Clincal Integration: Case Study 1 (Exam #7)
D
A 15 year old male presents to the clinic with easy fatigue and breathlessness with activity, and mild pain in the legs when walking. On a physical exam, no fever is noted, but his heart rate is 96 bpm (NR: 60-100 bpm) and a systolic murmur is heard. If the patient's symptoms are due to the inability to convert methyl-tetrahydrofolate (Methyl-THF) to tetrahydrofolate (THF), what is the most likely cause of his symptoms and what important process is being blocked? A. Methotrexate or sulfa drug use; antagonist of dihydrofolate reductase (DHFR), which prevents synthesis of DNA B. Chronic Inflammation; inability to induce hepcidin and increase EPO resistance in erythroid progenitors C. Iron Deficiency; erythropoiesis is ineffective D. Cobalamin deficiency; prevents synthesis of DNA E. Folate deficiency; prevents synthesis of DNA
B (Muscle glycogen provides energy for contraction of the muscles during exercise.)
A 16-year-old female athlete is admitted to the hospital for dehydration following a big track meet earlier in the day. She tells the nurse that she was running late for the race, so she skipped breakfast and ran anyway. Which best describes a valid source of energy, and appropriate location of that energy source, that her body utilized during the race? A. glycogen; adipose B. glycogen; muscle C. Ketones; erythrocytes D. proteins; adipose E. Fat; muscle
D
A 20-year-old premedical student visits her Primary Care Physician due to recent episodes of dizziness, nausea, headaches, and joint pain. Upon review of the patient's history, she reports that she has been eating only animal products in order to lose weight as part of a "carnivore diet." In an online forum she read that she could eat 3oz of beef liver as one daily meal and has been doing so every day for about two months. Her provider explains that liver is very high in Vitamin A and there are certain medical concerns that arise from overconsumption. The patient's plan of care includes reviewing Dietary Reference Intakes. What value in these dietary guidelines will her physician emphasize as part of her care plan? A. RDA: Recommended Dietary Allowance B. EAR: Estimated Average Requirement C. AI: Adequate Intake D. UL: Tolerable Upper Intake Level E. EAC: Excessive Amount Consumed
B
A 22-year-old male, who has Anemia of Chronic Inflammation, shows elevated levels of hepcidin. Which of the following mediators has most likely caused this to occur? A. Increased levels of Ferritin B. Increased levels of Interleukin-6 (IL-6) C. Increased Ferroportin function D. Increased proliferation of red blood cells E. Alopecia
B
A 23-year-old female patient complaining of fatigue and shortness of breath. Her physical examination showed a smooth red tongue. Her blood tests displayed leukopenia with hyper segmented granulocytes and elevated levels of methylmalonic acid. After further testing, the physician found that she is suffering from pernicious anemia. What vitamin is the patient deficient in? A. Vitamin C B. Vitamin B12 C. Folic acid D. Vitamin A E.Iron
B
A 25 year old male goes to his primary care with complaints of fatigue, muscle weakness and palpitations (increased heart rate). His physician notes his appearance as pallor, with yellow eyes. CBC test reveals high reticulocyte count. What is the most likely diagnosis and reason behind his clinical symptoms? A) Patient is suffering from anemia due to nutritional deficiencies. B) Patient is suffering from anemia due to RBCs destruction (hemolysis) C) Patient is suffering from anemia due to hemorrhaging D) Patient is suffering from anemia due to a systemic illness E) Patient is suffering from anemia due to overproduction of erythrocytes
E (Here it is vital to remember the caloric content of fuels. Carbohydrates contain 4kcal/g, Fats contain 9kcal/g, and Proteins contain 4kcal/g. Computing (72*9) + (138*4) + (200*4) = 2000, which maximizes his allotted calorie limit.)
A 25-year-old bodybuilder is meeting with his nutritionist to figure out the best way to maximize his 2000 calorie daily limit. Which of the following is most likely the daily diet recommended to him by his nutritionist? A. 150 grams of protein, 200 grams of carbohydrates, 70 grams of fat B. 200 grams of fat, 138 grams of carbohydrates, 72 grams of protein C. 195 grams of carbohydrates, 145 grams of protein, 67 grams of fat D. 200 grams of carbohydrates, 72 grams of protein, 101 grams of fat E. 72 grams of fat, 138 grams of protein, 200 grams of carbohydrates
E
A 25-year-old female comes to the emergency room with substernal pain, which has progressed for the past four months, and an enlarged lower esophagus. She mentions, after a meal she tends to feel her swallowed food build up in her throat. This is most likely due to her: A. Pyloric sphincter being spastically contracted. B. Longitudinal muscles being paralyzed. C. Excessive HCl secretions causing inflammation to her submucosa. D. Inhibitory Neurons being tonically active. E. Gastroesophageal sphincter being spastically contracted.
