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  • Question 1 - How are amino acids transported across the luminal surface of the small intestinal...

    Correct

    • How are amino acids transported across the luminal surface of the small intestinal epithelium?

      Your Answer: Co-transport with sodium ions

      Explanation:

      Once complex peptides are broken down into amino acids by the peptidases present in the brush border of small intestine, they are ready for absorption by at least four sodium-dependent amino acid co-transporters – one each for acidic, basic, neutral and amino acids, present on the luminal plasma membrane. These transporters first bind sodium and can then bind the amino acids. Thus, amino acid absorption is totally dependent on the electrochemical gradient of sodium across the epithelium. The basolateral membrane in contrast, possesses additional transporters to carry amino acids from the cell into the blood, but these are sodium-independent.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      9.2
      Seconds
  • Question 2 - What is the basic chemical reaction that takes place in the breakdown of...

    Correct

    • What is the basic chemical reaction that takes place in the breakdown of complex foodstuffs?

      Your Answer: Hydrolysis

      Explanation:

      Breakdown of complex food into simpler compounds is achieved by hydrolysis, with the help of different enzymes specific for different compounds.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      6.4
      Seconds
  • Question 3 - What is the pH of freshly formed saliva at ultimate stimulation? ...

    Correct

    • What is the pH of freshly formed saliva at ultimate stimulation?

      Your Answer: 8

      Explanation:

      Saliva has four major components: mucus (lubricant), α-amylase (enzyme that initiates digestion of starch), lingual lipase (enzyme that begins fat digestion), and a slightly alkaline electrolyte solution for moistening food. As the secretion rate of saliva increases, its osmolality increases. Moreover, the pH changes from slightly acidic (at rest) to basic (pH 8) at ultimate stimulation. This occurs due to increase of HCO3-. Amylase and mucus also increase in concentration after stimulation.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      2.3
      Seconds
  • Question 4 - Which of the following is a likely cause of jaundice? ...

    Correct

    • Which of the following is a likely cause of jaundice?

      Your Answer: Hepatic disease if plasma albumin is low and serum aminotransferase elevations > 500 units

      Explanation:

      Jaundice can occur due to any of the possible causes and treatment depends upon diagnosing the correct condition. Mild hyperbilirubinemia with normal levels of aminotransferase and alkaline phosphatase is often unconjugated (e.g., due to haemolysis or Gilbert’s syndrome rather than hepatobiliary disease). Moderate or severe hyperbilirubinemia along with increased urinary bilirubin (bilirubinuria), high alkaline phosphatase or aminotransferase levels suggest hepatobiliary disease. Hyperbilirubinemia produced by any hepatobiliary disease is largely conjugated. In this case, other blood tests include hepatitis serology for suspected hepatitis, prothrombin time (PT) or international normalised ratio (INR), albumin and globulin levels, and antimitochondrial antibody levels (suspected primary biliary cirrhosis). Low albumin and high globulin levels suggest chronic rather than acute liver disease. In cases where there is only a an elevation of alkaline phosphatase, γ-glutamyl transpeptidase (GGT) levels should be checked – the levels of which will be found high in hepatobiliary disease, but not in bone disorder which can also lead to elevated alkaline phosphatase levels. In diseases of hepatobiliary origin, aminotransferase elevations > 500 units suggest a hepatocellular cause, whereas disproportionate increases of alkaline phosphatase (e.g., alkaline phosphatase > 3 times normal and aminotransferase < 200 units) suggest cholestasis. Because hepatobiliary disease alone rarely causes bilirubin levels > 30 mg/dl, higher levels are suggestive of a combination of severe hepatobiliary disease and haemolysis or renal dysfunction. Imaging is best for diagnosing infiltrative and cholestatic causes of jaundice. Liver biopsy is rarely needed, but can be of use in intrahepatic cholestasis and in some types of hepatitis.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      20.2
      Seconds
  • Question 5 - Which is the site of action of the drug omeprazole? ...

    Correct

    • Which is the site of action of the drug omeprazole?

      Your Answer: H+/K+ ATPase

      Explanation:

      H+/K+-ATPase or ‘proton pump’ located in the canalicular membrane plays a major role in acid secretion. The ATPase here is magnesium-dependent. Omeprazole is a proton pump inhibitor and blocks H+/K+- ATPase.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      4.6
      Seconds
  • Question 6 - Post-total gastrectomy, there will be a decreased production of which of the following...

    Incorrect

    • Post-total gastrectomy, there will be a decreased production of which of the following enzymes?

