1. The enzyme that breaks down starch to short chains is secreted by
    • A. The salivary glands.
    • B. Pancreatic exocrine cells.
    • C. Pancreatic duct cells.
    • D. A and B.
    • E. A and C.

    Correct Answer: D
  2. 2. Esophageal and gastric endoscopic examination is routinely used for:
    • A. Diagnosing gastrointestinal reflux disease (GERD)
    • B. Detecting presence of infections w/ Helicobacter pylori or Candida albicans
    • C. Detecting presence of hiatal hernia
    • D. Detecting presence of Barrett’s esophagus
    • E. b and d

    Correct Answer: E
  3. 3. All of the following stimulate gastic acid (H+) secretion EXCEPT:
    • A. Acetylcholine release from nerve plexus neurons stimulated by the smell of food
    • B. Reflex stimulation of parietal cells induced by distension of the stomach wall
    • C. Acid-induced release of somatostatin in the stomach
    • D. Oligopeptide-stimulated gastrin release in the stomach
    • E. Paracrine action of histamine released from enterochromaffin cells in the stomach

    Correct Answer: C
  4. Which of the following patients is most likely to have ulcerative colitis?
    • A. 14 year old boy with rectal bleeding and colon biopsies that demonstrate branched crypts
    • B. 25 year old woman with copious diarrhea and colon biopsies with straight crypts
    • C. 85 year old man with diverticular disease, bloody diarrhea and branched crypts on colon biopsy
    • D. 35 year old man with HIV, CMV colitis and branched crypts on colon biopsy
    • E. All of the above

    The boy with rectal bleeding and branched (abnormal) crypts on colon biopsies is likely to have ulcerative colitis, although cultures are needed to rule out infection. Ulcerative colitis usually presents with rectal bleeding because the disease starts at the rectum and works it’s way back. Diarrhea does occur but usually later in the disease process. The 85 year old man could also have ulcerative colitis but this is less likely. Diverticular disease can cause histological changes that are identical to ulcerative colitis.

    Correct Answer: A
  5. A patient with a three-week history of diarrhea may have:
    • A. Ingested large quantities of sorbitol
    • B. Crohn’s disease
    • C. Used clindamycin recently
    • D. All of the above

    Correct Answer: D
  6. In the current guidelines used in the United States, which of the following patients would need to be followed for surveillance of his or her condition after having endoscopic biopsies of the esophagus?
    • A. A sixteen year old with normal biopsies
    • B. A 45 year old with a patch of columnar epithelium in the tubular esophagus
    • C. A 25 year old with columnar epithelium that includes goblet cells in the tubular esophagus
    • D. A 45 year old with columnar epithelium that includes goblet cells at the gastroesophageal junction
    • E. A 51 year old with columnar epithelium that includes goblet cells at the gastroesophageal junction

    Current guidelines in the United States suggest that people with intestinal metaplasia of the tubular esophagus (Barrett Esophagus) should be followed by surveillance endoscopy due to the increased risk of dysplasia and carcinoma. The current definition of intestinal metaplasia is twofold: 1) the endoscopist identifies a patch likely intestinal metaplasia within the tubular esophagus (above the end of the rugal folds of the stomach) and 2) that this is biopsied and intestinal metaplasia is confirmed by a pathologist. There is some controversy about the need to find goblet cells in the biopsy and in some parts of Europe the definition for intestinal metaplasia is just columnar mucosa with or without goblet cells.

    Correct Answer: C
  7. Hepatic dysfunction may occur as a consequence of:
    • A. Hepatitis
    • B. Alcoholic liver disease
    • C. Portal hypertension
    • D. All of the above

    Correct Answer: D
  8. Which of the following symptoms is expected in a patient with gall stones?
    • A. Right upper quadrant abdominal pain
    • B. Blood in the stool
    • C. Diarrhea
    • D. Constipation

    Correct Answer: A
  9. What are the diagnostic features of celiac disease?
    • A. Increased intraepithelial lymphocytes and villous blunting
    • B. Acute inflammation in the crypts of the duodenal mucosa and ulceration
    • C. Villous blunting and increased intraepithelial lymphocytes followed by a symptomatic response to a gluten free diet
    • D. Negative result for HLA-DQ2 and HLA-DQ8 testing
    • E. Positive result for HLA-DQ2 and HLA-DQ8 testing

