BRS Flashcards
1
Q
1. Which of the following substances is released from neurons in the GI tract and produces smooth muscle relaxation? (A) Secretin (B) Gastrin (C) Cholecystokinin (CCK) (D) Vasoactive intestinal peptide (VIP) (E) Gastric inhibitory peptide (GIP)
A
- The answer is D [II C 1]. Vasoactive intestinal peptide (VIP) is a gastrointestinal (GI)
neurocrine that causes relaxation of GI smooth muscle. For example, VIP mediates the
relaxation response of the lower esophageal sphincter when a bolus of food approaches it,
allowing passage of the bolus into the stomach.
2
Q
2. Which of the following is the site of secretion of intrinsic factor? (A) Gastric antrum (B) Gastric fundus (C) Duodenum (D) Ileum (E) Colon
A
- The answer is B [IV B 1; Table 6.3; Figure 6.7]. Intrinsic factor is secreted by the parietal cells
of the gastric fundus (as is HCl). It is absorbed, with vitamin B12, in the ileum.
3
Q
3. Vibrio cholerae causes diarrhea because it (A) increases HCO3 − secretory channels in intestinal epithelial cells (B) increases Cl− secretory channels in crypt cells (C) prevents the absorption of glucose and causes water to be retained in the intestinal lumen isosmotically (D) inhibits cyclic adenosine monophosphate (cAMP) production in intestinal epithelial cells (E) inhibits inositol 1,4,5-triphosphate (IP3 ) production in intestinal epithelial cells
A
- The answer is B [V D 4 c]. Cholera toxin activates adenylate cyclase and increases cyclic
adenosine monophosphate (cAMP) in the intestinal crypt cells. In the crypt cells, cAMP
activates the Cl−
-secretory channels and produces a primary secretion of Cl−
with Na+
and
H2
O following.
4
Q
- Cholecystokinin (CCK) has some gastrinlike
properties because both CCK and gastrin
(A) are released from G cells in the stomach
(B) are released from I cells in the
duodenum
(C) are members of the secretin-homologous
family
(D) have five identical C-terminal amino
acids
(E) have 90% homology of their amino acids
A
- The answer is D [II A 2]. The two hormones have five identical amino acids at the C terminus.
Biologic activity of cholecystokinin (CCK) is associated with the seven C-terminal
amino acids, and biologic activity of gastrin is associated with the four C-terminal amino
acids. Because this CCK heptapeptide contains the five common amino acids, it is logical
that CCK should have some gastrin-like properties. G cells secrete gastrin. I cells secrete CCK.
The secretin family includes glucagon.
5
Q
5. Which of the following is transported in intestinal epithelial cells by a Na+ -dependent cotransport process? (A) Fatty acids (B) Triglycerides (C) Fructose (D) Alanine (E) Oligopeptides
A
- The answer is D [V A–C; Table 6.4]. Fructose is the only monosaccharide that is not
absorbed by Na+
-dependent cotransport; it is transported by facilitated diffusion. Amino
acids are absorbed by Na+
-dependent cotransport, but oligopeptides (larger peptide units)
are not. Triglycerides are not absorbed without further digestion. The products of lipid
digestion, such as fatty acids, are absorbed by simple diffusion.
6
Q
- A 49-year-old male patient with severe
Crohn disease has been unresponsive to
drug therapy and undergoes ileal resection.
After the surgery, he will have steatorrhea
because
(A) the liver bile acid pool increases
(B) chylomicrons do not form in the
intestinal lumen
(C) micelles do not form in the intestinal
lumen
(D) dietary triglycerides cannot be digested
(E) the pancreas does not secrete lipase
A
- The answer is C [IV D 4]. Ileal resection removes the portion of the small intestine that
normally transports bile acids from the lumen of the gut and recirculates them to the liver.
