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Exam 43: Digestion: Anatomy, Biochemistry, and Physiology

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Question 1

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Patients with functional dyspepsia and prominent nausea frequently experience spurts of excessive gastric acid exposure to the proximal duodenum. This results in increased pancreatic secretion, mainly through the action of which of the following substances?

A) cholecystokinin, CCK
B) gastrin
C) glucagon
D) secretin
E) vasoactive intestinal polypeptide, VIP

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Question 2

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A 54-year-old alcoholic man is admitted to the emergency room with an 8-hour history of severe epigastric pain. He reports that the pain radiates to his back and is more intense when he lies down. Physical examination reveals tachycardia, hypotension, and low-grade fever consistent with the early stage of shock. Which of the following serum measurements would be most useful in providing a diagnosis of his condition?

A) amylase
B) aspartate aminotransferase, AST
C) bilirubin
D) serum calcium
E) troponin I

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Question 3

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The manufacturer of energy bars makes claim that the fructose contained in their bars serves as an ideal source of energy for extreme mountain climbing and mountain biking expeditions. Which of the following statements concerning fructose reflects the basis for these claims?

A patient presented with an acute abdomen including fever, marked abdominal distension, acidosis, and leukocytosis. Laparoscopy revealed that large parts of the small intestine were necrotic, and as a consequence the entire ileum of the patient was resected. It is expected that very soon after the surgery the patient will have considerable problems resulting from the malabsorption of which of the following?

As a physician on a mission to treat patients in sub-Saharan Africa you encounter numerous children with a common cluster of signs and symptoms. These include chronic diarrhea, dizziness, fatigue, delayed wound healing, and muscle wasting. Given the constellation of symptoms in your patients, your normal course of treatment would most likely include which of the following?

A healthy adult male of average size contains approximately 11 kg of total body protein. Approximately 5 kg of this is available as a source of energy primarily from skeletal muscle. Which of the following most closely represents the total caloric contribution of this protein source during prolonged fasting?

A 63-year-old man is being seen by his physician as a follow-up to gastric surgery for the treatment of a severe duodenal ulcers. This patient has the ulcers removed by surgical resection of the proximal portion of the duodenum to the distal end of the corpus of the stomach. The patient has been prescribed a proton pump inhibitor (PPI) because the surgery required removal of the region of the stomach that contains cells involved in the negative regulation of acid secretion. Which of the following represents these antrum located cells?

You are examining digestive enzymes and their processes of activation. You have isolated a mutant form of one particular enzyme and find that it remains inactive in a mixture of digestive juices. The wild-type enzyme is normally activated by hydrolysis on the C-terminal side of Arg and Lys residues and you determine that the mutant enzyme contains Ser residues at these critical positions. Which of the following digestive enzymes is most likely responsible for activation of the wildtype enzyme in your studies?

You are carrying out in vitro experiments that are designed to test the efficacy of novel compounds in the treatment of gastroesophageal reflux disease (GERD) . You are testing the various compounds on gastric parietal cells in culture. You discover that one of the compounds exerts a significant inhibition of hydrogen ion (H+) secretion from the cells. This compound most likely mimics the effects of which of the following natural peptides?

Acetylcholine (ACh) directly stimulates parietal cell secretion of gastric acid by binding to muscarinic receptors of the M3 family present on these cells. Acetylcholine can also indirectly influence gastric acid secretion by activating M2 and M4 receptors present on which of the following cell types?

As a physician on a mission to treat patients in subSaharan Africa you encounter numerous children with a common cluster of signs and symptoms. These include protuberant abdomens, generalized edema, loss of muscle mass, lethargy, irritability, and fatigue. Given the constellation of symptoms in your patients, your normal course of treatment would most likely include which of the following?

You are tending to a 27-year-old woman whose chief complaint is that she can no longer taste sweetness in food, particularly fruits. You suspect that she may have a defect or disease of her tongue but physical examination as well as a small tissue biopsy show no anomalies. You order an assay of her saliva because you suspect she may have a defect in the secretion of which of the following enzymes?

You are examining a 33-year-old man whose chief complaints are that he has experienced recent weight loss and that he believes is due to the fact that he feels full after eating only a small amount of food. You determine that these symptoms are manifest due to a delay in the normal rate of gastric emptying. Given these findings, which of the following hormones is most likely to be excessively active in this patient?

Which of the following hormones is responsible for the stimulation of bile secretions from the gallbladder?

Which of the following statements relates to the role of salivary production of mucin?

You are studying the gastric secretions of a patient swith a rare form of nutritional malabsorption. You discover that the defect is due to a near complete loss of secretion of pepsinogen into the stomach in response to food intake. These observations could be explained by a defect in which type of gastrointestinal secretory cell?

A 45-year-old woman has come to her physician with complaints of abdominal pain, loss of appetite, fatigue, diarrhea, cramping, and bloating. Further history reveals that in addition to the frequent diarrhea, her stools are often bloody. Her physician suspects colitis and orders a colonoscopy which shows colonic mucosal erythema, ulcers, and bleeding. The symptoms of colitis seen in this patient are most likely due to a defect in the secretory properties of which of the following cell types?

A 14-year-old boy presents with weight loss and diarrhea. His tongue becomes sore and blistery after eating oatmeal or rye bread, which leads to the diagnosis of celiac disease. The boy and his parents are advised to be sensitive to symptoms of tetany and paresthesias since they can occur as a consequence of malabsorption of which of the following?

Pancreatic amylase in the intestine cleaves starch primarily into which of the following?

A 37-year-old man is being seen in the emergency room because of a 3-month history of nausea, vomiting, excessive thirst, increased urination, and generalized weakness. The patient has a 2-year history of gastric discomfort and pain which he has been attempting to manage with large quantities of antacids, a bland diet, and milk. Which of the following laboratory abnormalities is most likely in this patient?