask about enterokinase, followed by wanting you to know that once we've got active trypsin,
it is the latter that now activates other things. Enterokinase merely gets things started.
QUESTION 5
MRCP
CORRECT ANSWER
- Magnetic resonance cholangiopancreatography.
- Never seen this as correct answer on NBME, but I observe that students always pick it when they don't
know what's going on, maybe because it sounds weird and specific.
- Can visualize biliary tree much more safely than ERCP, but unlike ERCP, it isn't a form of treatment
(ERCP is both diagnostic and therapeutic).
QUESTION 6
Rotavirus
CORRECT ANSWER
- Most common cause of watery diarrhea in unvaccinated children < 5 years. - Vaccine normally given
orally at 2, 4, and 6 months of age. - Double-stranded, segmented RNA (NBME asks it). - Wheel-shaped
(also on NBME)
QUESTION 7
Focal nodular hyperplasia
CORRECT ANSWER
- Obscure diagnosis where they tell you adult has an abdominal CT for unrelated reason and has a 1-2-cm
hepatic lesion with a central scar. There will be zero mention of trauma or infection. Every student says
WTF.
- This is a lesion of hepatocellular hyperplasia that does not require treatment. This is the answer on
NBME, where they tell you CT shows hepatic lesion with central scar. Answer = "no further diagnostic
studies indicated."
QUESTION 8
Gallstone ileus
CORRECT ANSWER
- Gallstone enters small bowel and causes an intestinal obstruction.
- The answer on USMLE if they say "air in the biliary tree" (pneumobilia).
- Can be caused by cholecystoduodenal fistula, which is when a patient with cholelithiasis can develop a
conduit between the gallbladder and small bowel.
- What the USMLE will do is give you a long, rambling paragraph where they say "air in the biliary tree" in
Trusted by thousands of students and professionals worldwide Page 3 of 93
, the last line. The answer will then just be "gallstone ileus" straight up, or it will be "cholecystoduodenal
fistula."
QUESTION 9
Motilin
CORRECT ANSWER
- Stimulates peristalsis in the absence of food.
- Responsible for borborygmi (GI sounds).
- Erythromycin (yes, the antibiotic) can agonize motilin receptors in patients with gastroparesis
QUESTION 10
Biliary atresia: peds
CORRECT ANSWER
- As discussed earlier, increased direct bilirubin in a kid under the age of 6 weeks.
- Caused by lack of development of the intrahepatic bile ductules and biliary tree.
- Ultrasound will be done first, but USMLE wants liver biopsy to confirm the diagnosis.
- Kasai procedure is done to treat, followed by liver transplant if unsuccessful
QUESTION 11
Mucoepidermoid carcinoma
CORRECT ANSWER
- The answer on USMLE for a salivary gland tumor that invades / has spread / if the patient has B-
symptoms (fever, night sweats, weight loss).
- Most common malignant salivary gland tumor.
- Malignant means capable of invading, whereas pleomorphic adenoma will not invade
QUESTION 12
Hyperbilirubinemia: Unconjugated (indirect)
CORRECT ANSWER
- Bilirubin is produced from breakdown of heme from RBCs at the spleen. It will initially be
"unconjugated" in this form, where it merely leaves the spleen non-covalently bound to albumin and is
not water-soluble - i.e., it won't show up in the urine. Unconjugated bilirubin is aka indirect bilirubin.
- In the setting of hemolysis or increased RBC turnover (i.e., sickle cell, hereditary spherocytosis, blood
given during surgery), where we have RBC breakdown, we get increased indirect bilirubin.
- Once it arrives at the liver, it is taken up by the liver and conjugated to glucuronide, making it water-
soluble. Conjugated bilirubin is aka direct bilirubin.
- If the there's a problem with uptake at the liver (i.e., acute hepatitis), or there is deficient conjugation
enzyme (Gilbert syndrome, Crigler-Najjar), indirect bilirubin also goes up.
- Hemolysis or increased RBC turnover can cause direct bilirubin to go up sometimes as well, but the shift
will be more toward indirect being high. I point this out because students often get confused by this, but
if we have increased indirect bilirubin going into the liver, then this means increased direct bilirubin going
out. A 2CK NBME Q gives 9 packs of RBCs given during surgery -> days later, total bilirubin is 5.0 and
direct bilirubin 2.3 -> answer = "overproduction of bilirubin."
- In regard to neonatal labs (i.e., first month of life), I should note that hematocrit % can be in the 50s
Trusted by thousands of students and professionals worldwide Page 4 of 93
310+ (2026/2027) Exam-Style Questions & Answers | 100% Verified
Solutions | Grade A+ Guarantee
100% Guarantee Pass
📋 DOCUMENT OVERVIEW 311 Qs
This document, "Mehlman HY Gastro - Info," covers various gastrointestinal topics, including abdominal
imaging, esophageal disorders, gastroenterology, and parasitology, as well as specific infections and
treatments. The document provides 311 questions with correct answers, along with diagrams and
images, serving as a comprehensive review of gastrointestinal concepts. Students can use this
document to study, review, and understand complex gastrointestinal topics, facilitating their preparation
for exams and enhancing their knowledge retention.
✓ Verified Answers ✓ Exam Ready ✓ Study Guide
Trusted by thousands of students and professionals worldwide
EXAM QUESTIONS
QUESTION 1
MRI shows satellite nodule of HCC that grows next to the larger, initial growth
CORRECT ANSWER
Trusted by thousands of students and professionals worldwide Page 1 of 93
, QUESTION 2
Perioral impetigo
CORRECT ANSWER
- Often confused with herpes
- If they show you image of young kid in particular with lip lesions, it's usually impetigo caused by S.
aureus or Group A Strep (S. pyogenes).