    The diagnosis of celiac disease (gluten sensitive enteropathy) rests on proving that the problem arises from a reaction to gluten (a component of many grains). While the answer in A is correct in the sense that these are the diagnostic histological features of celiac, the findings are not specific for this disease and can be seen in many disorders including infection. To confirm a diagnosis of celiac, the person with these findings on biopsy must be put on a diet free of gluten to see if he or she responds (usually the response is monitored clinically, but sometimes they will rebiopsy to see if there is a histologic response to the treatment). Tests for HLA-DQ2 and DQ8, although not diagnostic, are helful in the diagnosis. If the patient does not have one of these two HLA genes, it is highly unlikely that they will have celiac disease. This can be helpful in difficult cases. The distinction of celiac from other forms of disease is important because the only cure is to go on a gluten free diet, which is difficult and expensive for the patient.

    Correct Answer: C
  10. Which of the following is not a component of the bile secreted by hepatocytes?
    • A. Cholesterol
    • B. Bile salt
    • C. Bilirubin
    • D. Lecithin
    • E. Bicarbonate

    Correct Answer: E
  11. Which of the following bacteria does not produce enterotoxins?
    • A. Clostridium botulinum
    • B. Clostridium perfringens
    • C. Staphylococci aureus
    • D. Salmonella enteritidis

    Correct Answer: A
  12. Which if the following tests is NOT be helpful in determining a patient’s hepatitis C status?
    • A. Anti-HBs IgG
    • B. RT-PCR for HCV RNA
    • C. Anti HCV IgG
    • D. Serum transaminases

    Correct Answer: A
  13. Peptic ulcer development may be related to:
    • A. Helicobacter pylori infection
    • B. Candida albicans infection
    • C. Long term use of NSAIDs
    • D. a and b
    • E. a and c

    Correct Answer: E
  14. Which of the following statements is true regarding the emulsification of fats?
    • A. Fat emulsification requires pancreatic lipase.
    • B. Fat emulsification requires secretion of bile salts and phospholipids by the liver.
    • C. Fat emulsification results in the formation of small fat droplets.
    • D. A and B.
    • E. B and C.

    Correct Answer: E
  15. The functions of the stomach include
    • A. The complete digestion of protein.
    • B. Dissolving all the food that enters it.
    • C. Killing bacteria.
    • D. Storing partially digested food.
    • E. C and D.

    Correct Answer: E
  16. Which of the following event is not part of the swallowing reflex?
    • A. Chewing of food
    • B. Relaxation of the upper esophageal sphincter
    • C. Elevation of the soft palate
    • D. Closing of the glottis by epiglottis
    • E. Relaxation of the lower esophageal sphincter

    Correct Answer: A
  17. Which of the following representative drugs are effective antiemetics?
    • A. Diphenhydramine (H1 receptor antagonist)
    • B. Dronabinol (cannabinoid receptor agonist)
    • C. Metoclopromide (D2 receptor antagonist)
    • D. Scopolamine (muscarinic receptor antagonist)
    • E. All of the above

    Correct Answer: E
  18. Causing diarrhea by food infection, intracellular pathogen, non-Enterobacteriaceae family?
    • A. Listeria monocytogenes
    • B. Staphylococus aureus
    • C. Vibrio
    • D. Shigella

    Correct Answer: A
  19. What is the order of layers, from the lumen (inside the tube) to the external surface, of the tubular GI tract?
    • A. Serosa, subserosa, muscularis mucosae
    • B. Mucosa; serosa, ganglion layer, subganglia
    • C. Mucosa, submucosa, muscularis propria, serosa
    • D. Muscularis propria, submuscularis, mucosa, submucosa
    • E. Mucosa, muscularis propria, submucosa, serosa

    Remembering the layers of the general organization of the tract helps to make understanding GI diseases easier. Most abnormal pathology occurs in the layer of the mucosa. One of the main functions of the mucosa is barrier to harmful things that come in from the outside world along with ingested food. For this reason inflammatory responses in this layer are common.

