GI Formative Flashcards
A 45 year old man undergoes gastrectomy for treatment of a benign ulcer.
Which of the following hormones is likely to be most deficient as a result?
A. Cholecystokinin
B. Gastrin
C. Motilin
D. Secretin
E. Vasoactive intestinal polypeptide
B)Gatrin
A 34 year old man undergoes pH monitoring of his stomach as part of a
physiology trial. The pH of his gastric secretions is found to be 1.0.
What mechanism is responsible for achieving this?
A. Hydrogen/potassium adenosine triphosphatase pumps
B. UDP-Glucuronyl transferase
C. Alpha-amylase
D. Endopeptidase
E. Lipase
A) Hydrogen/potassium adenosine triphosphatase
- A digestive tract enzyme may be initially released in an inactive form.
What is the best term to describe this compound?
A. Enterokinase
B. Enzyme
C. Polypeptide
D. Protease
E. Zymogen
E. Zymogen
A 19 year old man eats a large bar of white chocolate. Which of the following digestive processes is most important to promote digestion of this food? A. Conjugation B. Emulsification C. Enterohepatic circulation D. Enterohepatic circulation E. Phosphorylation
B.Emulsification
A 34 year old woman with jaundice undergoes investigation. Blood tests
reveal a raised indirect serum bilirubin, and a normal direct serum bilirubin.
Urinalysis reveals absent urine bilirubin and an increased urobilinogen. Stool
tests identify increased urobilinogen.
Which is the most likely explanation?
A. Cholestasis
B. Crigler-Najjar syndrome
C. Haemolytic anaemia (correct answer)
D. Sepsis causing hepatocellular congestion
E. Viral hepatitis
C. Haemolytic anaemia
A 45 year old man develops moderate diarrhoea after food poisoning. Which of the following combinations of blood electrolyte disturbance is most likely? pH Chloride Potassium respectively A. Low High High B. Low High Low C. Low Low High D. High High Low E. High Low High
Correct answer is B
A 50 year old man presents to accident and emergency complaining of a 3
month history of epigastric pain and a 2 day history of a very high volume of
vomiting.
What is the most likely anatomic site of bowel obstruction to cause this
symptom?
A. Mid-oesophagus
B. Gastro-oesophageal junction
C. Third part of the duodenum
D. Distal ileum
E. Sigmoid colon
c. Third part of the duodenum
A 45 year old woman has surgical removal of her distal ileum to treat inflammatory bowel disease. Which of the following enzymes is she at risk of becoming deficient in? A. Vitamin A B. Vitamin B1 C. Vitamin B5 D. Vitamin B6 E. Vitamin C
A. Vitamin A
A 24 year old man has an inherited defect and is unable to produce intrinsic factor. The absorption of which of the following substances is most likely to be impaired? A. Bile salts B. Free amino acids C. Glucose D. Vitamin B12 E. Water
D. Vitamin B12
1. A 24 year old woman contracts Cholera while on holiday, and develops very severe diarrhoea. To which receptor does the cholera toxin bind to cause this symptom? A. Histamine B. Motilin C. Secretin D. Somatostatin E. Vasoactive intestinal polypeptide
C. Secretin
A 30 year old man presents acutely with jaundice. He has been complaining
of intermittent right hypochondrial pain and nausea for several months, but
the pain has worsened, his urine is darker than usual and his stools pale.
Which imaging test is most appropriate in the first instance?
A. Abdominal ultrasound
B. Abdominal radiograph
C. Computed tomography
D. Positron emission tomography
E. Isotope liver scintigraphy
A) Abdominal ultrasound
A 45 year old man is stabbed in the lower chest. The knife cuts most of the
vagus nerve fibres around the oesophagus. He makes a good recovery.
Which of the following is most likely to occur as a result of this nerve injury?
