Physiology II Exam 1 Review

(d) Involves contraction of circular smooth muscle behind the food bolus and relaxation of circular smooth muscle in front of the bolus

A 24 y/o male graduate student participates in a clinical research study on intestinal motility. Peristalsis of the small bowl: (a) Mixes the food bolus (b) Is coordinated by the CNS (c) Involves contraction of similar muscle behind and in front of the food bolus (d) Involves contraction of circular smooth muscle behind the food bolus and relaxation of circular smooth muscle in front of the bolus (e) Involves relaxation of circular and longitudinal smooth muscle simultaneously in front of the bolus

(b) Blocks H2 receptors on parietal cells

A 38 y/o male patient with a duodenal ulcer is treated successfully with the drug cimetidine. The bases for cimetidine's inhibition of gastric H+ secretion is that is: (a) Blocks muscarinic receptors on parietal cells (b) Blocks H2 receptors on parietal cells (c) Increases intracellular cAMP levels (d) Blocks H+, K+ ATPase (e) Enhances the action of ACh on parietal cells

(c) Gastrocolic reflex

A 4 y/o infant that is having breakfast stops eating because he has an urge to go to the bathroom to defecate. Which of the following reflexes stimulates the motility of the large intestine when distention of the stomach occurs? (a) Colonoileal reflex (b) Gastroileal reflex (c) Gastrocolic reflex

(d) Decreased parietal cell mass

A 44 y/o woman is diagnosed with Zollinger-Ellison Syndrome. Which of the following findings is consistent with the diagnosis? (a) Decreased serum gastrin levels (b) Increased serum insulin levels (c) Increased absorption of dietary lipids (d) Decreased parietal cell mass (e) None of the givens answers are correct

(c) Inappropriate relaxation of the lower esophageal sphincter

A 48 y/o man has a 6-month history of burning pain that begins in the epigastric area and radiates up into the chest. Episodes occur most frequently after large meals and at night. Endoscopic examination shows moderately severe inflammation in the distal 3 cm of the esophagus. Which of the following is most likely cause of this condition? (a) Failure of the lower esophageal sphincter to relax after a swallow (b) Hypersecretion of gastric acid (c) Inappropriate relaxation of the lower esophageal sphincter

(c) Dietary triglycerides cannot be reabsorbed

A 49 y/o patient with severe Crohn's disease has been unresponsive to drug therapy and undergoes ileal resection. After the surgery, he will have steatorrhea because: (a) The liver bile acid pool increases (b) Micelles do not form in the intestinal lumen (c) Dietary triglycerides cannot be reabsorbed (d) The pancreas does NOT secrete lipase

(e) Parietal cells NOTE: Parietal cells release Inhibitory Factor (IF) which helps transport vitamin B12 to the terminal ileum for absorption.

A 70 y/o woman is diagnosed with Zollinger-Ellison Syndrome and undergoes gastrectomy. Her primary physician tells her that she will need to take intramuscular vitamin B12 shots for the rest of her life. Absence of which of the following cells is responsible for the vitamin replacement requirement? (a) Chief cells (b) G-cells (c) Goblet cells (d) Mucous neck cells (e) Parietal cells

(a) Submucosal Plexus

A change in pH of the chyme would most likely stimulate which part of the Enteric Nervous System? (a) Submucosal Plexus (b) Myenteric Plexus (c) Both (d) Neither

(c) Sjogren's syndrome

A chronic inflammatory disease, found predominantly in older women, that is characterized by a dryness of mucous membranes and infiltration of the affect tissues by lymphocytes is known as: (a) Mumps (b) Infectious mononucleosis (c) Sjogren's syndrome (d) Xerostomia

(b) The orad region

A function of the stomach is storage of ingested food. Which area would be considered the storage portion? (a) The antrum (b) The orad region (c) The caudad region (d) The distal region