      Your Answer: Trypsin

      Correct Answer: Pepsin

      Explanation:

      Pepsin is a protease that is released from the gastric chief cells and acts to degrade proteins into peptides. Released as pepsinogen, it is activated by hydrochloric acid and into pepsin itself. Gastrin and the vagus nerve trigger the release of pepsinogen and HCl when a meal is ingested. Pepsin functions optimally in an acidic environment, especially at a pH of 2.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      10.8
      Seconds
  • Question 7 - Which of the following is involved in vitamin B12 absorption? ...

    Correct

    • Which of the following is involved in vitamin B12 absorption?

      Your Answer: Intrinsic factor

      Explanation:

      Absorption of vitamin B12 is by an active transport process and occurs in the ileum. Most cobalamins are bound to proteins and are released in the stomach due to low pH and pepsin. The cobalamins then bind to R proteins, i.e. haptocorrin (HC) secreted from salivary glands and gastric juice. Another cobalamin binding protein is Intrinsic factor (IF) secreted from the gastric parietal cells. The cobalamin-HC complex is digested by pancreatic proteases in the intestinal lumen, and the free cobalamin then binds to IF. The complex then reaches a transmembrane receptor in the ileum and undergoes endocytosis. Cobalamin is then released intracellularly and binds to transcobalamin II (TC II). The newly formed complex then exits the ileal cell and enters the blood circulation.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      3.5
      Seconds
  • Question 8 - What is the result of maltase deficiency in the brush border of the...

    Correct

    • What is the result of maltase deficiency in the brush border of the small intestine?

      Your Answer: Results in increased passage of maltose in stool

      Explanation:

      Maltase is an enzyme produced from the surface cells of the villi, lining the small intestine and aids in hydrolysing the disaccharide maltose, which splits into two molecules of α-glucose. It is done by breaking the glycosidic bond between the ‘first’ carbon of one glucose and the ‘fourth’ carbon of the other (a 1–4 bond). Hence, a deficiency of enzyme maltase will result in the increased passage of maltose in the stool.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      9
      Seconds
  • Question 9 - Which of the following enzymes is secreted by the small intestinal mucosa? ...

    Correct

    • Which of the following enzymes is secreted by the small intestinal mucosa?

      Your Answer: Lactase

      Explanation:

      Lactase, an enzyme belonging to β-galactosidase family of enzymes, brings about the hydrolysis of the disaccharide lactose into galactose and glucose. In humans, it is present along the brush border membrane of the cells lining the small intestinal villi. Deficiency of lactase causes lactose intolerance.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      17.5
      Seconds
  • Question 10 - A child defecates a few minutes after being fed by the mother. This...

    Correct

    • A child defecates a few minutes after being fed by the mother. This is most likely due to:

      Your Answer: Gastrocolic reflex

      Explanation:

      The gastrocolic reflex is a physiological reflex that involves increase in colonic motility in response to stretch in the stomach and by-products of digestion in the small intestine. It is shown to be uneven in its distribution throughout the colon, with the sigmoid colon affected more than the right side of the colon in terms of a phasic response. Various neuropeptides have been proposed as mediators of this reflex, such as serotonin, neurotensin, cholecystokinin and gastrin.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      9
      Seconds
  • Question 11 - A 55-year old gentleman presented to the doctor with worsening dysphagia for both...

    Correct

    • A 55-year old gentleman presented to the doctor with worsening dysphagia for both solids and liquids over 6 months. This was associated with regurgitation of undigested food and occasional chest pain. Barium swallow revealed distal oesophageal dilatation with lack of peristalsis in the distal two-third oesophagus. The likely diagnosis is:

      Your Answer: Achalasia

      Explanation:

      Achalasia is an oesophageal motility disorder where inappropriate contractions in the oesophagus lead to reduced peristalsis and failure of the lower oesophageal sphincter to relax properly in response to swallowing. Classical triad of symptoms include dysphagia to fluids followed by solids, chest pain and regurgitation of undigested food. Other symptoms include belching, hiccups, weight loss and cough. Diagnosis is by:

      – X-ray with a barium swallow or oesophagography : narrowing at the gastroesophageal junction (‘bird/parrot beak’ or ‘rat tail’ appearance) and various degrees of mega-oesophagus (oesophageal dilatation) as the oesophagus is gradually stretched by retained food. Effectiveness of treatment can be measured with a 5-minute timed barium swallow.

      – Manometry – probe measures the pressure waves in different parts of oesophagus and stomach while swallowing.

      – Endoscopy

      – CT scan to exclude other causes like malignancy

      – Pathological examination showing defect in the nerves which control oesophageal motility (myenteric plexus).