Because this process maintains the bile acid pool, new synthesis of bile acids is needed
only to replace those bile acids that are lost in the feces. With ileal resection, most of the
bile acids secreted are excreted in the feces, and the liver pool is significantly diminished.
Bile acids are needed for micelle formation in the intestinal lumen to solubilize the
products of lipid digestion so that they can be absorbed. Chylomicrons are formed within
the intestinal epithelial cells and are transported to lymph vessels.
7
Q
7. Cholecystokinin (CCK) inhibits (A) gastric emptying (B) pancreatic HCO3 − secretion (C) pancreatic enzyme secretion (D) contraction of the gallbladder (E) relaxation of the sphincter of Oddi
A
- The answer is A [II A 2 a; Table 6.1]. Cholecystokinin (CCK) inhibits gastric emptying and
therefore helps to slow the delivery of food from the stomach to the intestine during
periods of high digestive activity. CCK stimulates both functions of the exocrine pancreas—
HCO3
−
secretion and digestive enzyme secretion. It also stimulates the delivery of bile from
the gallbladder to the small intestinal lumen by causing contraction of the gallbladder
while relaxing the sphincter of Oddi.
8
Q
8. Which of the following abolishes “receptive relaxation” of the stomach? (A) Parasympathetic stimulation (B) Sympathetic stimulation (C) Vagotomy (D) Administration of gastrin (E) Administration of vasoactive intestinal peptide (VIP) (F) Administration of cholecystokinin (CCK)
A
- The answer is C [III C 1]. “Receptive relaxation” of the orad region of the stomach is
initiated when food enters the stomach from the esophagus. This parasympathetic
(vagovagal) reflex is abolished by vagotomy
9
Q
9. Secretion of which of the following substances is inhibited by low pH? (A) Secretin (B) Gastrin (C) Cholecystokinin (CCK) (D) Vasoactive intestinal peptide (VIP) (E) Gastric inhibitory peptide (GIP)
A
- The answer is B [II A 1; Table 6.1]. Gastrin’s principal physiologic action is to increase H+
secretion. H+
secretion decreases the pH of the stomach contents. The decreased pH, in
turn, inhibits further secretion of gastrin—a classic example of negative feedback.
10
Q
10. Which of the following is the site of secretion of gastrin? (A) Gastric antrum (B) Gastric fundus (C) Duodenum (D) Ileum (E) Colon
A
- The answer is A [II A 1 b; Table 6.3; Figure 6.7]. Gastrin is secreted by the G cells of the
gastric antrum. HCl and intrinsic factor are secreted by the fundus.
11
Q
11. Micelle formation is necessary for the intestinal absorption of (A) glycerol (B) galactose (C) leucine (D) bile acids (E) vitamin B12 (F) vitamin D
A
- The answer is F [V E 1; Table 6.4]. Micelles provide a mechanism for solubilizing fat-soluble
nutrients in the aqueous solution of the intestinal lumen until the nutrients can be brought
into contact with and absorbed by the intestinal epithelial cells. Because vitamin D is fat
soluble, it is absorbed in the same way as other dietary lipids. Glycerol is one product of
lipid digestion that is water soluble and is not included in micelles. Galactose and leucine
are absorbed by Na+
-dependent cotransport. Although bile acids are a key ingredient
of micelles, they are absorbed by a specific Na+
-dependent cotransporter in the ileum.
Vitamin B12 is water soluble; thus, its absorption does not require micelles.
12
Q
- Which of the following changes occurs
during defecation?
(A) Internal anal sphincter is relaxed
(B) External anal sphincter is contracted
(C) Rectal smooth muscle is relaxed
(D) Intra-abdominal pressure is lower than
when at rest
(E) Segmentation contractions predominate
A
- The answer is A [III E 3]. Both the internal and external anal sphincters must be relaxed
to allow feces to be expelled from the body. Rectal smooth muscle contracts and intraabdominal
pressure is elevated by expiring against a closed glottis (Valsalva maneuver).
