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Questions and Answers
- 1.
In a laboratory experiment, a segment of esophagus is placed in a tissue bath. The circular muscle in this segment contracts tonically but relaxes upon stimulation of the extrinsic nerves supplying it. From which part of the esophagus is this segment most likely to come?
- A.
Distal region of the esophagus
- B.
Lower esophageal sphincter
- C.
Middle region of the esophagus
- D.
Proximal region of the esophagus
- E.
Upper esophageal sphincter
Correct Answer
B. Lower esophageal sphincterExplanation
Contractions of the body of the esophagus are coordinated by both central and peripheral mechanisms. It is innervated mostly by vagal fibers. Stimulation of these fibres causes a peristaltic contraction not a relaxation. The upper esophageal sphincter is composed of striated muscle and its tone is determined by extrinsic nerves, stimulation of which causes contraction (relaxation of this sphincter is mediated by inhibition of these fibers). The LES under resting conditions is tonically contracted. Relaxation of the LES is via the vagus and ENS, and is caused by release of NO (and probably VIP) from inhibitory nerves.Rate this question:
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- 2.
You are given an esophageal manometery recording obtained from a patient with Achalasia. What would be the distinctive feature in these recordings that you might see at either the upper or lower esophageal sphincters at rest and during swallowing?
- A.
Higher than normal pressure at the lower esophageal sphincter
- B.
Lower than normal pressure at the lower esophageal sphincter
- C.
Higher than normal pressure at the upper esophageal sphincter
- D.
Lower than normal pressure at the upper esophageal sphincter
Correct Answer
A. Higher than normal pressure at the lower esophageal sphincterExplanation
In achalasia the pressure at the LES is either normal or raised. Pressure at the upper esophageal sphincter is unaffected. Achalasia is associated with a "failure to relax" of the lower esophageal sphincter due to loss of nitrergic & VIP - containing neurons in the ENS. This sometimes also results in lack of coordinated peristalsis in the distal esopahgus. Lower pressures at either the upper or lower esophageal sphincters would facilitate movement of food not cause difficulties in swallowing.Rate this question:
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- 3.
A pressure recording was made at an unknown site in the esophagus of a normal healthy male volunteer. At rest, the pressure recorded was stable and high (40 mmHg) in comparison to atmospheric pressure. Upon a single voluntary swallow, the pressure recorded fell immediately to below atmospheric and then increased rapidly to a peak of 55 mmHg before returning to 40 mmHg. Where was the pressure sensor likely to have been located?
- A.
Upper esophageal sphincter
- B.
The body of the esophagus in the thorax
- C.
The body of the esophagus below the diaphragm
- D.
The lower esophageal sphincter
- E.
The fundus of the stomach
Correct Answer
A. Upper esophageal sphincterExplanation
The high resting pressure indicates that the sensor was located at a sphincter (which are tonically contracted). The pattern of pressure changes are consistent with the sensor having been located at the upper esophageal sphincter - the pressure fell upon swallowing to allow the bolus to enter the sphincter and this was followed by a peristaltic contraction, (that forced the bolus into the esophagus) the pressure of this strong contraction peaked before falling again to the same pressure as at rest. The sensor could not have been at the lower esophageal sphincter (which also has a high pressure at rest), because the lower esophageal sphincter relaxes, shortly after a swallow commences. The fundus of the stomach can also be eliminated, because the pressure at rest is not appreciably higher than atmospheric (it is not tonically contracted) and it also relaxes. The main body of the esophagus in the thorax displays a pressure at rest below atmospheric and in the abdomen is only slightly above atmospheric. At both locations - the pressure increases first - before relaxing.Rate this question:
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- 4.
Which of the following is higher in saliva compared with blood plasma?
- A.
Chloride concentration
- B.
Sodium concentration
- C.
Potassium concentration
- D.
Osmolarity
Correct Answer
C. Potassium concentrationExplanation
Potassium is secreted by both the acini and ductular epithelia to levels that may reach as high as 40 mM at low flow rates and is usually around 20 mM even when maximally stimulated. Sodium and chloride concentrations are normally lower than that of plasma at all flow rates and the osmolarity of saliva is always lower than that of plasma.Rate this question:
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- 5.
