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PHYSIOLOGY > 7th Evals 2018 - GIT > Flashcards

7th Evals 2018 - GIT Flashcards

1
Q
  1. Patient reports substernal burning pain that is most pronounced after ingestion of coffee, chocolates, french fries and alcohol. Which of the following is the most likely cause of gastroesophageal reflux/disease in this patient?
    a. delayed gastric emptying
    b. decreased esophageal motility
    c. decreased lower esophageal sphincteric tone
    d. decreased upper esophageal sphincteric tone
A

c. decreased lower esophageal sphincteric tone = GERD

pg. 4

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2
Q
  1. A 56 y/o male patient’s manometry showed increased lower esophageal pressure with no relaxation upon swallowing indicating a diagnosis of achalasia. Which of the following is the inhibitory neurotransmitter responsible for relaxation of gastrointestinal sphincteric tones?
    a. Dopamine
    b. Vasoactive intestinal peptide (VIP)
    c. Somatostatin
    d. Substance P
    e. Acetylcholine (Ach)
A

B. VIP

  • VIP affects the vagus nerve which helps relax the sphincter
  • relaxation of GI sphincteric tones = vago-vagal reflex

pg 5

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3
Q
  1. A 49 y/o man undergoes vagotomy for his peptic ulcer disease. As a result, which of the following gastrointestinal motor activities will be affected most?
    a. secondary esophageal peristalsis
    b. distension-induced intestinal segmentation
    c. proximal stomach accommodation
    d. distal stomach peristalsis
    e. migrating myoelectric complex
A

C. proximal stomach accommodation

pg 5

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4
Q
  1. Peristaltic antral contractions:
    a. occur at the rate of 3 per minute
    b. are responsible for gastric emptying
    c. are responsible for mixing food and gastric enzymes within the antrum
    d. all of the above
A

D

pg 5

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5
Q
  1. Gastric emptying is primarily controlled by:
    a. the neuronal signals emanating from the medullary swallowing center b. the volume of chyme in the stomach
    c. conditions/factors in the duodenum
    d. the degree of fluidity of the chyme in the stomach
A

C

slower gastric emptying when

  • high vol of food in duodenum
  • distention or irritation in duodenum

pg 5

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6
Q
  1. Which of the following statements best describes water and electrolyte absorption in the gastrointestinal tract?
    a. Most water and electrolytes came from ingested fluids.
    b. The small intestines and colon have similar absorptive capacities. c. Majority of the absorption occurs in the jejenum.
    d. All of the above
A

C

II, pg 12

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7
Q
  1. The pH of the saliva rises as its rate of secretion increases.
    a. True
    b. False
A

A

II, pg 2

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8
Q
  1. The chloride content of the pancreatic juice falls as the rate of secretion increases
    a. True
    b. False
A

A

II, pg 6

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9
Q
  1. Gastric emptying is inhibited by the enterogastric reflex.
    a. True
    b. False
A

A

II, pg 5

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10
Q
  1. Carbohydrate digestion continues in the stomach.
    a. True
    b. False *(bonus)
A

BONUS

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11
Q
  1. Saliva contains the carbohydrate-digesting enzyme? a. lysozyme
    b. carboxypeptidase
    c. amylase
    d. mucins e. lipase
A

C

II, pg 1

  • isozyme - immune protection
  • mucins - protection (not found in saliva)
  • lipase - lipid digestion
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12
Q
  1. Primary salivary secretion is essentially identical in its composition to plasma. However, as it flows into the ducts, the following modification in the composition of the secretion renders the saliva hypotonic as it flows from acini into the the ducts:
    a. Na+ and Cl- are extracted b. K+ and HCO3- are added c. Both A and B
    d. Neither A or B
A

C

II, pg 2

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13
Q
  1. Which GI hormone is secreted by the stomach and upper duodenum during fasting and has the only known function of increasing gastrointestinal motility?
    a. Gastrin
    b. Cholecystokinin
    c. Secretin
    d. Gastric Inhibitory Peptide (GIP) e. Motilin
A

E

pg 6

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14
Q
  1. The hormone that inhibit gastric secretion and motility is:
    a. Gastrin
    b. Histamine
    c. Secretin
    d. Cholecystokinin
    e. Motilin
A

C

pg 3

  • gastrin, histamine, motilin - all stimulate gastric secretion and motility
  • cck - also inhibits gastric emptying
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15
Q
  1. After a high-protein meal, which type of cells will be more active in the stomach?
    a. D cells
    b. G cells
    c. M cells
    d. S cells
A

B

protein=stimulates G cells

Gcells = produce gastrin
Dcells = produce somatostatin
Mcells = produce motilin, stimulated by acid
Scells = produce secretin; stimulated by fat or acid
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16
Q
  1. A newborn with severe diarrhea is found to have an inherited defect in a glucose transporter resulting in glucose/galactose malabsorption, necessitating a glucose and galactose free diet. Which of the following is the transporter protein responsible for entry of glucose and galactose into the intestinal enterocyte?
    a. GLUT-2
    b. GLUT-5
    c. SGLT1
    d. SGLT2
    e. SGLT5
A

