Download - Physio Cont
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1. A surgeon makes an incision in the
jejunum starting at the serosal surface
and ending in the lumen. What is the
sequential order of bisected structures
as the scalpel passes through the
intestinal wall?
(A) Circular muscle longitudinal
muscle submucous plexus
(B) Longitudinal muscle myenteric
plexus circular muscle
(C) Myenteric plexus circular
muscle longitudinal muscle
(D) Network of interstitial cells of
Cajal longitudinal muscle
circular muscle
(E) Longitudinal muscle network of
interstitial cells of Cajal submucous
plexus
2. A mouse with a new genetic mutation
is discovered not to have electrical
slow waves in the small intestine. What
cell type is most likely affected by the
mutation?
(A) Enteric neurons
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(B) Inhibitory motor neurons
(C) Enterochromaffin cells
(D) Interstitial cells of Cajal
(E) Enteroendocrine cells
3. A patient with chronic intestinal
pseudoobstruction has action
potentials and large- amplitude
contractions of the circular muscle
associated with every electrical slow
wave at all levels of the intestine in the
interdigestive state. Dysplasia of which
cell type most likely explains this
patients condition?
(A) Unitary-type smooth muscle
(B) Interstitial cells of Cajal
(C) Inhibitory motor neurons
(D) Sympathetic postganglionic
neurons
(E) Vagal efferent neurons
4. A neural tracer technique labels the
axon and cell body when it is applied
to any part of a neuron. Where are
labeled cell bodies most likely to be
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found after the tracer substance is
injected into the wall of the stomach?
(A) Prefrontal cortex
(B) Intermediolateral horn of spinal
cord
(C) Dorsal vagal complex
(D) Hypothalamus
(E) Gray matter of sacral spinal cord
5. An electrophysiological study of a
neuron in the ENS detects a fast EPSP.
Which is the most likely property
associated with the EPSP?
(A) Acetylcholine (ACh) receptors
(B) Suppression of hyperpolarizing
after-potentials
(C) Receptor activation of adenylyl
cyclase
(D) Hyperpolarization of the
membrane potential
(E) Mediation by a metabotropic
receptor
6. The application of norepinephrine
(NE) to the ENS suppresses
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cholinergically mediated EPSPs but has
no effect on depolarizing responses to
applied acetylcholine (ACh). This
finding is best interpreted as
(A) Postsynaptic excitation
(B) Slow synaptic inhibition
(C) Presynaptic inhibition
(D) Postsynaptic facilitation
(E) Inhibitory junction potential
7. A 10-cm segment of small intestine is
removed surgically and placed in a
37 C physiological solution containing
tetrodotoxin. A stimulus at one end of
the segment evokes an action potential
and an accompanying contraction that
travels to the opposite end of the
segment. This finding is best explained
by
(A) Electrical slow waves
(B) Varicose motor nerve fibers
(C) Interstitial cells of Cajal
(D) Functional electrical syncytial
properties
(E) Release of neurotransmitters
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8. A disease that results in the loss of
enteric inhibitory motor neurons to the
musculature of the digestive tract will
most likely be expressed as
(A) Rapid intestinal transit
(B) Accelerated gastric emptying
(C) Gastroesophageal reflux
(D) Diarrhea
(E) Achalasia of the lower esophageal
sphincter
9. The viewing of intestinal peristaltic
propulsion in real time with magnetic
resonance imaging shows the
stereotyped formation of propulsive
and receiving segments. What is the
normal sequence of events in enteric
neural programming of the propulsive
and receiving segments?