An 80-year-old male suffers a stroke, that eliminates vagal nerve input to the gastrointestinal tract and also severely reduces the functions of the glossopharyngeal nerve. Of the following motility functions of the esophagus which would remain largely intact?
- A.
Pharyngeal phase of swallowing
- B.
Primary peristalsis in the thoracic esophagus
- C.
Receptive relaxation of the lower esophageal sphincter
- D.
Secondary peristalsis in the smooth muscle portion of the esophagus
Correct Answer
D. Secondary peristalsis in the smooth muscle portion of the esophagusExplanation
Secondary peristalsis can occur in all areas of the esophagus and can be triggered by food particles "left behind" from a primary peristaltic event, or, by gastric reflux of debris. Secondary peristalsis is elicited by distension of the esophagus and does not require a primary peristaltic (swallow-induced) event to precede it. In the skeletal muscle portion of the esophagus, distension triggers a peristaltic contraction mediated by central mechanisms, so this would be abolished by loss of vagal input. In the smooth muscle portion of the esophagus, the contraction is triggered locally due to the myogenic response of the muscle as well as reflexes within the ENS triggering peristaltic contraction and relaxation. Receptive relaxation of the LES is triggered by a pharyngeal swallow and involves vagally-mediated reflexes.Rate this question:
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- 6.
Which of the following characteristics is a characteristic of salivary secretion?
- A.
It has a low concentration of potassium in comparison with plasma
- B.
The volume of secretion is low relative to the total weight of the glands
- C.
Parasympathetic nerves reduce, but sympathetic nerves increase the rate of secretion
- D.
The secreted saliva has an osmotic pressure lower than that of plasma
- E.
It is primarily regulated by hormones
Correct Answer
D. The secreted saliva has an osmotic pressure lower than that of plasmaExplanation
Saliva is always hypotonic to blood plasma, but its potassium concentration can be ten times that of plasma. It is unusual in that stimulation of either branch of the autonomic nervous system increase the rate of secretion. The neural supply to the salivary glands is the key regulator of salivary secretion. Hormones (ADH and aldosterone) can modify ductular function, but this is really only important in sates of volume depletion or dehydration.Rate this question:
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- 7.
A 45-year-old woman has been referred to a gastroenterology clinic for evaluation of chronic heartburn. Endoscopic evaluation of her lower esophagus reveals erosion and scarring of the distal esophagus in the region adjacent to the lower esophageal sphincter. The woman reports that for several years she has suffered from severe itchy, dry eyes and always has thick, "stringy" saliva. She also says that food really doesn't taste of much these days. Reduced production of which of the following components of saliva is the most likely contributor to her esophageal damage?
- A.
Lactoferrin
- B.
Mucin
- C.
Bicarbonate
- D.
Amylase
- E.
Lipase
Correct Answer
C. BicarbonateExplanation
This patient has the symptoms of gastroesophageal reflux disease (GERD). She is also showing some of the classic signs of Sjorgen's syndrome - an autoimmune disease that leads to diminished lachrymal and salivary gland function. Saliva contains a number of proteins including antibacterial agents such as secretory IgA, lactoferrin, lysozyme and peroxidase. However none of these will be effective in protection against acid reflux. Likewise salivary amylase and lipase will have no effect on acid buffering. Mucin is an important protein component of the adherent mucus gel that is found on gastric mucosa. However, the esophagus does not normally secrete mucin in significant amounts - and so does not contribute to normal protection against acid reflux in the esophagus. Salivary bicarbonate is a buffer against hydrochloric acid and studies show that diminished salivary production as occurs in Sjorgen's syndrome is associated with esophageal ulceration.Rate this question:
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- 8.
A normal swallow triggers a series of motor events including which one of the following?
- A.
Concentration of the lower esophageal sphincter
- B.
Relaxation of the gastric antrum
- C.
Secondary esophageal peristalsis
- D.
Relaxation of the pyloric sphincter
- E.