C. SGLT1 = glucose or galactose

GLUT-5 (fructose) and SGLT1 = entry
GLUT-2 (glucose, galactose, fructose) = exit

II, pg 10

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17
Q
  1. Dietary fat, after being processed is extruded from the intestinal cells by exocytosis into the lymphatic ducts in the form of:
    a. monoglycerides
    b. diglycerides
    c. triglycerides
    d. chylomicrons
    e. free fatty acids
A

D. chylomicrons

  • monoglycerides & FFA = product of lipids after hydrolyzed by pancreatic lipase
  • tricglycerides = products of lipid digestion are re-esterified to triglycerides in the intestinal cells
  • chylomicrons = transported our via exocytosis; too large to enter capillaries so they are transferred to lymph vessels instead.
18
Q
  1. An 18 year-old male with pernicious anemia lacks intrinsic factor (IF) which is needed for absorption of cyanocobalamin. Vitamin B-12 is absorbed primarily from which portion of the gastrointestinal tract?
    a. stomach
    b. duodenum
    c. jejenum
    d. ileum
    e. colon
A

D. ileum = vit b-12 ONLY

*other vitamins are best absorbed in the duodenum

II, pg 13 & pg 3

19
Q
  1. A child developed iron-deficiency anemia requiring iron supplements. Which of the following statements is correct regarding iron digestion and absorption?
    a. Most iron in the diet are in the ferrous form that are easily absorbed
    b. Iron is absorbed rapidly from the small intestines
    c. Iron is transported in the blood bound to transferrin
    d. Iron is transported into the enterocytes by the ferroportin transporter on the apical
    membrane
    e. All of the above
A

C.

  • A = NOT easily absorbed bec they have to be absorbed a heme iron & then degraded to produce free Fe
  • B = not small intestines - sa duodenum lang
  • D = not ferroportin, APOFERRITIN dapat.
20
Q
  1. Electroneutral mechanism of NaCl absorption is the major route of NaCl absorption. This transport is mediated by:
    a. electrogenic Cl- secretion by CFTR
    b. apical Na+/H+ (NHE2/3) and Cl-/HCO3 exchangers
    c. electrogenic Na+ absorption by ENaC d. nutrient-coupled Na+ absorption
    e. AandC
A

B

II, pg. 13

Na+-Cl- co transport
Cl- HCO3 exchange

21
Q
  1. The intrinsic innervations of the gastrointestinal tract a. are located in the mucosal region
    b. are network of neurons that act as “gut” brain c. made up of 2 plexuses
    d. BandC
    e. all of the above
A

D

pg. 1&2

  • A = SUBMUCOSA, not mucosal region
  • C = 2 plexuses = meissner’s & myenteric nerve plexuses
22
Q
  1. Spike potentials superimposed on depolarizing portion of the slow waves do increase muscle tension. The depolarizing portion of each spike is due to:
    a. Na+ influx
    b. Ca2+ influx
    c. K+ efflux d. Na+ efflux
A

B

pg. 2
* A = Na+ influx - unstable resting membrane potentials are caused by Na+ influx

23
Q
  1. True of Interstitial Cells of Cajal (ICC), except:
    a. act as the pacemakers of smooth muscle slow waves
    b. frequency of ICC pacemaker activity differs in the different regions of the gastrointestinal
    tract
    c. are located in the outer circular muscle layer near the myenteric plexus in the stomach
    and intestines
    d. are located in the submucosal border of the circular muscle layer in the colon e. none of the above
A

E

pg 3

24
Q
  1. What prevents food from entering the nasal passages during swallowing?
    a. elevation of the uvula
    b. contraction of the pharyngeal muscles
    c. opposition of vocal folds d. elevation of epiglottis
A

A

25
Q
  1. During the ingestion and digestion of a meal, peristaltic contractions are the primary type of contractions occurring in the:
    a. esophagus
    b. proximal stomach c. jejenum
    d. ileum
    e. colon
A

A

pg 4

*segmentation is the main type of contraction in the small intestine

26
Q
  1. What is the only protease that can function in the presence of acid? a. trypsin
    b. pepsin
    c. chymotrypsin
    d. procarboxypeptidase A e. procarboxypeptidase B
A

B. pepsin = optimum activity is in pH range of 1.6 to 3.2 (acidic)

II, pg 3 & 5

27
Q
  1. Which of the following agents inhibit gastric acid secretion and visceral blood flow?
    a. Gastrin
    b. Somatostatin
    c. Histamine
    d. Pepsin
    e. Acetylcholine
A