- Can lead to PSGN (if caused by Strep), as discussed in the HY Renal PDF
QUESTION 3
Esophageal manometry
CORRECT ANSWER
- Answer for achalasia after barium swallow shows bird's beak.
- A pressure study of the esophagus
QUESTION 4
Trypsin
CORRECT ANSWER
Trusted by thousands of students and professionals worldwide Page 2 of 93
, - Secreted by exocrine pancreatic acinar cells as the zymogen trypsinogen.
- Converted by enterokinase at the brush border into trypsin.
- Trypsin is a protease that breaks down protein.
- Once active trypsin is formed, it activates other zymogens (e.g., chymotrypsinogen) into active
proteases.
- USMLE will ask about enterokinase, followed by wanting you to know that once we've got active trypsin,
it is the latter that now activates other things. Enterokinase merely gets things started.
QUESTION 5
MRCP
CORRECT ANSWER
- Magnetic resonance cholangiopancreatography.
- Never seen this as correct answer on NBME, but I observe that students always pick it when they don't
know what's going on, maybe because it sounds weird and specific.
- Can visualize biliary tree much more safely than ERCP, but unlike ERCP, it isn't a form of treatment
(ERCP is both diagnostic and therapeutic).
QUESTION 6
Rotavirus
CORRECT ANSWER
- Most common cause of watery diarrhea in unvaccinated children < 5 years. - Vaccine normally given
orally at 2, 4, and 6 months of age. - Double-stranded, segmented RNA (NBME asks it). - Wheel-shaped
(also on NBME)
QUESTION 7
Focal nodular hyperplasia
CORRECT ANSWER
- Obscure diagnosis where they tell you adult has an abdominal CT for unrelated reason and has a 1-2-cm
hepatic lesion with a central scar. There will be zero mention of trauma or infection. Every student says
WTF.
- This is a lesion of hepatocellular hyperplasia that does not require treatment. This is the answer on
NBME, where they tell you CT shows hepatic lesion with central scar. Answer = "no further diagnostic
studies indicated."
QUESTION 8
Gallstone ileus
CORRECT ANSWER
- Gallstone enters small bowel and causes an intestinal obstruction.
- The answer on USMLE if they say "air in the biliary tree" (pneumobilia).
- Can be caused by cholecystoduodenal fistula, which is when a patient with cholelithiasis can develop a
conduit between the gallbladder and small bowel.
- What the USMLE will do is give you a long, rambling paragraph where they say "air in the biliary tree" in
Trusted by thousands of students and professionals worldwide Page 3 of 93
, the last line. The answer will then just be "gallstone ileus" straight up, or it will be "cholecystoduodenal
fistula."
QUESTION 9
Motilin
CORRECT ANSWER
- Stimulates peristalsis in the absence of food.
- Responsible for borborygmi (GI sounds).
- Erythromycin (yes, the antibiotic) can agonize motilin receptors in patients with gastroparesis
QUESTION 10
Biliary atresia: peds
CORRECT ANSWER
- As discussed earlier, increased direct bilirubin in a kid under the age of 6 weeks.
- Caused by lack of development of the intrahepatic bile ductules and biliary tree.
- Ultrasound will be done first, but USMLE wants liver biopsy to confirm the diagnosis.
- Kasai procedure is done to treat, followed by liver transplant if unsuccessful
QUESTION 11
Mucoepidermoid carcinoma
CORRECT ANSWER
- The answer on USMLE for a salivary gland tumor that invades / has spread / if the patient has B-
symptoms (fever, night sweats, weight loss).
- Most common malignant salivary gland tumor.
- Malignant means capable of invading, whereas pleomorphic adenoma will not invade
QUESTION 12
Hyperbilirubinemia: Unconjugated (indirect)
CORRECT ANSWER
- Bilirubin is produced from breakdown of heme from RBCs at the spleen. It will initially be
"unconjugated" in this form, where it merely leaves the spleen non-covalently bound to albumin and is
not water-soluble - i.e., it won't show up in the urine. Unconjugated bilirubin is aka indirect bilirubin.
- In the setting of hemolysis or increased RBC turnover (i.e., sickle cell, hereditary spherocytosis, blood
given during surgery), where we have RBC breakdown, we get increased indirect bilirubin.
- Once it arrives at the liver, it is taken up by the liver and conjugated to glucuronide, making it water-
soluble. Conjugated bilirubin is aka direct bilirubin.
- If the there's a problem with uptake at the liver (i.e., acute hepatitis), or there is deficient conjugation
enzyme (Gilbert syndrome, Crigler-Najjar), indirect bilirubin also goes up.
- Hemolysis or increased RBC turnover can cause direct bilirubin to go up sometimes as well, but the shift
will be more toward indirect being high. I point this out because students often get confused by this, but
if we have increased indirect bilirubin going into the liver, then this means increased direct bilirubin going
out. A 2CK NBME Q gives 9 packs of RBCs given during surgery -> days later, total bilirubin is 5.0 and
direct bilirubin 2.3 -> answer = "overproduction of bilirubin."
- In regard to neonatal labs (i.e., first month of life), I should note that hematocrit % can be in the 50s
Trusted by thousands of students and professionals worldwide Page 4 of 93