(d) Secretin

A patient comes in with abdominal pain. Their lab results reveal normal levels of pancreatic enzymes, pepsinogen, and both stomach and gallbladder motility, but an acidic small intestine environment. Which hormone in the gastrointestinal tract is ABSENT that causes this condition? (a) Leptin (b) Cholecystokinin (CCK) (c) Gastrin (d) Secretin

(c) Water reabsorption

A patient comes to you with a colostomy bag inserted. Of the functions of the large intestine, which one is the most important that is hindered here? (a) Nutrient absorption (b) Fecal storage (c) Water reabsorption (d) Loss of normal gut flora for vitamin production

(c) Cholecystokinin (CCK) is no longer being released

A patient had their gallbladder removed. Why would they need to be on a modified diet? (a) Micelles are not forming adequately (b) Starches and carbohydrates are not being metabolized (c) Cholecystokinin (CCK) is no longer being released (d) Cholesterol is clumping up in the GI tract, so a minimal fatty diet is needed

(c) Irritable bowel syndrome

A patient suffers from abnormal bowel movements with associated abdominal pain, nausea, decreased appetite, and weight loss. No medications help, her symptoms get worse when she is under stress. What is most likely? (a) Inflammatory bowel disease (b) Megacolon (c) Irritable bowel syndrome (d) Bulimia nervosa

(d) Increased fecal fat levels

A patient with chronic pancreatitis in which more than 90% of pancreatic function is lost will probably exhibit: (a) Decreased serum secretin levels (b) Enhanced bile acid micelle formation (c) Increased duodenal pH levels (d) Increased fecal fat levels

(a) Calcium

Action potentials in the GI smooth muscles are primarily mediated by inward movement of which ion? (a) Calcium (b) Potassium (c) Sodium (d) Chloride

(c) Pernicious anemia Chronic gastritis causes the destruction of parietal cells, which supplies the Intrinsic Factor (IF) that helps transport B12 (cobalamine) to the terminal ileum. Deficiency in B12 absorption leads to pernicious anemia.

Chronic gastritis is often associated with which of the following? (a) Hyperchlorhydria (b) Microcytic anemia (c) Pernicious anemia (d) Steatorrhea

(c) Peristaltic reflex

Distention at one area of the small intestine induces contraction above the stimulus and relaxation below the stimulus. Which process facilitates this? (a) Ileocecal reflex (b) Segmentation reflex (c) Peristaltic reflex (d) Basal electrical rhythm

(a) Distention of the ileum relaxes the sphincter while the distention of the colon contracts it and inhibits contraction in the terminal ileum

Distention of the following statements best described the ileocecal sphincter? (a) Distention of the ileum relaxes the sphincter while the distention of the colon contracts it and inhibits contraction in the terminal ileum (b) Distention of the duodenum relaxes the sphincter to release contents into the colon (c) It is hormonally controlled (d) The sphincter does not control flow into the colon, the ileocecal valve does

(d) The lower esophageal sphincter fails to relax to allow food into the stomach NOTE: This person is exhibiting clinical manifestations of Achalasia.

During a meal, a person feels a strong forceful pressure in the anterior chest and begins to feel that they are unable to breath and have difficulty swallowing. The only relief they get is vomiting their meal. What could be a cause of this phenomenon? (a) The upper esophageal sphincter fails to relax (b) The stomach is too full (c) The lower esophageal sphincter fails to contract to allow food into the stomach (d) The lower esophageal sphincter fails to relax to allow food into the stomach

(d) The uvula

During swallowing, food is prevented from entering the nasal passages by: (a) The epiglottis (b) The glottis (c) The tongue (d) The uvula

(b) Somatostatin

During the cephalic phase, 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) Somatostatin (c) Intrinsic factor (d) Cholecystokinin (CCK) (e) Secretin

(d) Somatostatin is released from D-cells

During the gastric phase of acid secretion, all of the following occur EXCEPT: (a) Acetylcholine is released by distention (b) Acid secretion is stimulated by gastrin (c) Bombesin (gastrin-releasing peptide) stimulates gastrin release from G-cells (d) Somatostatin is released from D-cells