      In Chagas disease, there is destruction of ganglion cells by Trypanosoma cruzi.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      26
      Seconds
  • Question 12 - Which of the following can occur even in the absence of brainstem co-ordination?...

    Correct

    • Which of the following can occur even in the absence of brainstem co-ordination?

      Your Answer: Gastric emptying

      Explanation:

      Although gastric emptying is under both neural and hormonal control, it does not require brainstem co-ordination. Increased motility of the orad stomach (decreased distensibility) or of the distal stomach (increased peristalsis), decreased pyloric tone, decreased duodenal motility or a combination of these, all increase the rate of gastric emptying. The major control mechanism for gastric emptying is through duodenal gastric feedback. The duodenum has receptors for the presence of acid, carbohydrate, fat and protein digestion products, osmolarity different from that of plasma, and distension. Activating these receptors decreases the rate of gastric emptying. Neural mechanisms involve both enteric and vagal pathways and a vagotomy impairs the gastric emptying regulation. CCK (cholecystokinin) slows gastric emptying at physiological levels of the hormone. Gastrin, secretin and glucose-1-phosphate also slow gastric emptying, but require higher doses.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      5.5
      Seconds
  • Question 13 - Which of the following is a likely consequence of severe diarrhoea? ...

    Incorrect

    • Which of the following is a likely consequence of severe diarrhoea?

      Your Answer: A metabolic alkalosis

      Correct Answer: A decrease in the sodium content of the body

      Explanation:

      Diarrhoea can occur due to any of the numerous aetiologies, which include infectious, drug-induced, food related, surgical, inflammatory, transit-related or malabsorption. Four mechanisms have been implicated in diarrhoea: increased osmotic load, increased secretion, inflammation and decreased absorption time. Diarrhoea can result in fluid loss with consequent dehydration, electrolyte loss (Na+, K+, Mg2+, Cl–) and even vascular collapse. Loss of bicarbonate ions can lead to a metabolic acidosis.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      10.9
      Seconds
  • Question 14 - What is a major source of fuel being oxidised by the skeletal muscles...

    Correct

    • What is a major source of fuel being oxidised by the skeletal muscles of a man who has undergone starvation for 7 days?

      Your Answer: Serum fatty acids

      Explanation:

      Starvation is the most extreme form of malnutrition. Prolonged starvation can lead to permanent organ damage and can be fatal. Starved individuals eventually lose significant fat and muscle mass as the body uses these for energy.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      10.3
      Seconds
  • Question 15 - The majority of gallstones are mainly composed of: ...

    Correct

    • The majority of gallstones are mainly composed of:

      Your Answer: Cholesterol

      Explanation:

      Bile salts are formed out of cholesterol in the liver cells. Occasionally, precipitation of cholesterol occurs resulting into cholesterol stones developing in the gall bladder.

      These cholesterol gallstones are the most common type and account for 80% of all gallstones. Another type, accounting for 20% gallstones is pigment stones which are composed of bilirubin and calcium salts. Occasionally, stones of mixed origin are also seen.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      5.5
      Seconds
  • Question 16 - Which of the following has the highest content of triglycerides? ...

    Correct

    • Which of the following has the highest content of triglycerides?

      Your Answer: Chylomicron

      Explanation:

      Created by the small intestinal cells, chylomicrons are large lipoprotein molecules which transport lipids to the liver, adipose, cardiac and skeletal tissue. Chylomicrons are mainly composed of triglycerides (,85%) along with some cholesterol and cholesteryl esters. Apo B-48 is the main apolipoprotein content.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      4.4
      Seconds
  • Question 17 - Which of the following will be a likely sequelae of complete ileal resection?...

    Correct

    • Which of the following will be a likely sequelae of complete ileal resection?

      Your Answer: Vitamin B12 deficiency

      Explanation:

      The ileum is a part of the small intestine and has a pH of around 7-8 (neutral or slightly alkaline). Its main function is absorption of products of digestion. The ileal wall has multiple villi, which in turn have numerous microvilli. This increases the surface area available for absorption significantly. The cells lining the ileum contain multiple enzymes such as protease and carbohydrase, which aid in the final stages of digestion. Villi contain lacteals which absorb the products of fat digestion, fatty acids and glycerol. Thus, ileal resection will lead to their decreased absorption and increased fat content in the stool. The ileum is also responsible for absorption of vitamin B12.

      Maximum water absorption occurs in the colon followed by the jejunum. Hence, ileal resection is less likely to lead to fluid volume deficiency. Also, most minerals (like calcium, iron etc.) are absorbed in the duodenum, and thus will not be affected by ileal resection.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      13.6
      Seconds
  • Question 18 - A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is...