    Correct Answer: C
  20. What is the primary cause of dysphagia (difficulty swallowing) in achalasia?
    • A. Inflammation of the mucosa with secondary fibrosis
    • B. External compression from serosal fibrosis
    • C. Loss of inhibitory innervation of the smooth muscle in the lower esophageal sphincter
    • D. Increased contraction of the smooth muscle in lower esophageal sphincter
    • E. Regurgitation of stomach acid causing inflammation of the gastroesophageal junction

    The primary cause of achalasia is loss of relaxation of the lower esophageal sphincter. Normally the lower esophageal sphincter is contracted to prevent reflux of gastric contents back into the esophagus. When swallowing occurs the signal is sent through the parasympathetic nervous system to relax this sphincter to allow food or liquid to enter the stomach. In primary achalasia an inflammatory process (possibly an autoimmune process) causes loss of the final relay switch (the nerve ganglia) of this signal.

    Correct Answer: C
  21. Ingestion of which of the following most markedly decreases gastric emptying?
    • A. Fats
    • B. Water
    • C. Minerals
    • D. Proteins
    • E. Carbohydrates

    Correct Answer: A
  22. Which of the following molecules crosses the luminal membrane of intestinal cells by facilitated diffusion?
    • A. Glucose
    • B. Lactose
    • C. Fructose
    • D. A and B.
    • E. All of the above.

    Correct Answer: C
  23. Which of the following sphincter/valve does not directly control the GI tract itself?
    • A. Ileo-cecal valve
    • B. Pyloric sphincter
    • C. Lower esophageal sphincter
    • D. Upper esophageal sphincter
    • E. Sphincter of Oddi

    Correct Answer: E
  24. In the Lauren classification of gastric cancer what are some of the features that distinguish the two types of cancer
    • A. Intestinal type tumors are usually bulky and diffuse usually infiltrate within the normal wall (linitis plastica)
    • B. Intestinal type tumors are made up of cohesive groups of cells and diffuse tumors of discohesive cells
    • C. Intestinal type tumors tend to arise in a background of intestinal metaplasia more often than diffuse
    • D. Intestinal type tumors are more often associated with H. pylori infection than diffuse
    • E. All of the above

    Correct Answer: E
  25. A Gram positive bacillus, spore-former, produces bacterial toxins, causes antibiotic associated diarrhea:
    • A. Bacillus cereus
    • B. Clostidium botulinum
    • C. Clostidium tetani
    • D. Clostridium difficile

    Correct Answer: D
  26. Lipase
    • A. Catalyzes the breakdown of triacylglycerol to glycerol and the three fatty acids
    • B. Emulsifies lipids
    • C. Is secreted by the endocrine pancreas
    • D. A and B
    • E. None of the above.

    Correct Answer: E
  27. Which of the following representative G-I drugs decreases the hepatic metabolism of many other dugs?
    • A. Cimetidine (H2 receptor antagonist)
    • B. Misoprostol (prostaglandin analog)
    • C. Omeprazole (proton pump inhibitor)
    • D. Sodium bicarbonate (gastric antacid)
    • E. Sucralfate (cytoprotective drug)

    Correct Answer: A
  28. All of the following play a role in the normal enterohepatic circulation of bile acids, EXCEPT:
    • A. Gall bladder.
    • B. Portal vein.
    • C. Ileum.
    • D. Bile ducts.
    • E. Aorta.

    Correct Answer: E
  29. Which of the following are considered aggressive factors in the formation of peptic ulcers?
    • A. H+
    • B. Bicarbonate
    • C. Mucus
    • D. Prostaglandins
    • E. None of the above

    Correct Answer: A
  30. Which of the following statements regarding hormonal regulation of gastrointestinal function is true?
    • A. The presence of hydrogen ion in the small intestine stimulates secretion of secretin, which in turn stimulates bicarbonate secretion by the pancreas.
    • B. The presence of fatty acids in the small intestine stimulates secretion of CCK, which in turn stimulates enzyme secretion by the pancreas.
    • C. The presence of amino acids in the small intestine stimulates secretion of gastrin, which in turn stimulates HCl secretion by parietal cells.
    • D. A and B.
    • E. All of the above.

    Correct Answer: D
Card Set
Systems 2 SA1-12