A. Delayed gastric emptying
B. Increased gastrin secretion
C. Increased intestinal peristalsis
D. Increased pancreatic enzyme production
E. Reduced bile production
A. Delayed gastric emptying
14. A 40 year old man has a total colectomy to treat a colonic carcinoma. The operation is curative. Which of the following is most likely to occur as a result of this operation? A. Excessive water retention B. Hyponatraemia C. Reduced absorption of Vitamin A D. Constipation E. Reduced glucose absorption
B). Hyponatraemia when the lelvel of sodium in blood is abnormally low - sodium is absorbed in colon
A 40 year old patient presents with explosive watery diarrhoea. Stool cultures
are negative for infectious agents. An abdominal ultrasound and computed
tomography scan reveals a mass in the pancreas, which is found to be a
VIPoma, a pancreatic islet cell tumour.
Which of the following biochemical abnormalities is most likely to be found?
A. Alkalosis
B. Decreased mucosal cell cyclic Adenosine Monophosphate (cAMP)
C. Increased bicarbonate secretion
D. Hypernatraemia
E. Increased bilirubi
C.) Increased bicarbinate secretion
A 70 year old man presents with abdominal pain, vomiting and abdominal
distension. He reports absolute constipation. An abdominal radiograph shows
multiple dilated loops of bowel.
Which of the following findings on abdominal xray would be in keeping with
small bowel obstruction?
A. Peripheral distribution of loops of bowel
B. Haustral mucosal folds
C. Wide angle of curvature of loops of bowel
D. Central distribution of loops of bowel
E. Relatively few loop
D.) Central distribution of loops of bowel
A 45 year old smoker with massive haematemesis and melaena. Endoscopy
reveals an actively bleeding posterior ulcer in the first part of the duodenum.
Which artery is most likely to be bleeding?
A. Splenic
B. Common hepatic
C. Right gastric
D. Gastro-duodenal
E. Aorta
D.) Gastro-duodenal
A 30 year old man is suspected of having impaired intestinal motility. Routine
blood and imaging tests are normal.
Which of the following may explain his impaired motility?
A. The basic electrical rhythm has a lower frequency in the distal ileum
compared with the duodenum
B. The intensity of segmentation contractions is increased following increased
parasympathetic activity
C. Segmentation contractions are reduced during a meal
D. The intensity of segmentation contractions is reduced following increased
sympathetic activity
E. The migrating motility complex hinders bacterial colonisation of the small
intestine
C.) Segmentation contractions are reduced during a meal
A patient undergoes a cholecystectomy for treatment of chronic cholecystitis.
During the operation, the surgeon notices arterial blood loss from the gall
bladder neck.
Which artery is most likely to have been injured?
A. Cystic artery
B. Superior mesenteric artery
C. Inferior Mesenteric artery
D. Splenic artery
E. Inferior pancreaticodudenal artery
A.) Cystic artery
A 50 year old patient has chronic peptic ulcer disease that has not responded
to drug therapy, and undergoes surgical removal of the gastric antrum to
reduce gastric acid production.
How does the surgical procedure reduce acid production?
A. Virtually eliminates pepsin synthesis
B. Increased cholecystokinin production
C. Virtually eliminates gastrin production
D. Increased bile production
E. Increased gastric emptying
C.) Virtually eliminates gastrin production
. A 25 year old woman presents with a six week history of diarrhoea, and oral apthous ulcers. His stool contains blood and mucus. What is the most likely diagnosis? A. Crohn’s disease B. Diverticulitis C. Infective diarrhoea D. Irritable bowel syndrome E. Ulcerative colitis
A.) Crohns Disease
A 25 year old man presents with fever, bloody diarrhoea and cramping for
several weeks that does not resolve with antibiotic therapy.
Proctosigmoidoscopy reveals red, raw mucosa and pseudopolyps. What is the
most likely cause?
a. Campylobacter infection
b. Crohn’s disease
c. Irritable bowel disease
d. Ulcerative colitis (correct answer)
e. Viral gastroenteritis
d. Ulcerative Collitis
A 20- year old man presents with a 12 hour history of colicky periumbilical pain, which shifts to the right iliac fossa, fever and loss of appetite. What is the most likely diagnosis? a. Acute appendicitis b. Acute pancreatitis c. Acute viral hepatitis d. Diverticular disease e. Perforated peptic ulce
a. Acute appendicitis
A 45 year old heterosexual man was admitted to hospital after ingesting 25g
of paracetamol 3 days earlier. He had no past medical history of note, took no
regular medication and rarely consumed alcohol.