    Correct

    • A TRUE statement regarding abolition of the cephalic phase of pancreatic secretion is that it:

      Your Answer: Will result after vagotomy

      Explanation:

      Recognition and integration of the sight, smell and taste of food triggers the cephalic phase of pancreatic secretion, causing an increase in pancreatic HCO3- and enzyme secretion. The degree of enzyme secretion in this phase is about 50% of the maximal response seen with exogenous CCK and secretin. The vagus nerve regulates the secretion through the cholinergic fibres innervating the acinar cells of the pancreas, and through peptidergic nerve fibres, which innervate ductal cells.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      12
      Seconds
  • Question 19 - Pain in the right upper quadrant of the abdomen on ingestion of a...

    Correct

    • Pain in the right upper quadrant of the abdomen on ingestion of a fatty meal is seen in a condition which involves which of the following substances?

      Your Answer: Cholecystokinin

      Explanation:

      The clinical scenario described here favours the presence of gallstones. During food ingestion, vagal discharges stimulate gallbladder contraction. Moreover, presence of fat and amino acids in the intestinal lumen stimulates the release of cholecystokinin (CCK) in the duodenum. This causes sustained gallbladder contraction and relaxation of the sphincter of Oddi. If gallstones are present, there will be inflammation in the gallbladder and CCK will aggravate it due to contractions.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      17.8
      Seconds
  • Question 20 - A glycogen storage disorder is characterised by increased liver glycogen with a normal...

    Correct

    • A glycogen storage disorder is characterised by increased liver glycogen with a normal structure and no increase in serum glucose after oral intake of a protein-rich diet. Deficiency of which of the following enzymes is responsible for this disorder?

      Your Answer: Glucose-6-phosphatase

      Explanation:

      The most common glycogen storage disorder is von Gierke’s disease or glycogen storage disease type I. It results from a deficiency of enzyme glucose-6-phosphatase which affects the ability of liver to produce free glucose from glycogen and gluconeogenesis; leading to severe hypoglycaemia. There is also increased glycogen storage in the liver and kidneys causing enlargement and various problems in their functioning. The disease also causes lactic acidosis and hyperlipidaemia. The main treatment includes frequent or continuous feedings of corn-starch or other carbohydrates.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      17.1
      Seconds
  • Question 21 - In what form are fats primarily transported in the body? ...

    Correct

    • In what form are fats primarily transported in the body?

      Your Answer: Free fatty acids

      Explanation:

      Fat is mainly transported in the body as free fatty acids. Once out of the adipose cell, the free fatty acids get ionized and combine with albumin.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      7.3
      Seconds
  • Question 22 - A 45-year old gentleman presents with diarrhoea for two weeks. He has no...

    Correct

    • A 45-year old gentleman presents with diarrhoea for two weeks. He has no history of fever and the diarrhoea stops on fasting. Which is the most likely type of diarrhoea that he is suffering from?

      Your Answer: Osmotic

      Explanation:

      The different types of diarrhoea are:

      1. Secretory diarrhoea – Due to increased secretion or decreased absorption. There is minimal to no structural damage in this type. The most common cause is cholera toxin which stimulates secretion of anions (especially chloride), with sodium and water.

      2. Osmotic diarrhoea – Due to increased osmotic load, there is water loss. This occurs in cases of maldigestion syndromes, such as coeliac or pancreatic disease.

      3. Motility-related diarrhoea – Occurs in cases of abnormal gastrointestinal motility. Due to increased motility, there is poor absorption and this leads to diarrhoea. This is seen post-vagotomy or in diabetic neuropathy.

      4. Inflammatory diarrhoea – Due to damage to the mucosa or brush border, there is a loss of protein-rich fluids and poor absorption. Features of all the above three types can be seen in this type. Aetiology includes bacterial, viral, parasitic infections or autoimmune problems including inflammatory bowel disease.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      21.8
      Seconds
  • Question 23 - Severe abdominal pain radiating to the back, along with increased serum amylase levels,...

    Correct

    • Severe abdominal pain radiating to the back, along with increased serum amylase levels, is seen in which of the following conditions?

      Your Answer: Pancreatitis

      Explanation:

      The primary test for diagnosis and monitoring of pancreatitis is amylase. Increased plasma levels of amylase can be found in: salivary trauma (including anaesthetic intubation), mumps, pancreatitis and renal failure. However, a rise in the total amylase levels over 10 times the upper limit of normal (ULN) is suggestive of pancreatitis; 5–10 times the ULN may indicate ileus or duodenal disease or renal failure. Lower levels are commonly found in salivary gland disease.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      7.4
      Seconds
  • Question 24 - Basal Metabolic Rate (BMR) will most likely be reduced by which of the...

