Alimentary System 1 Flashcards by Ndeye Fatou Gueye

A feeling of fullness after meals accompanied by regurgitation of gastric contents and dyspepsia are most likely associated with:

A. Oesophageal carcinomas 
B. Oesophageal diverticula
C. Hiatal hernias 
D. Gastric polyps
E. Stress ulcerations in the stomach

C. Hiatal hernias

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What easy test detects Salmonella and/or Shigella in a stool sample?

A. Gram stain
B. No growth on blood agar
C. Beta hemolysis on blood agar
D. Light color of colonies on EMB or MacConkeys agar plates
E. Acid-fast stain

C. Beta hemolysis on blood agar

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Which cells secrete pepsinogen? 

A. Parietal cells 
B. Oxyntic cells 
C. Chief cells 
D. Mucous neck cells 
E. Both A and B

C. Chief cells 

Parietal cells secrete HCl, intrinsic factor (IF) and R protein ( = haptocorrin, see transport of vitamin B12)

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Barrett’s metaplasia of the oesophagus is associated with:

A. Persistent reflux 
B. Peptic ulceration 
C. Stricture formation 
D. Increased incidence of adenocarcinomas 
E. A and B only 
F. All of the above

F. All of the above

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What type of tissue lines the upper oesophagus?
 
A. Simple squamous epithelium 
B. Simple cuboidal epithelium
C. Simple columnar epithelium 
D. Stratified squamous epithelium 
E. Transitional epithelium

D. Stratified squamous epithelium 

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Which layer of the gastrointestinal tract contains the GALT? 

A. Mucosa 
B. Submucosa 
C. Muscularis externa 
D. Muscularis mucosae 
E. Serosa

A. Mucosa 

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Choose the best response to each of the next 5 questions from the following list of terms:

Weight loss
Flat fingernails
Dark, sticky stool
Difficulty swallowing
Fluid in the peritoneal cavity

A. Dysphagia
B. Odynophagia
C. Malaena
D. Haematemesis
E. Ascites
F. Oedema
G. Anorexia
H. Diarrhoea
I. Steattorhoea
J. Cachexia
K. Koilonychia
L. Leuconychia
M. Clubbing

1 = J (Cachexia)
2 = K (Koilonychia)
3 = C (Malaena)
4 = B (Odynophagia)
5 = E (Ascites)

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Of the following cancers, which is responsible for the greatest number of deaths in the UK?

A. Liver
B. Oesophagus
C. Pancreas
D. Colorectal
E. Stomach

D. Colorectal

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Bicarbonate is secreted from submucosal glands:

A. In the oesophagus only
B. In the stomach only
C. In the duodenum only
D. In the jejunum only
E. In the small intestine only

B. In the stomach only

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Where are Brunner’s glands located? 

A. Oesophagus 
B. Stomach 
C. Small intestine 
D. Large intestine 
E. Rectum

C. Small intestine 

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What nutrient deficiency is likely to be seen in a patient who has had a terminal ileum resection?

A. Iron
B. Calcium
C. Vitamin A
D. Vitamin E
E. Vitamin B12

E. Vitamin B12

Vitamin B12 leaves the gut lumen at the distal ileum.

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Choose the best response to each of the next 5 questions from the following list of terms:

Weight loss
Flat fingernails
Dark, sticky stool
Difficulty swallowing
Fluid in the peritoneal cavity

A. Dysphagia
B. Odynophagia
C. Malaena
D. Haematemesis
E. Ascites
F. Oedema
G. Anorexia
H. Diarrhoea
I. Steattorhoea
J. Cachexia
K. Koilonychia
L. Leuconychia
M. Clubbing

1 = J (Cachexia)
2 = K (Koilonychia)
3 = C (Malaena)
4 = A (Dysphagia)
5 = E (Ascites)

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Which of the following statements is false?

A. It is possible to be an asymptomatic carrier of HBV.
B. HBV can lead to cirrhosis or hepatocellular cancer.
C. Most patients infected with HCV experience self-limited infection.
D. Most patients when HBV seen in UK clinics are immigrants.
E. There are fewer cases of HCV in the UK compared with HBV

C. Most patients infected with HCV experience self-limited infection.

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Concerning the stomach, which of the following is FALSE?