Relaxation of the gastric cardia
Correct Answer
E. Relaxation of the gastric cardiaExplanation
During a normal swallow, the muscles in the esophagus contract to push food down into the stomach. The relaxation of the gastric cardia is an important motor event that occurs during swallowing. The gastric cardia is the upper part of the stomach that connects to the esophagus. When it relaxes, it allows the food to enter the stomach smoothly. This relaxation of the gastric cardia is necessary for the food to pass through the esophagus and into the stomach without any obstruction or difficulty.Rate this question:
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- 9.
A hormone is injected intravenously into a human volunteer. The hormone initiates a phase of intense sequential contractions of the duodenum that appears to migrate slowly towards the cecum. What is the likely identity of the hormone that was injected?
- A.
Cholecystokinin (CKK)
- B.
Gastrin
- C.
Motilin
- D.
Secretin
- E.
Vasoactive intestinal polypeptide (VIP)
Correct Answer
C. MotilinExplanation
Of the available options, motilin is the only hormone known to stimulate intestinal (and gastric) motility. It is released during fasting in a cyclical manner and it may be involved in regulation of MMC cycle length.Rate this question:
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- 10.
Intraluminal pressure is monitored by manometery in a region of the colon that exhibits a relatively constant resting pressure (of about 20 mm Hg). When an adjacent region of the colon is distended, the resting pressure falls to near 0 mm Hg and then increases slowly, back towards the resting pressure even though the distension of the adjacent region persists. Where is the region being monitored likely to be?
- A.
External Anal Sphincter
- B.
Ileocecal Sphincter
- C.
Internal anal sphincter
- D.
Transverse colon
- E.
Ascending colon
Correct Answer
C. Internal anal sphincterExplanation
Normally the anal canal is closed because of contraction of the internal and external anal sphincters. Upon distension of the rectum, the internal sphincter relaxes as part of the recto-sphincteric reflex. The external anal sphincter reflexly contracts on relaxation of the internal anal sphincter. Relaxation of the internal sphincter is transient, because rectal receptors accommodate the stimulus of distension, and the internal sphincter regains its tone unless defecation can be completed. The ileocecal valve contracts, rather than relaxes on distension of the colon adjacent to it. This is important in preventing reflux of colonic chyme into the ileum.The tone of the ascending and transverse colon is determined by contractions, modified by ENS reflexes and are segmental in nature. Contractions in adjacent sites occur independently. Though distension might be expected to trigger relaxation (colono-colonic reflex).Rate this question:
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- 11.
The presence of a solution of pH less than 4.0 in the duodenum will cause which of the following responses?
- A.
Stimulation of gastrin release by somatostatin
- B.
Increased pancreatic secretion of HCO3
- C.
Decreased secretion of secretin
- D.
Increased gastric acid production
- E.
Decreased secretion of CCK
Correct Answer
B. Increased pancreatic secretion of HCO3Explanation
The S-cells in the duodenum act essentially as pH sensors. Acidification of the lumen causes the release of secretin which stimulates HCO3- secretion by pancreatic duct cells. Acidification of the duodenum lumen stimulates the release of somatostatin, but somatostatin inhibits secretion of gastrin not stimulates it. Therefore, acid secretion will also fall - not increase. Although CCK is released on entry of the components of a meal into the duodenum, H+ in itself is not a stimulus for release.Rate this question:
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- 12.
Of the 8 to 10 litres of fluid entering the digestive tract, which of the following best describes its processing?
- A.
100 to 200 mL is excreted in feces
- B.
Most of the fluid is derived from the diet
- C.
Most of the fluid is absorbed by the large intestine
- D.
Gastric secretions contribute around twice that of the pancreas
- E.
Most of the fluid is absorbed againsst a concentration gradient
Correct Answer
A. 100 to 200 mL is excreted in fecesExplanation
On a normal diet and gastrointestinal function, the volume of fluid exiting in the feces is between 100 and 200 mL. Of the volume of fluid (7 - 10 litres) entering the duodenum, Dietary intake is around 1.5 - 2.0 litres, the rest is the result of secretion. Gastric secretion is usually around 2.5 litres and pancreatic 1.5 litres. So gastric secretion is higher than pancreatic, but not double. The remainder comes from saliva (1.5 litres), and intestinal secretions (1.0 litres). The bulk of the reabsorption occurs in the jejunum and ileum (7 litres) the rest in the large intestine. Most of the fluid absorption is so-called isotonic absorption. That is it does not occur against a significant gradient - the chyme and plasma are the same osmolarity. Most meals are hypertonic to plasma. In the duodenum, water enters the lumen from the blood and in so doing, brings this chyme into osmotic equilibrium with plasma, from there on, water absorption is coupled to solute absorption.Rate this question:
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- 13.