(d) Esophagus, stomach, duodenum, jejunum, ileum, cecum, colon, rectum

Going in an aboral direction (away from mouth), the various anatomical regions that make up the gastrointestinal (GI) tract are found in the following order: (a) Esophagus, stomach, jejunum, duodenum, ileum, colon, cecum, rectum (b) Esophagus, stomach, pylorus, duodenum, ileum, colon, rectum (c) Esophagus, stomach, ileum, duodenum, jejunum, colon, rectum (d) Esophagus, stomach, duodenum, jejunum, ileum, cecum, colon, rectum

(c) 6 Lower (I) and upper esophageal sphincters (II), pyloric sphincter (III), ileocecal valve (IV), and internal (V) and external anal sphincter (VI)

How many sphincters are found in the GI tract? (a) 4 (b) 5 (c) 6 (d) 7

(c) Increase myosin light chain kinase

In contraction of GI smooth muscle, which of the following events occurs after binding of Ca2+ to calmodulin? (a) Depolarization of the sarcolemma membrane (b) Ca2+ induced Cal release (c) Increase myosin light chain kinase (d) Increased intracellular Ca2+ concentration (e) Opening of ligand-gated Ca2+ channels

(e) Intrinsic factor or GIF

In gastric mucosal atrophy due to pernicious anemia or chronic H. pylori infection, the epithelial lining of the stomach deteriorates. Of all substances that are produced in this region, which is the one whose loss will have the most serious long-term physiological consequences? (a) HCl (b) HCO3- (c) Mucus (d) Pepsin (e) Intrinsic factor or GIF

(b) Coordinate longitudinal and circular muscle contractions

In the intestine, the function of the neurons of the myenteric plexus (Auerbach's plexus) is to: (a) Control the amplitude of slow waves (b) Coordinate longitudinal and circular muscle contractions (c) Link gut muscle function to hepatic and pancreatic secretion (d) Modulate epithelial function

(d) To make bilirubin water-soluble so that it can be excreted

In the liver, bilirubin is conjugated with glucuronic acid to form bilirubin glucuronide. The purpose of this process is: (a) To convert bilirubin into a form that can be stored in the body (b) To produce the bile salts that are necessary for lipid absorption (c) To allow bilirubin to be transported in the blood to sites where it can be utilized (d) To make bilirubin water-soluble so that it can be excreted

(c) Inhibition of parietal cells

Increased stomach pH is the consequence of which of the following? (a) Damage to the mucous cells (b) Increased G-cell activity (c) Inhibition of parietal cells (d) Over-expression of chief cells

(b) Near the lower esophageal sphincter

Mallory-Weiss Syndrome is characterized by a tear in the mucosal lining of the esophagus that is generally caused by prolonged severe vomiting and violent coughing. Where would you suspect the tear to be found? (a) Near the upper esophageal sphincter (b) Near the lower esophageal sphincter (c) Within the middle-third of the esophagus (d) This is due to a diaphragm tear

(b) Near the lower esophageal sphincter

Mallory-Weiss Syndrome is characterized by a tear in the mucosal lining of the esophagus that is generally caused by prolonged severe vomiting. Where would you expect the tear to occur? (a) Near the upper esophageal sphincter (b) Near the lower esophageal sphincter (c) Within the middle-third of the esophagus (d) This is due a sphincter tear

(d) Vitamin D

Micelle formation is necessary for the intestinal absorption of: (a) Glycerol (b) Galactose (c) Vitamin B12 (d) Vitamin D (e) Bile salts

(a) Deficiency; diarrhea

Over the long term, surgical removal of the terminal ileum would cause __________ of fat-soluble vitamins and __________. (a) Deficiency; diarrhea (b) Excess; constipation (c) Deficiency; constipation (d) Excess; constipation (e) Excess; diarrhea