    Correct

    • Basal Metabolic Rate (BMR) will most likely be reduced by which of the following?

      Your Answer: Decrease in body temperature

      Explanation:

      The basal metabolic rate (BMR) is defined as the rate of calorie consumption after an overnight fast, in the absence of any muscular activity, with the patient in a restful state. Various factors affect the BMR including weight, body surface area and age. The BMR is 30 kcal/m2 per hour at birth; at age 2, the rate is 57 kcal/m2 per hour; and at age 20, 41 kcal/m2 per hour. After this, the BMR decreases by 10% between 20-60 years of age. Women are known to have a 10% lower BMR than men (due to higher fat content). A one-degree change in body temperature leads to a 10% change in BMR in the same direction. However, shivering and increasing ambient temperature brings about a rise in BMR, and so does stress, physical activity, caffeine, theophylline and hyperthyroidism. Also, thermogenesis induced by diet results in increased metabolic rate and hence, BMR should be ideally measured after overnight fasting.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      6.1
      Seconds
  • Question 25 - Which of the following is a true statement regarding secretion of gastric acid?...

    Correct

    • Which of the following is a true statement regarding secretion of gastric acid?

      Your Answer: Acetylcholine increases gastric acid secretion

      Explanation:

      Gastric acid secretion is increased by acetylcholine, histamine and gastrin, with the help of cAMP as a secondary messenger. They increase H+ and Cl- secretion by increasing the number of H+/K+ ATPase molecules and Cl- channels. In contrast, gastric acid secretion is decreased by somatostatin, epidermal growth factor and prostaglandins.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      13.5
      Seconds
  • Question 26 - Bile salt reuptake principally occurs where? ...

    Correct

    • Bile salt reuptake principally occurs where?

      Your Answer: In the ileum

      Explanation:

      90 – 95% of the bile salts are absorbed from the small intestine (mostly terminal ileum and then excreted again from the liver. This is known as the enterohepatic circulation. The entire pool recycles twice per meal and approximately 6 to 8 times per day.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      17
      Seconds
  • Question 27 - Which of the following substances brings about a dilatation of the gastrointestinal resistance...

    Correct

    • Which of the following substances brings about a dilatation of the gastrointestinal resistance vessels?

      Your Answer: Vasoactive intestinal peptide

      Explanation:

      Gastric vasoconstrictors include catecholamines, angiotensin II and vasopressin. Vasodilators include vasoactive intestinal peptide and the hormones; gastrin, cholecystokinin and glucagon.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      6.8
      Seconds
  • Question 28 - Which of the following is responsible for the activation of pepsinogen released in...

    Correct

    • Which of the following is responsible for the activation of pepsinogen released in the stomach?

      Your Answer: Acid pH and pepsin

      Explanation:

      Pepsinogen is the inactive precursor of pepsin. Once secreted, it comes in contact with hydrochloric acid and pepsin, previously formed, and undergoes cleavage to form active pepsin.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      17.3
      Seconds
  • Question 29 - A neonate with failure to pass meconium is being evaluated. His abdomen is...

    Correct

    • A neonate with failure to pass meconium is being evaluated. His abdomen is distended and X-ray films of the abdomen show markedly dilated small bowel and colon loops. The likely diagnosis is:

      Your Answer: Aganglionosis in the rectum

      Explanation:

      Hirschsprung’s disease (also known as aganglionic megacolon) leads to colon enlargement due to bowel obstruction by an aganglionic section of bowel that starts at the anus. A blockage is created by a lack of ganglion cells needed for peristalsis that move the stool. 1 in 5000 children suffer from this disease, with boys affected four times more commonly than girls. It develops in the fetus in early stages of pregnancy. Symptoms include not having a first bowel movement (meconium) within 48 hours of birth, repeated vomiting and a swollen abdomen. Two-third of cases are diagnosed within 3 months of birth. Some children may present with delayed toilet training and some might not show symptoms till early childhood. Diagnosis is by barium enema and rectal biopsy (showing lack of ganglion cells).

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      22.6
      Seconds
  • Question 30 - Which organ is responsible for the secretion of enzymes that aid in digestion...

    Correct

    • Which organ is responsible for the secretion of enzymes that aid in digestion of complex starches?

      Your Answer: Pancreas

      Explanation:

      α-amylase is secreted by the pancreas, which is responsible for hydrolysis of starch, glycogen and other carbohydrates into simpler compounds.

    • This question is part of the following fields:

      • Gastroenterology
      • Physiology
      12.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Gastroenterology (28/30) 93%
Physiology (28/30) 93%
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