A laboratory study is undertaken to determine the features of intestinal amino acid absorption. Which is the most likely conclusion to come from this study?
- A.
Amino acids are absorbed primarily in the distal gut
- B.
Amino acids compete with glucose transport
- C.
Amino acids are transported primarily by passive mechanisms
- D.
Amino acids appear more rapidly in the blood when administered as small peptides rather than the free amino acid
- E.
Amino acids are produced in the lumen of the gut primarily by the action of peptidases
Correct Answer
D. Amino acids appear more rapidly in the blood when administered as small peptides rather than the free amino acidExplanation
Amino acids appear in the blood more rapidly when administered in the form of di and tri peptides than when the amino acids are administered as free acids. This is probably because under physiological conditions, the absorption of some individual amino acids is competitive with that of others and so may become effectively saturated for that particular amino acid. That same amino acid can however still be absorbed as a peptide which is then hydrolysed by intracellular peptidases, allowing exit of the amino acid across the basolateral membrane. Transporters for amino acids are specific to the particular group of amino acids. They have no affinity for glucose at all. The transport of amino acids is via facilitated diffusion. There will be a small but finite amount of absorption by passive difussion, but this is almost insignificant compared to the carrier mediated fluxes. Luminal digestion of a protein meal by pancreatic proteases yields 40% free amino acids and and the rest (60%) small peptides. These peptides are then hydrolysed by brush border peptidases to free amino acids and di and tri peptides.Rate this question:
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- 14.
Of the following conditions, which would NOT result in osmotic diarrhea?
- A.
Cholera
- B.
Lactase deficiency
- C.
Pancreatic lipase deficiency
- D.
Gastrinoma
- E.
Reduced small intestinal surface area
Correct Answer
A. CholeraExplanation
Cholera toxin activates chloride secretion by activation of cAMP dependent channels (CFTR). All of the other conditions can produce an osmotic diarrhea. Malabsorptive disorders caused e.g. by reduced fat absorption (lipase deficiency, increased acid secretion by gastrinoma); Lactase deficiency or reduced absorptive area results in the retention of osmotically active particles that retain water which enters the colon - causing increased water excretion in the stools.Rate this question:
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- 15.
The effects of vagal stimulation on pancreatic function is likely due to which of the following mechanisms?
- A.
Acetylcholine (ACh) potentiated the effects of Cholecystokinin (CCK) on pancreatic acinar cells
- B.
ACh stimulates directly pancreatic enzyme secretion
- C.
ACh causes the release of CCK from the duodenum
- D.
ACh inhibits the effect of secretin on pancreatic duct cells
- E.
ACh releases secretin from the duodenum
Correct Answer
B. ACh stimulates directly pancreatic enzyme secretionExplanation
Pancreatic enzyme and bicarbonate secretion occurs in three "phases": cephalic, gastric and intestinal. Trunkal vagotomy reduces the pancreatic response to a meal by about half - due to the loss of the potentiating effects of acetylcholine on secretin action. There is however, a direct vagal component of stimulation in the cephalic phase, which is blocked by vagotomy. Acetylcholine triggers both acinar and ductal secretion and also potentiates the effect of secretin. Ach has a greater effect on enzyme secretion than on bicarbonate secretion.Rate this question:
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- 16.
The fact that patients with a congenital absence of one of the amino acid carriers do not become deficient in that amino acid is due to which of the following features?
- A.
The amino acid is transported by another amino acid carrier
- B.
The amino acid is absorbed by passive diffusion
- C.
The amino acid is transported by facilitated diffusion
- D.
The amino acid is an essential amino acid
- E.