A. Trypsin initiates protein digestion in the stomach.
B. Stomach peptidase is secreted from the body and fundus of the stomach.
C. Activation of stretch receptors in the stomach causes makes you feel full after a meal.
D. The musculature of the stomach is only comprised of an inner layer of circular muscles and an outer layer of longitudinal muscles.
E. Acid secretion in the stomach occurs due to a K+/H+ exchanger located in the luminal membrane of G-cells.

D. The musculature of the stomach is only comprised of an inner layer of circular muscles and an outer layer of longitudinal muscles.

The stomach has an additional oblique layer not present in the rest of the gut.

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Bicarbonate is secreted from submucosal glands:

A. In the oesophagus only
B. In the stomach only
C. In the duodenum only
D. In the jejunum only
E. In the small intestine only

C. In the duodenum only

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Which one of these has been shown to be most successful in IBS treatment in clinical trials?

A. Biofeedback
B. Psychotherapy
C. CBT
D. Dietary advice
E. Hypnotherapy

C. CBT

Which one of the following statements is TRUE?

A. The stomach is lined by stratified columnar epithelium
B. Simple glands in the stomach secrete into pits
C. The stomach lining contains crypts
D. The stomach epithelial cells have microvilli
E. There are 2 layers of smooth muscle in the stomach

B. Simple glands in the stomach secrete into pits

Which of the following functions is NOT performed by the liver?

A. Activation of oestrogens
B. Synthesis of bile
C. Inactivation of cortisol
D. Synthesis of albumin
E. Storage of vitamins

A. Activation of oestrogens

Encephalopathy, cerebral oedema, coagulopathy, and low glucose, potassium, and sodium levels are all clinical features of:

A. Renal failure
B. Colorectal cancer
C. Liver failure
D. Pancreatic cancer
E. Aneurysm of the abdominal aorta

C. Liver failure

Acute fatty liver of pregnancy:

A. Presents with vomiting in the first trimester.
B. Is less common with multiple births
C. Is a cause of chronic liver failure
D. Results from defects in fatty acid oxidation
E. Will only ever happen to the same patient once

D. Results from defects in fatty acid oxidation

The top 3 causes of chronic liver failure are:

A. Alcoholic liver disease, Hepatitis A, Hepatitis E
B. Alcoholic liver disease, Hepatitis B, Hepatitis C
C. Alcoholic liver disease, Paracetamol overdose, Hepatitis B
D. Alcoholic liver disease, Wilson’s Disease, Hepatitis C
E. Alcoholic Liver Disease, Haemochromatosis, Hepatitis A

B. Alcoholic liver disease, Hepatitis B, Hepatitis C

Which of the following mutations involved in colorectal cancer is found on chr. 18 and leads to inactivation of TGF-B signalling?

A. SMAD mutations
B. p53 mutations
C. MYH gene mutations
D. KRAS mutations
E. Mismatch repair gene mutation

A. SMAD mutations

Which of the following GI infections is associated with production of the enterotoxin NSP4?

A. Cholera
B. C. difficile
C. Microsporidia 
D. Rotavirus 
E. Norovirus

D. Rotavirus

Which of the following hormones is released in response to presence of fat/peptides in the upper part of the small intestine?

A. Leptin
B. Ghrelin
C. Somatostatin
D. Secretin
E. CCK

E. CCK

Which of these is particularly associated with left sided tumours? ``` A. Red meat B. Cholecystectomy C. Hereditary Non-Polyposis Colorectal Cancer (HNPCC) D. Heavy alcohol E. Smoking ```

A. Red meat Cholecystectomy (gall bladder removal) and HNPCC are more associated with right-sided tumours.

Mutations in which gene contribute to most cases of colorectal cancer? ``` A. KRAS B. p53 C. MutHY D. SMAD E. APC ```