(c) Decrease in rate and intensity

Patient is exhibiting an enhanced sympathetic response; auscultation of the bowel sounds should reveal: (a) Increase in rate and intensity (b) Increase in rate and decrease in intensity (c) Decrease in rate and intensity (d) Normal rate and intensity

(a) A gradient in slow waves going from the top to the bottom

Peristalsis in the muscle component of the human esophagus is produced by: (a) A gradient in slow waves going from the top to the bottom (b) Gravity moving swallowed food down the esophagus (c) Simultaneous contraction of the entire longitudinal muscle layer (d) Sequential firing of the extrinsic nerves from the nucleus ambiguous (e) The latency gradient of the "off contraction" in the circular muscle layer

(a) Cholecystokinin (CCK)

Relaxation of the sphincter of Oddi is normally coordinated with gallbladder contraction to allow bile outflow into the duodenum. Which of the following mediators circulates through the bloodstream to mediate this coordination when the meal is in the duodenum? (a) Cholecystokinin (CCK) (b) Gastrin (c) Motilin (d) Gastric inhibitory peptide (GIP) or glucose-dependent insulotropic peptide

(b) Basal (basic) electrical rhythm

Rhythmic episodes of spontaneous depolarization fo 5 to 15 mV in amplitude mastering 1 to 5 seconds that control the frequency of the contractions are known as: (a) Syncytium (b) Basal (basic) electrical rhythm (c) Pacemaker cells (d) Interstitial cells of Cajal

(c) Water impermeability of the ductal cells

Saliva becomes hypotonic relative to plasma as it flows through the ducts due to the: (a) Water impermeability of the acinar cells (b) HCO3- impermeability of the ductal cells (c) Water impermeability of the ductal cells (d) HCO3- impermeability of the acinar cells (e) Water impermeability of both acinar and ductal cells

(d) Oscillating restin membrane potentials

Slow waves in intestinal smooth muscle cells are: (a) Action potentials (b) Phasic contractions (c) Tonic contractions (d) Oscillating restin membrane potentials (e) Oscillating release of cholecystokinin (CCK)

(c) Relaxation of the internal anal sphincter and contraction of the external anal sphincter

The initial response to distention of the rectum is: (a) Contraction of the internal and external anal sphincters (b) Contraction of the internal anal sphincter and relaxation of the external anal sphincter (c) Relaxation of the internal anal sphincter and contraction of the external anal sphincter (d) Relaxation of the internal and external anal sphincters

(c) Acetylcholine

The main neurotransmitter in the GI tract responsible for increased motility and secretions via the parasympathetic nervous system is: (a) Epinephrine (b) Norepinephrine (c) Acetylcholine (d) Vasoactive intestinal polypeptide

(a) An involuntary reflex that begins with the swallowing center in the brain

The primary peristaltic wave that moves a bolus of food through the esophagus is characterized by: (a) An involuntary reflex that begins with the swallowing center in the brain (b) An involuntary reflex that does not involve the swallowing center (c) A voluntary reflex that requires cortical control of the esophageal skeletal muscle (d) A controlled passage of food that is voluntary in nature

(d) Receptive relaxation

The process by which the stomach expands to accommodate volume without any increase in intraluminal pressure is known as: (a) Emesis (b) Osmoreceptor activation (c) Invagination (d) Receptive relaxation

(d) Nutcracker Esophagus

This condition is characterized by abnormal, high amplitude peristaltic waves in the distal esophagus. This condition is also painful. What is this condition? (a) Achalasia (b) GERD (c) Gastroesophageal Reflux (d) Nutcracker Esophagus

(c) Motilin

This hormone, when injected intravenously, would be able to initiate a phase of intense sequential contractions in the proximal duodenum that appears the migrate slowly towards the cecum: (a) Cholecystokinin (CCK) (b) Gastrin (c) Motilin (d) Secretin (e) Vasoactive intestinal polypeptide (VIP)