The amino acid can be transported as a peptide by different carriers
Correct Answer
E. The amino acid can be transported as a peptide by different carriersExplanation
Di and Tri peptides can be absorbed via the H+-dependent cotransporter " PepT1". Once in the enterocyte, these peptides are hydrolysed by peptidases, liberating free amino acids which can exit the cell via facilitated diffusion. Thus an inherited loss of function in a group-specific carrier system that prevents uptake of the free amino acid from the gastrointestinal lumen, does not lead to a deficiency in that amino acid.Rate this question:
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- 17.
Pertaining to the absorption of lipids by enterocytes, which of the following are correct?
- A.
Triglycerides are resynthesized in smooth endoplasmic reticulum
- B.
Chylomicrons are synthesized in smooth endoplasmic reticulum
- C.
Fatty acid-binding proteins transport long chain fatty acids to the Golgi
- D.
Triglycerides are synthisezed from medium and short-chain fatty acids
- E.
The major triglyceride resynthesis pathway utilizes dietary glycerol
Correct Answer
A. Triglycerides are resynthesized in smooth endoplasmic reticulumExplanation
Monoglycerides and free fatty acids are resynthesized into triglycerides through two different enzymatic pathways both of which are associated mainly with smooth ER. Chylomicrons are composed in the rough ER and Golgi. Fatty-acid binding proteins appear to preferentally bind fatty acids of different lengths, but these are important after absorption has taken place and before esterification occurs, but have no role in intracellular transport. The major triglyceride (TG) resynthesis pathway involves synthesis of TGs from 2-monolycerides and coenzyme A - activated fatty acids. Glycerol is formed by pancreatic lipase - dependent conversion of triglycerides to monoglycerides, and free fatty acids and glycerol. The glycerol enters and exits the enterocyte by passive diffusion.Rate this question:
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- 18.
You are in ER. A distressed mother brings in her 7-year-old son who as part of a dare from his friends has swallowed one or two stainless steel ball bearings from his father's unattended toolbox. The mother shows you the type of ball bearing: which is about half a centimeter in diameter. You tell her not to worry, but to take the child home and withhold food overnight, and that the bearings will probably pass in the childs's stools over the next day. What is the physiological basis for your advice?
- A.
Raised plasma gastrin will increase peristaltic movements of the stomach
- B.
Raised plasma histamine will cause increased acid secretion which will dissolve the bearing
- C.
Raised plasma motilin will cause increased phase 3 MMC activity
- D.
Raised plasma CCK will increase gastric emptying
- E.
Raised plasma somatostatin will stimulate small intestinal peristalsis
- F.
Raised plasma secretin will increase gastric emptying
Correct Answer
C. Raised plasma motilin will cause increased phase 3 MMC activityExplanation
During the fasting state raised motilin levels in the blood are thought to be involved in the coordination of the conduction of the MMC from the stomach to terminal ileum. The MMC triggers powerful peristaltic waves responsible for transportation (sweeping) of undigested particles (e.g. bone, ball bearings)from the stomach through the small intestine and through the ileocecal valve to the colon.
In the fed-state, gastrin does increase antral peristaltic movement and relaxes the pyloric sphincter, thereby stimulating gastric emptying. However the contractions are not of sufficient to force through such a large object. Cholecystokinin and secretin are enterogastrones - released by the presence of nutrients in the duodenum. Both act to reduce the rate of stomach emptying. Histamine is a paracrine regulator of acid secretion - working through H2 receptors on the parietal cell. Although the pH of the stomach is highly acid, it is unlikely to be able to dissolve a stainless steel ball bearing during the normal duration of gastric emptying. Somatostatin is primarilly a paracrine mediator, which supresses the relase of a number of hormones (including motilin) and generally decreases gastric and intestinal motility.Rate this question:
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- 19.
A mouse is genetically engineered so that it no longer is able to activate pancreatic proteases, though secretion of the inactive forms is unaffected. Which protein is the mouse most likely to be lacking?
- A.
Pancreatic amylase
- B.
Enterokinase
- C.
Pepsinogen
- D.
Ptyalin
- E.
Trypsin
Correct Answer
B. EnterokinaseExplanation
Enterokinase (also called Enteropeptidase) is a serine protease secreted from the intestinal glands. It functions to activate trypsinogen to form the active enzyme trypsin, which then activates the remaining peptidase enzymes. In humans there are known inherited mutations associated with the gene that encodes this enzyme (PRSS7 gene) that cause a recessive disorder in which "failure to thrive" is a characteristic feature.