(A) Relaxation of the longitudinal and
circular muscles in the propulsive
segment
(B) Relaxation of the circular and
longitudinal muscles in the receiving
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segment
(C) Contraction of the longitudinal
and circular muscles in the receiving
segment
(D) Relaxation of the circular muscle
and contraction of the longitudinal
muscle in the receiving segment
(E) Contraction of the longitudinal
muscle and relaxation of the circular
muscle in the propulsive segment
10.Examination of the properties of a
normal sphincter in the digestive tract
will show that
(A) Primary flow across the sphincter is
unidirectional
(B) The lower esophageal sphincter is
relaxed at the onset of a migrating
motor complex in the stomach
(C) Blockade of the sphincteric
innervation by a local anesthetic causes
the sphincter to relax
(D) The manometric pressure in the
lumen of the sphincter is less than the
pressure detected in the lumen on
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either side of the sphincter
(E) The inhibitory motor neurons to
the sphincter muscle stop firing during
a swallow
11.The absence of intestinal motility in
the normal small intestine is best
described as
(A) A migrating motor complex
(B) An interdigestive state
(C) Segmentation
(D) Physiological ileus
(E) Power propulsion
12.The best description of the lag phase
of gastric emptying is the time required
for
(A) Conversion from the interdigestive
to the digestive enteric motor program
(B) Maximal stimulation of gastric
secretion
(C) Return of the emptying curve to
baseline
(D) Reduction of particle size to occur
(E) Emptying of half of a liquid meal
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13. Increased strength of the trailing
component of the contractile complex
in the gastric antral pump is most
likely to occur when
(A) Excitatory motor neurons are
activated to release ACh at the antral
musculature
(B) Sympathetic postganglionic
neurons decrease the amplitude of the
plateau phase of the gastric action
potential
(C) Frequency of the gastric action
potential increases beyond 3/min
(D) The pyloric sphincter opens
(E) Excitatory motor neurons to the
musculature of the gastric reservoir are
activated
14.When elevated in an ingested meal,
the factor with the greatest effect in
slowing gastric emptying is
(A) pH
(B) Carbohydrate
(C) Protein
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(D) Lipid
(E) H2O
15.On a return visit after receiving a
diagnosis of functional dyspepsia, a 35-
year-old woman reports sensations of
early satiety and discomfort in the
epigastric region after a meal. These
symptoms are most likely a result of
(A) Malfunction of adaptive relaxation
in the gastric reservoir
(B) Elevated frequency of contractions
in the antral pump
(C) An incompetent lower esophageal
sphincter
(D) Premature onset of the
interdigestive phase of gastric motility
(E) Bile reflux from the duodenum
16.A 46-year-old university professor with
an allergy to shellfish must be cautious
when eating in restaurants because a
trace of shrimp in any form of food
triggers an allergic reaction, including
abdominal cramping and diarrhea.
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Which kind of contractile behavior is
the most likely intestinal motility
pattern during the professors allergic
reaction to shellfish?
(A) Physiological ileus
(B) Migrating motor complex
(C) Retrograde peristaltic propulsion
(D) Segmentation
(E) Power propulsion
17.The instillation of markers in the large
intestine is used to evaluate transit time
in the large intestine and diagnose
motility disorders. In healthy subjects,
dwell-times for instilled markers in the
large intestine are greatest in the
(A) Ascending colon
(B) Sigmoid colon
(C) Descending colon
(D) Transverse colon
(E) Anorectum
18.An 86-year-old woman has complaints
of a compromised lifestyle because of
fecal incontinence. Examination of this
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patient will most likely reveal the
underlying cause of the incontinence
to be
(A) Absence of the rectoanal reflex
(B) Elevated sensitivity to the presence
of feces in the rectum
(C) Loss of the ENS in the distal large
intestine (adult Hirschsprungs disease)
(D) Weakness in the puborectalis and
external anal sphincter muscles
(E) A myopathic form of chronic
pseudoobstruction in the large
intestine
1. Most of the following GI secretions
have a basal output during the
interdigestive period (between meals).
However, the sight and smell of a tasty
meal stimulates GI secretions. Of the
various GI secretions, which is the
most stimulated?
(A) Gastric secretion
(B) Intestinal secretion
(C) Pancreatic secretion
(D) Salivary secretion
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(E) Biliary secretion
2. Bile acid uptake by hepatocytes is
dependent on
(A) Calcium
(B) Iron
(C) Sodium
(D) Potassium
(E) Chloride
3. Parietal cells in the stomach secrete a
protein crucial for the absorption of
vitamin B12 by the ileum. What is this
protein?
(A) Intrinsic factor
(B) Gastrin
(C) Somatostatin
(D) Cholecystokinin (CCK)
(E) Chylomicrons
4. Gastric acid secretion is stimulated
during several phases associated with
the ingestion and digestion of a meal.
Which phase is associated with the
bulk of acid secretion?
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(A) Cephalic
(B) Esophageal
(C) Gastric
(D) Intestinal
(E) Colonic
5 Carbonic anhydrase is an enzyme that
occurs in plants, bacteria, and animals
and is involved in the formation of
which chemical?
(A) Carbon dioxide from carbon and
oxygen
(B) Carbonic acid from carbon dioxide
and water
(C) Bicarbonate ion from carbonic acid
(D) Hydrochloric acid
(E) Hypochlorous acid
6. Parasympathetic stimulation induces
salivary acinar cells to release the
protease
(A) Bradykinin
(B) Kallikrein
(C) Kininogen
(D) Kinin
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(E) Aminopeptidase
7. Which protein is absent in saliva?
(A) Lactoferrin
(B) Amylase
(C) Mucin
(D) Intrinsic factor
(E) Muramidase
8. After the ingestion of a meal, the pH
in the stomach lumen increases in
response to the dilution and buffering
of gastric acid by the arrival of food.