(b) Distention of the colon

Under which of the following conditions would the ileocecal sphincter contract? (a) Distention of the ileum (b) Distention of the colon (c) Eating a meal (d) Injection of gastrin (e) Injection of CCK

(b) Bile salts

Venous blood leaving the intestine must first pass through the liver before going to the heart and enter the systemic circulation. This entero-hepatic circulation is the mechanism for the conservation of: (a) Red blood cells (b) Bile salts (c) Proteins (d) Pancreatic enzymes

(b) Increases Cl- secretory channels in crypt cells

Vibrio cholerae causes diarrhea because is: (a) Increases HCO3- secretory channels in intestinal epithelial cells (b) Increases Cl- secretory channels in crypt cells (c) Prevents the absorption of glucose and causes water to be retained in the intestinal lumen isosmotically (d) Inhibits cAMP production in intestinal epithelial cells

(a) It contains skeletal muscle along the superior one-third of its length

What is unusual about the muscularis externa of the esophagus? (a) It contains skeletal muscle along the superior one-third of its length (b) It is surrounded by serosa (c) It contains a combination of smooth muscle and skeletal muscle along the superior one-third of its length (d) It contains nerves

(d) K+

When comparing the composition of both saliva and pancreatic juice, the ion species whose concentration both secretions is virtually independent of flow rate is: (a) Na+ (b) Cl- (c) HCO3- (d) K+

(c) C

Where do we find the myenteric plexus? (a) A (b) B (c) C (d) D

(c) C

Which letter is pointing to the circular muscle layer? (a) A (b) B (c) C (d) D

(c) Nitric oxide

Which neurotransmitter is responsible for relaxation events in the GI tracts? (a) Epinephrine (b) Norepinephrine (c) Nitric oxide (d) Acetylcholine

(b) Vagotomy

Which of the following abolishes "receptive relaxation" of the stomach? (a) Parasympathetic stimulation (b) Vagotomy (c) Administration of gastrin (d) Administration of vasoactive intestinal peptide (VIP) (e) Administration of cholecystokinin (CCK)

(a) Gastrin

Which of the following agents would NOT be responsible for a decrease in lower esophageal sphincter pressure? (a) Gastrin (b) Ethanol (c) Chocolate (d) Peppermint

(a) Internal anal sphincter is relaxed

Which of the following changes occurs during defecation? (a) Internal anal sphincter is relaxed (b) External anal sphincter is contracted (c) Rectal smooth muscle is relaxed (d) Intra-abdominal pressure is lower than when at rest (e) Segmentation contraction predominate

(a) Hypotonicity relative to plasma

Which of the following characteristic of the salivary secretions? (a) Hypotonicity relative to plasma (b) A lower HCO3- concentration than plasma (c) The presence of protease (d) Secretion rate that is increased by vagotomy (e) Modification by the salivary cells involves reabsorption of K+ and HCO3-

(a) Vagal input, histamine, gastrin

Which of the following combinations will result in the most acid secretion through potentiation (post-receptor interaction yielding a response that is greater with the sum of each agent acting together)? (a) Vagal input, histamine, gastrin (b) Vagal input, histamine, secretin (c) Histamine, gastrin, secretin (d) Gastrin, vagal input, secretin

(c) Hydrogen ions supplied by a basolateral hydrogen/sodium pump

Which of the following does NOT contribute to HCl secretion in the stomach? (a) A basolateral bicarbonate/chloride exchanger to maintain intracellular chloride ions also resulting in an "alkaline tide" in the blood stream (b) Passive flow of chloride and potassium ions through apical channels (c) Hydrogen ions supplied by a basolateral hydrogen/sodium pump (d) The primary contributor to HCl acid secretion is hydrogen/potassium pump ATPase that pumps out hydrogen in exchange for extracellular potassium

(b) Cholecystokinin (CCK)

Which of the following does NOT regulate gastrin acid secretion? (a) Vagal stimulation (b) Cholecystokinin (CCK) (c) Histamine (d) Gastrin (e) Acetylcholine