A. KRAS KRAS is the most important oncogene in CRC development. Mutation of K-ras is an early event in cancer development. Note: p53 is the most commonly mutated gene in human cancer in general

If you had one first-degree relative with CRC, what is your risk of developing it as well? ``` A. Same as background population B. 8% C. 25% D. 50% E. Can’t tell from information given. F. 100% ```

E. Can’t tell from information given. Average risk = 5% One 1st degree relative = 8% Two 1st degree relatives = 20-25% One 1st degree relative <45yrs = 20-25%

Where would you expect to find Folds of Kerkring? ``` A. Oesophagus B. Stomach C. Duodenum D. Small intestine E. Large intestine ```

E. Large intestine The folds of Kerkring increase the surface area of the intestine 3-fold compared to a cylinder.

The ileum has a large role in absorption of: ``` A. Carbohydrates B. Protein C. Iron D. Bile salts E. Water ```

D. Bile salts Most of the carbohydrate, protein and iron has already been absorbed by this stage

True or false: concerning the stomach: A. Trypsin initiates protein digestion in the stomach. B. Stomach peptidase is secreted from the body and fundus of the stomach. C. Activation of stretch receptors in the stomach causes makes you feel full after a meal. D. The musculature of the stomach is only comprised of an inner layer of circular muscles and an outer layer of longitudinal muscles. E. Acid secretion in the stomach occurs due to a K+/H+ exchanger located in the luminal membrane of G-cells.

A. Trypsin initiates protein digestion in the stomach. FALSE - Protein digestion in the stomach is carried out by pepsin. B. Stomach peptidase is secreted from the body and fundus of the stomach. TRUE C. Activation of stretch receptors in the stomach causes makes you feel full after a meal. FALSE - Peptide YY3-36 is released from the gut into the circulation after a meal to decrease appetite by acting on nerves in the arcuate nucleus. D. The musculature of the stomach is only comprised of an inner layer of circular muscles and an outer layer of longitudinal muscles. FALSE. Unlike the SI and LI, the stomach has a third layer of oblique muscles which aid in grinding food into small particles. E. Acid secretion in the stomach occurs due to a K+/H+ exchanger located in the luminal membrane of G-cells. FALSE. Acid secretion occurs from the parietal cells.

Which of the following is FALSE? (More than one answer may be correct) A. Lipase is secreted as an inactive precursor. B. Lipase requires colipase for activity. C. Lipase requires bile salts for optimal activity. D. Lipid digestion begins in the stomach. E. CCK activity reduces secretion of lipase into the duodenum. F. Most pancreatic lipase is secreted from the tail of the pancreas.

A. Lipase is secreted as an inactive precursor. FALSE -Lipase is secreted in its active form B. Lipase requires colipase for activity. TRUE - Colipase is secreted as a precursor and must be activated, which is why lipase can be secreted in its final form. C. Lipase requires bile salts for optimal activity. TRUE - All lipases require bile salts for full activity. D. Lipid digestion begins in the stomach. TRUE - Gastric lipase is secreted from the fundus of the stomach; it is the only lipase produced in the stomach E. CCK activity reduces secretion of lipase into the duodenum. FALSE - Peptides and fat in the duodenum cause a sharp rise in CCK and vagal stimulation --> Increased release of lipases and peptidase into the duodenum. F. Most pancreatic lipase is secreted from the tail of the pancreas. FALSE - The tail of the pancreas is mainly concerned with endocrine function

Which of the following is NOT a clinical feature of acute liver failure? ``` A. Coma B. Cerebral oedema C. Delayed blood clotting D. Increased blood glucose E. Increased risk of infection ```

A. Coma - ALF can cause hepatic encephalopathy B. Cerebral oedema - Cerebral oedema is a common cause of death in ALF C. Delayed blood clotting - The liver synthesises ALL clotting factors except factor VIII --> ALF is often accompanied by coagulopathy D. Increased blood glucose - FALSE: ALF --> Hypoglycaemic state and hyperinsulinaemia E. Increased risk of infection - Infections are common due to poor Kupffer cell and polymorph function.