Segmentation contractions are prominent in the small intestine during digestion and
absorption.
13
Q
13. Which of the following is characteristic of saliva? (A) Hypotonicity relative to plasma (B) A lower HCO3 − concentration than plasma (C) The presence of proteases (D) Secretion rate that is increased by vagotomy (E) Modification by the salivary ductal cells involves reabsorption of K+ and HCO3
A
- The answer is A [IV A 2 a; Table 6.2]. Saliva is characterized by hypotonicity and a high
HCO3
−
concentration (relative to plasma) and by the presence of α-amylase and lingual
lipase (not proteases). The high HCO3
−
concentration is achieved by secretion of HCO3
−
into saliva by the ductal cells (not reabsorption of HCO3
−
). Because control of saliva
production is parasympathetic, it is abolished by vagotomy.
14
Q
14. Which of the following substances is secreted in response to an oral glucose load? (A) Secretin (B) Gastrin (C) Cholecystokinin (CCK) (D) Vasoactive intestinal peptide (VIP) (E) Glucose-dependent insulinotropic peptide (GIP)
A
- The answer is E [II A 4; Table 6.4]. Glucose-dependent insulinotropic peptide (GIP) is the
only gastrointestinal (GI) hormone that is released in response to all three categories of
nutrients—fat, protein, and carbohydrate. Oral glucose releases GIP, which, in turn, causes
the release of insulin from the endocrine pancreas. This action of GIP explains why oral
glucose is more effective than intravenous glucose in releasing insulin.
15
Q
15. Which of the following is true about the secretion from the exocrine pancreas? (A) It has a higher Cl− concentration than does plasma (B) It is stimulated by the presence of HCO3 − in the duodenum (C) Pancreatic HCO3 − secretion is increased by gastrin (D) Pancreatic enzyme secretion is increased by cholecystokinin (CCK) (E) It is hypotonic
A
- The answer is D [II A 2, 3; Table 6.2]. The major anion in pancreatic secretions is HCO3
−
(which is found in higher concentration than in plasma), and the Cl−
concentration is
lower than in plasma. Pancreatic secretion is stimulated by the presence of fatty acids
in the duodenum. Secretin (not gastrin) stimulates pancreatic HCO3
−
secretion, and
cholecystokinin (CCK) stimulates pancreatic enzyme secretion. Pancreatic secretions are
always isotonic, regardless of flow rate.
16
Q
- Which of the following substances must
be further digested before it can be absorbed
by specific carriers in intestinal cells?
(A) Fructose
(B) Sucrose
(C) Alanine
(D) Dipeptides
(E) Tripeptides
A
- The answer is B [V A, B; Table 6.4]. Only monosaccharides can be absorbed by intestinal
epithelial cells. Disaccharides, such as sucrose, must be digested to monosaccharides
before they are absorbed. On the other hand, proteins are hydrolyzed to amino acids,
dipeptides, or tripeptides, and all three forms are transported into intestinal cells for
absorption.
17
Q
17. Slow waves in small intestinal smooth muscle cells are (A) action potentials (B) phasic contractions (C) tonic contractions (D) oscillating resting membrane potentials (E) oscillating release of cholecystokinin (CCK)
A
- The answer is D [III A; Figure 6.3]. Slow waves are oscillating resting membrane potentials
of the gastrointestinal (GI) smooth muscle. The slow waves bring the membrane potential
toward or to threshold, but are not themselves action potentials. If the membrane
potential is brought to threshold by a slow wave, then action potentials occur, followed by
contraction.