(c) Migrating motor complexes

Which of the following gastrointestinal motor activities is most affected by vagotomy? (a) Cauded stomach peristalsis (b) Distention-induced intestinal segmentation (c) Migrating motor complexes (d) Orad stomach accommodation (e) Secondary esophageal peristalsis

(d) Metabolism

Which of the following is NOT a function of the GI system? (a) Digestion (b) Secretion (c) Absorption (d) Metabolism

(c) Excretion of iron

Which of the following is NOT a function of the liver? (a) Synthesis and release of bilirubin (b) Metabolic processing of absorption of nutrients (c) Excretion of iron (d) Storage of iron, fats, vitamins (A, D, E, K, B12) and glycogen

(b) Bicarbonate

Which of the following is the most important product of digestive pancreatic secretions? (a) Insulin (b) Bicarbonate (c) Water (d) Bile

(d) Pancreatic enzyme secretion is increased by cholecystokinin (CCK)

Which of the following is true about the secretions from the exocrine pancreas? (a) It has a higher Cl- concentration than plasma (b) It is stimulated by the presence of HCO3- in the duodenum (c) Pancreatic HCO3- is increased by gastrin (d) Pancreatic enzyme secretion is increased by cholecystokinin (CCK) (e) It is hypotonic

(c) Amylase and lipase

Which of the following pancreatic enzymes are secreted in their active form? (a) Trypsinogen and elastase (b) Colipase and amylase (c) Amylase and lipase (d) Trypsin and carboxypeptidase

(a) Oral

Which of the following phases of swallowing is voluntary? (a) Oral (b) Pharyngeal (c) Esophageal

(c) Cholecystokinin (CCK)

Which of the following substances inhibits gastric emptying? (a) Secretin (b) Gastrin (c) Cholecystokinin (CCK) (d) Vasoactive intestinal polypeptide (VIP) (e) Gastric inhibitory peptide (GIP)

(d) Vasoactive intestinal peptide (VIP)

Which of the following substances is released from neurons in the GI tract and produces smooth muscle relaxation? (a) Secretin (b) Gastrin (c) Cholecystokinin (CCK) (d) Vasoactive intestinal peptide (VIP) (e) Gastric inhibitory peptide (GIP)

(e) Glucose-dependent insulotropic peptide or gastric inhibitory peptide (GIP)

Which of the following substances is secreted in response to an oral glucose load, fats, and proteins? (a) Secretin (b) Gastrin (c) Cholecystokinin (CCK) (d) Vasoactive intestinal polypeptide (e) Glucose-dependent insulotropic peptide or gastric inhibitory peptide (GIP)

(a) Parasympathetic stimulation

Which of the following would lead to contraction of the large intestine? (a) Parasympathetic stimulation (b) Sympathetic stimulation (c) The BER (basal electrical rhythm) (d) Intrinsic nerves within the colon

(c) Mucosa

Which of the layers of the GI tract is most closely associated with the luminal wall? (a) Muscularis (b) Serosa (c) Mucosa (d) Submucosa

(b) Segmentation

Which of them following motility patterns in the small intestine is primarily responsible for the mixing of chyme with digestive juices and exposing the products of digestion to the intestinal wall? (a) Haustrations (b) Segmentation (c) Migrating motor complex (MMC) (d) Tonic contraction

(a) The upper third

Which region of the esophagus requires input from the CNS to coordinate peristalsis? (a) The upper third (b) The middle third (c) The lower third (d) The entire esophagus

(a) Fat content of the chyme within the duodenum stimulates its release

Why would there be an increased release of cholecystokinin? (a) Fat content of the chyme within the duodenum stimulates its release (b) Carbohydrate rich meals slow down gastric motility and stimulate the release of cholecystokinin (CCK) (c) Protein content will stimulate the release of cholecystokinin (CCK) (d) Hormones are released during all meals