Which of the following signs would be consistent with his presentation?
a. Finger clubbing
b. Gynaecomastia
c. Jaundice
d. Palmar erythema
e. Spider naevi
c. Jaundice
A new admission to the neonatal unit has a very rare condition of tracheooesophageal
fistula, with an imperforate anus. While looking up the related
embryology of the gut from an unverified internet resource, you come across
the following bits of information:
Which of the following statements is incorrect?
a. As a consequence of embryonic folding, a part of the endodermal–
lined amniotic cavity is incorporated into the gut.
b. The parenchyma of glands developing in the gut is formed from
endoderm.
c. The respiratory diverticulum helps form the oesophagus.
d. The superior mesenteric artery formation results in formation of an axis
of rotation for the primary intestinal loop.
e. The distal part of the anal canal is formed from ectoderm.
A. As a consequence of embryonic folding a part of the endodermal- lined amniotic cavity is incorporated into the gut
Thirty years ago, a bilateral vagotomy (cutting of right and left vagus nerves) was
performed on a male patient undergoing surgery for gastric ulceration.
What would be the consequences of this procedure on the following aspects of
alimentary function (2 marks awarded for each)
(a) Salivary secretion
No effect on salivary secretion. No vagal innervation of head & neck.
Facial/glossopharyneal = parasympathetic control of salivary secretion ⇒ stimulation
of watery serous secretion
(b) Parietal cell HCl secretion
Direct stimulation of parietal cell HCl secretion (via ACh) would be removed. Also
reduced activation via vagal-stimulated histamine release from enterochromaffin-like
(ECL) cells and via vagus-mediated gastrin release from G cells
(c) G cell gastrin secretion
Stimulation of gastrin secretion during cephalic phase of gastric acid secretion (sight,
smell, taste) would be removed. However, distension/peptide-induced stimulation of
G-cell secretion would remain.
(d) Gastric motility
Gastric motility would be reduced but local enteric reflexes would maintain a degree
of motility. Specifically, gastric emptying into the duodeum would be reduced.
(e) Defaecation
Defaecation reflex mediated via vagus, therefore vagotomy would limit ability to
defecate. Particularly reflex contraction of rectum and control of internal and
external anal sphincter tone
A woman aged 55 presents with a 3-week history of increasing jaundice and right
upper quadrant pain. Liver function tests indicate normal aspartate and alanine
aminotransferases and significantly increased alkaline phosphatase.
1. List five relevant questions to ask in order to clarify the diagnosis.
history of gallstones characteristics of pain any previous episodes of pain/jaundice any episodes of pyrexia foreign travel IV drug abuse sexual contact blood transfusion or blood products alcohol history prescribed drug history any tattoos colour of urine has there been a change of colour of urine? is there a change in stool? is there a relation between meals and pain?
Liver function tests indicate normal aspartate and alanine
aminotransferases and significantly increased alkaline phosphatase.Do the liver function tests indicate a hepatic or post-hepatic cause of the
jaundice? (1)
Post hepatic
State three possible causes of obstructive jaundice.
- gall stone in common bile duct
- tumour of common bile duct
- stricture of common bile duct
- carcinoma head of pancreas
- tumour of ampulla of vater
- tumour of common hepatic duc
Imaging reveals a stone in the common bile duct. Give four complications of
gallstones.
acute inflammation of gall bladder chronic inflammation of gall bladder perforation of gall bladder wall biliary peritonitis empyema mucocele carcinoma of gall bladder secondary biliary cirrhosis jaundice biliary colic
State three risk factors for the development of gall stones
age female fertile obesity diabetes small bowel resection or disease hyperlipidaemia
Haematological investigation showed a normal peripheral blood count and
prolonged prothrombin time. Why does jaundice affect the clotting system?
absence of bile in small bowel
failure of absorption of fat soluble vitamins including vitamin K
vitamin K required for clotting factor synthesis