18
Q
- A 24-year-old male graduate student
participates in a clinical research study on
intestinal motility. Peristalsis of the small
intestine
(A) mixes the food bolus
(B) is coordinated by the central nervous
system (CNS)
(C) involves contraction of circular smooth
muscle behind and in front of the food
bolus
(D) involves contraction of circular smooth
muscle behind the food bolus and
relaxation of circular smooth muscle in
front of the bolus
(E) involves relaxation of circular
and longitudinal smooth muscle
simultaneously throughout the small
intestine
A
- The answer is D [III D 2]. Peristalsis is contractile activity that is coordinated by the
enteric nervous system (not the central nervous system [CNS]) and propels the intestinal
contents forward. Normally, it takes place after sufficient mixing, digestion, and absorption
have occurred. To propel the food bolus forward, the circular smooth muscle must
simultaneously contract behind the bolus and relax in front of the bolus; at the same time,
longitudinal smooth muscle relaxes (lengthens) behind the bolus and contracts (shortens)
in front of the bolus.
19
Q
19. A 38-year-old male patient with a duodenal ulcer is treated successfully with the drug cimetidine. The basis for cimetidine's inhibition of gastric H+ secretion is that it (A) blocks muscarinic receptors on parietal cells (B) blocks H2 receptors on parietal cells (C) increases intracellular cyclic adenosine monophosphate (CAMP) levels (D) blocks H+ ,K+ -adenosine triphosphatase (ATPase) (E) enhances the action of acetylcholine (ACh) on parietal cells
A
- The answer is B [IV B 3 c, d (1), 6]. Cimetidine is a reversible inhibitor of H2
receptors on
parietal cells and blocks H+
secretion. Cyclic adenosine monophosphate (cAMP) (the
second messenger for histamine) levels would be expected to decrease, not increase.
Cimetidine also blocks the action of acetylcholine (ACh) to stimulate H+
secretion.
Omeprazole blocks H+
, K+
-adenosine triphosphatase (ATPase) directly
20
Q
20. Which of the following substances inhibits gastric emptying? (A) Secretin (B) Gastrin (C) Cholecystokinin (CCK) (D) Vasoactive intestinal peptide (VIP) (E) Gastric inhibitory peptide (GIP)
A
- The answer is C [II A 2 a; Table 6.1]. Cholecystokinin (CCK) is the most important hormone
for digestion and absorption of dietary fat. In addition to causing contraction of the
gallbladder, it inhibits gastric emptying. As a result, chyme moves more slowly from the
stomach to the small intestine, thus allowing more time for fat digestion and absorption.
21
Q
21. When parietal cells are stimulated, they secrete (A) HCl and intrinsic factor (B) HCl and pepsinogen (C) HCl and HCO3 − (D) HCO3 − and intrinsic factor (E) mucus and pepsinogen
A
- The answer is A [IV B I; Table 6.3]. The gastric parietal cells secrete HCl and intrinsic factor.
The chief cells secrete pepsinogen.
22
Q
22. A 44-year-old woman is diagnosed with Zollinger–Ellison syndrome. Which of the following findings is consistent with the diagnosis? (A) Decreased serum gastrin levels (B) Increased serum insulin levels (C) Increased absorption of dietary lipids (D) Decreased parietal cell mass (E) Peptic ulcer disease
A
- The answer is E [II A 1 d; V C 3 b]. Zollinger–Ellison syndrome (gastrinoma) is a tumor of
the non–β-cell pancreas. The tumor secretes gastrin, which then circulates to the gastric
parietal cells to produce increased H+
secretion, peptic ulcer, and parietal cell growth
(trophic effect of gastrin). Because the tumor does not involve the pancreatic β-cells,
insulin levels should be unaffected. Absorption of lipids is decreased (not increased)
because increased H+
secretion decreases the pH of the intestinal lumen and inactivates
pancreatic lipases.
23
Q
23. Which of the following is the site of Na+ –bile acid cotransport? (A) Gastric antrum (B) Gastric fundus (C) Duodenum (D) Ileum (E) Colon
A
- The answer is D [IV D 4]. Bile salts are recirculated to the liver in the enterohepatic
circulation via a Na+
–bile acid cotransporter located in the ileum of the small intestine.