The pH in the stomach lumen in the
fasting state is usually between
0.1 to 0.5
(A) 1 to 2
(B) 4 to 5
(C) 6 to 7
(D) 9 to 10
9. Unlike other GI secretions, salivary
secretion is controlled almost
exclusively by the nervous system and
is significantly inhibited by
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(A) Atropine
(B) Pilocarpine
(C) Cimetidine
(D) Aspirin
(E) Omeprazole
10.The chief cells of the stomach secrete
(A) Intrinsic factor
(B) Hydrochloric acid
(C) Pepsinogen
(D) Gastrin
(E) CCK
11.The interaction of histamine with its
H2 receptor in the parietal cell results
in
(A) An increase in intracellular sodium
concentration
(B) An increase in intracellular cAMP
production
(C) An increase in intracellular cGMP
production
(D) A decrease in intracellular calcium
concentration
(E) A decrease in intracellular cAMP
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production
12.When the pH of the stomach lumen
falls below 3, the antrum of the
stomach releases a peptide that acts
locally to inhibit gastrin release. This
peptide is
(A) Enterogastrone
(B) Intrinsic factor
(C) Secretin
(D) Somatostatin
(E) CCK
13.Which hormone stimulates pancreatic
secretion that is rich in bicarbonate?
(A) Somatostatin
(B) Secretin
(C) CCK
(D) Gastrin
(E) Insulin
14.A patient suffering from Zollinger-
Ellison syndrome would be expected to
have
(A) Excessive acid reflux into the
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esophagus, resulting in esophagitis
(B) Excessive secretion of CCK,
causing continuous contraction of the
gallbladder
(C) A gastrin-secreting tumor of the
pancreas, causing excessive stomach
acid secretion and peptic ulcers
(D) Low plasma lipid levels, due to
failure of the liver to secrete VLDLs
(E) Inadequate secretion of bicarbonate
by the pancreas
15.Lactase is a brush border enzyme
involved in the digestion of lactose.
The digestion product or products of
lactose are
(A) Glucose
(B) Glucose and galactose
(C) Glucose and fructose
(D) Galactose and fructose
(E) Fructose
16.Maltase hydrolyzes maltose to form
(A) Glucose
(B) Glucose and galactose
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(C) Glucose and fructose
(D) Galactose and fructose
(E) Galactose
17.Which sugar is taken up by
enterocytes by facilitated diffusion?
(A) Glucose
(B) Galactose
(C) Fructose
(D) Xylose
(E) Sucrose
18.Dietary triglyceride is a major source
of nutrient for the human body. It is
digested mostly in the intestinal lumen
by pancreatic lipase to release
(A) Lysophosphatidylcholine and fatty
acids
(B) Glycerol and fatty acids
(C) Diglyceride and fatty acids
(D) 2-Monoglyceride and fatty acids
(E) Lysophosphatidylcholine and
diglyceride
19.After a meal of pizza, dietary lipid is
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absorbed by the small intestine and
transported in the lymph mainly as
(A) VLDLs
(B) Free fatty acids bound to albumin
(C) Chylomicrons
(D) LDLs
(E) HDLs
20.Hartnups disease is an inherited
autosomal recessive disorder involving
the malabsorption of amino acids,
particularly tryptophan, by the small
intestine. Feeding dipeptides and
tripeptides containing tryptophan to
patients with this disease improves
their clinical condition because
(A) Dipeptides and tripeptides, unlike
free amino acids, can be taken up
passively by enterocytes in the small
intestine
(B) Peptides, unlike free amino acids,
can be taken up by defective amino
acid transporters
(C) Dipeptides and tripeptides use
transporters that are different from the
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defective amino acid transporters
(D) The presence of dipeptides and
tripeptides in the intestinal lumen
enhances the uptake of amino acids by
the transporters
(E) Dipeptides and tripeptides, unlike
amino acids, can be taken up passively
by the colon
21.What would you expect to find in a
sample of hepatic portal blood after
protein has been digested and
absorbed by the GI tract?
(A) Free amino acids
(B) Dipeptides and tripeptides
(C) Free amino acids and dipeptides
(D) Free amino acids and tripeptides
(E) Free amino acids, dipeptides, and
tripeptides
22.Which vitamin is water-soluble?
(A) Vitamin A
(B) Vitamin D
(C) Vitamin K
(D) Vitamin B1
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(E) Vitamin E
23.Which one of the following vitamins
stimulates calcium absorption by the
GI tract?
(A) Vitamin E
(B) Vitamin D
(C) Vitamin A
(D) Vitamin K
(E) Vitamin C
24.Which vitamin is transported in
chylomicrons as an ester?
(A) Vitamin E
(B) Vitamin D
(C) Vitamin A
(D) Vitamin K
(E) Vitamin B12
25.Potassium is absorbed in the jejunum
by
(A) Active transport
(B) Facilitated transport
(C) Passive transport
(D) Active and passive transport
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(E) Coupling to sodium absorption
26.Ascorbic acid is a potent enhancer of
iron absorption because it
(A) Enhances the absorption of heme
iron
(B) Enhances the activity of heme
oxygenase
(C) Is a reducing agent, thereby
helping to keep iron in the ferrous
state
(D) Decreases the production of
ferritin by enterocytes
(E) Stimulates production of
transferrin