Both pancreatic and salivary amalase (ptyalin) are active enzymes responsible for digestion of starch and polysaccharides. They play no known role in activating other enzymes.
Pepsinogen is the inactive form of pepsin which is secreted by gastric chief cells, however it is rapidly inactivated on entry to the more alkaline duodenum.Rate this question:
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- 20.
A small intestinal epithelial cell layer is removed from an animal and bathed in physiological saline solution on the both apical and basolateral surfaces. Under these conditions there is a steady state in which there is constant absorption of Na+, Cl-, and H2O. A specific inhibitor of the basolateral Na+/K+-ATPase is then added to the fluid bathing the basolateral surface. Absorption is observed to fall. What are the changes in intracellular ion concentrations that might underlie this inhibitory effect?
- A.
Increased Na+ and K+ unchanged
- B.
Decreased Na+ and increased K+
- C.
Increased Na+ and decreased K+
- D.
Unchanged Na+ and decreased K+
- E.
Unchanged Na+ and unchanged K+
Correct Answer
C. Increased Na+ and decreased K+Explanation
Intracellular Na+ will rise and intracellular K+ will fall. An example of such an inhibitor is Ouabain a member of the group of drugs known as "cardiotonic glycosides". These drugs act by binding to the Na+/K+ pump from the extracellular side and preventing the dephosphorylation of the pump. Blocking the Na+/K+ pump increases the intracellular level of Na+ and decreases intracellular K+ - the mechanism of their therapeutic effects on cardiac muscle.
All other choices are incorrect:
Intracellular Na+ to rise and intracellular K+ to remain constant is incorrect. Because the Na+/K+ pump transfers three Na+ out and two K+ into the cell, blocking the pump will reduce intracellular K+ levels as well as increase intracellular Na+.
Intracellular Na+ to fall and intracellular K+ to rise is incorrect. Because the Na+/K+ pump is blocked less Na+ will move out of the cell so Na+ will rise, not fall.
Intracellular Na+ to remain constant and intracellular K+ to fall is incorrect. With blockade of the Na+/K+ pump intracellular Na+ will rise, not remain constant.
Intracellular Na+ to remain constant and intracellular K+ to remain constant is incorrect. Blocking the Na+/K+ pump will cause an increase in intracellular Na+ and a fall in intracellular K+.Rate this question:
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- 21.
A mildly disorientated 44-year-old male is admitted to the ER. He reports that he has had a watery diarrhea that has lasted for the last 48 hours and has similar bouts of diarrhea several times over the previous month. He reports no other symptoms such as vomiting or fever. An ECG recording shows abnormal waveforms. His plasma potassium level is found to be 2.1 mmol/L. What is the likely mechanism causing this man's cardiac symptoms?
- A.
Excess secretion of potassium in the small intestine
- B.
Excess secretion of potassium in the colon
- C.
Reduced absorption of potassium in the small intestine
- D.
Reduced absorption of potassium in the colon
Correct Answer
B. Excess secretion of potassium in the colonExplanation
The increased delivery of sodium and fluid to the large intestine causes an increase in sodium absorption by the colon. Increased sodium absorption through channels increases the driving force for potassium secretion. Potassium is not absorbed in the colon - only secreted. In the small intestine, potassium is absorbed not secreted. The absorption is passive and the concentration of potassium remains at plasma - like levels until the chyme reaches the colon. Although small intestinal absorption might be affected, the reduction would not be great enough to promote potassium wasting.Rate this question:
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- 22.
A deficiency in which of the following vitamins is likely to result from cystic fibrosis?
- A.
A and B1
- B.
A and C
- C.
A and D
- D.
B1 and C
- E.
B1 and D
- F.
C and D
Correct Answer
C. A and DExplanation
In cystic fibrosis there is often reduced fat absorption due to under activity of the lipase system. Fat-soluble vitamins rely on the absorption of lipids. A and D are fat soluble vitamins, B1 and C are water soluble.Rate this question:
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Current Version
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Mar 20, 2023Quiz Edited by
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Mar 06, 2012Quiz Created by
Chachelly
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