B. somatostatin = inhibit

II, pg 5

*all other choices STIMULATE

28
Q
  1. The following agonist/s of the parietal cell promote parietal cell secretion by increasing intracellular cyclic adenosine 3’,5’-monophosphate (cAMP):
    a. Acetylcholine
    b. Histamine
    c. Gastrin
    d. AandC
    e. BandC
A

B. histamine = increase cAMP

II, pg 4

*Acetylcholine and Gastrin = increase intracellular Calcium

29
Q
  1. Which of the following is true about pancreatic secretions?
    b. Secretin acts on pancreatic ducts to cause an alkaline pancreatic juice that is rich in bicarbonate and enzymes
    c. Secretion of pancreatic juice is primarily under neural control d. AandC
    e. All of the above
A

A

II, pg 7

  • B = POOR in enzyme
  • C = HORMONAL, not neural control
30
Q
  1. Which of the following is most likely to stimulate the pancreas to secrete increased amounts of bicarbonate?
    a. Somatostatin
    b. Secretin
    c. Cholecystokinin d. Gastrin
    e. Motilin
A

B

II, pg 7

31
Q
  1. Distension of the stomach:
    a. causes glucose absorption b. results in salivation
    c. triggers gastrocolic reflex d. inhibits gastric emptying
A

C

pg 6

*D = STIMULATES, not inhibits gastric emptying

32
Q
  1. A 27 y/o, female med student with irritable bowel syndrome (IBS) has an alteration in intestinal motility resulting in fluctuating constipation and diarrhea. Her condition has worsened in the past month as the date for her exam approaches. Which of the following statement about small intestinal motility is correct?
    a. contractile frequency is constant from duodenum to ileum
    b. peristalsis is the only contractile activity that occurs during feeding c. Migrating myoelectric complexes occur during digesting period
    d. Vagotomy abolishes contractile activity during the digestive period e. Contractile activity is initiated in response to bowel wall distension
A

E

  • C = occur 90 mins after a meal until fasting
  • D = Vagotomy (removal of vagus nerve) WILL LESSON, but not abolish contractile activity
33
Q 
33. A new mother calls the pediatrician because she is concerned that her infant defecates after every meal/feeding. Which of the following is the cause of these normal bowel movement in
the newborns?
a. gastroileal reflex
b. gastrocolic reflex
c. enterogastric reflex
d. defecation reflex
e. intestino-intestinal reflex
A

B

pg 6

34
Q
  1. True of Migrating Myoelectric Complex (MMC), except:
    a. gastric secretion, bile flow and pancreatic secretions increase during each MMC
    b. propagates at a rate of 5cm/min
    c. immediately stopped by ingestion of food
    d. serves to clear the stomach and small intestines of luminal contents during feeding state e. None of the above
A

D = not during feeding states, BUT IN BETWEEN MEALS

pg 6

35
Q
  1. True of vomiting, except:
    a. an example of central regulation of gut motility functions b. it starts with salivation and sensation of nausea
    c. the glottis opens
    d. the breath is held in mid inspiration
    e. none of the above
A

C = glottis CLOSES as well as vocal cords

PG 7

36
Q
  1. Bile is produced by the liver continuously. Which of the following is true?
    a. bile functions to catalyze digestive processes in a manner similar to enzymes b. bile salts emulsify large droplets of triglycerides
    c. bile salts reduce the surface area of droplets of triglycerides
    d. 95% of bile salts are lost in the stools
A

B

II, pg 8

37
Q
  1. A patient’s abdominal pain is subdued after eating. Which of the following is true regarding contraction of the gall bladder following a meal?
    a. it is inhibited by a fat-rich meal
    b. it is inhibited by the presence of amino acids in the duodenum
    c. it is stimulated by atropine
    d. it occurs in response to cholecystokinin
    e. it occurs simultaneously with the contraction of the Sphincter of Oddi
A

D

  • A = STIMULATED, not inhibited
  • E = RELAXATION, not contraction
38
Q
  1. If a patient undergoes surgical resection/removal of the distal 100 cm of the terminal ileum, this patient will likely develop malabsorption of which of the following?
    a. iron
    b. folate
    c. lactose
    d. bile salts
    e. protein
A

D

II, ,pg 8

  • bile salts = terminal ileum
  • sugar = jejunum
  • all vit (except Vit B12) = proximal small intestine = duodenum
39
Q
  1. The major chemical digestive activity that takes place in the stomach is:
    a. breakdown of starch
    b. breakdown of proteins
    c. digestion of fats
    d. neutralization of acid by buffers and mucous
A

B = breakdown of proteins = stomach = via pepsin/pepsinogen

  • A = breakdown of starch = mouth & duodenum via salivary and pancreatic amylase
  • C = digestion of fats = duodenum via pancreatic lipase
  • D = duodenum = via pancreatic secretion
40
Q
  1. Which of the following deficiencies would make protein digestion crucial? a. lipase deficiency
    b. defect in the amino acid intestinal transport system
    c. enterokinase deficiency
    d. nuclease deficiency
A

C

PHYSIOLOGY (21 decks)

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