B
A 25-year-old female presents to the emergency room with vomiting. What is the initial exciting factor that starts the act of vomiting? A. Contraction of the Lower Esophageal Sphincter B. Distention of the duodenum C. Contraction of the ileum D. Relaxation of the Upper Esophageal Sphincter E. Contraction of the Internal Anal Sphincter
C
A 26-year old male presents to the clinic with complaints of heartburn and stomach pain. He mentions that he is stressed at work which often causes similar symptoms, but his pain has worsened over the last few months. Several tests are run over time and he is diagnosed with stomach ulcers. What is the most likely cause of his ulcers? A. Increased mucus secretion by mucin cells B. Decreased mucus secretion by mucin cells C. Increased pepsinogen secretion by peptic cells D. Decreased pepsinogen secretion by peptic cells E. Increased HCl secretion by parietal cells F. Decreased HCl secretion by parietal cells
B
A 28-year-old female presents to the clinic with complaints of fatigue, chills, and dizziness that has worsened over the past six months. The patient has a history of Crohn's disease in her ileum and descending colon, although no bowel resections have been performed. It is to be noted that her menses is regular for a woman of child-bearing age. When the physician orders a CBC and anemia panel for this patient, she discovers that the patient has iron deficiency anemia. Aside from the low reticulocyte count, what is most likely reflected in the patient's CBC results? A) Low B12 B) A low MCV C) High hematocrit D) High B12 E) A high MCV
A
A 28-year-old man visited the Emergency Room complaining of not being able to see when driving at night. Through a physical examination, the patient was also found to have dry and scaly skin. When asked about his dietary lifestyle, he explained that he primarily ate meat and poultry. He also added that he rarely consumed any types of dark green vegetables and/or orange fruits. Through further testing, the patient was diagnosed with having a deficiency in a fat-soluble vitamin. Which of the following vitamins could the patient be deficient of? A. Vitamin A B. Vitamin K C. Vitamin D D. Vitamin E E. Vitamin B12
C
A 30-year-old female patient presents to her PCP with complaints of fatigue, decreased exercise tolerance, and palpitations. The patient states that she has a nine-month-old son, and a three-year-old daughter at home. The PCP decides to order a CBC and then a peripheral blood smear. The CBC revealed a low reticulocyte count and a low MCV. The PCP diagnosed the patient with the leading cause of anemia worldwide. With this information, what did the peripheral blood smear reveal? A. Hypersegmented neutrophils and large platelets B. Sickle or crescent moon-shaped RBCs C. Pencil-shaped elongated cells and hypochromic RBCs D. Biconcave disk-shape with no nucleus E. Teardrop cells and nucleated RBCs
D
A 30-year-old male has a one week history of burning stomach pain, heartburn, nausea and intolerance to fatty foods. Which of the following compensatory physiological changes would be most likely to occur? A. Increased motilin secretion from gastric and duodenal M-cells to promote the passage of undigested food to the large intestine. B. Stimulation from vagus nerves lining G-cells to promote the growth of gastric mucosa. C. The buildup of acidic chyme in the duodenum triggers the gastroileal reflex to reduce peristalsis in the stomach and decrease gastric emptying. D. Release of secretin from duodenal S-cells to promote rapid secretion of pancreatic juices. E. Increased secretion of Cholecystokinin to induce contraction of the Sphincter of Oddi.
C (Bacterial infection by Helicobacter pylori breaks down the gastroduodenal mucosal barrier and stimulates gastric acid secretion. The strong acidic digestive juices of the stomach secretions can penetrate into the underlying epithelium and literally digest the gastrointestinal wall, thus leading to peptic ulceration. Secretin from the intestinal mucosa passes by way of the blood to the pancreas to promote rapid secretion of pancreatic juice that contains a high concentration of sodium bicarbonate for neutralization of the gastric acid.)
A 30-year-old male patient comes into the clinic this morning complaining of abdominal discomfort. Upon examination, he suffered a peptic ulcer. Which of the following would cause peptic ulcer? A. High blood supply B. Increased secretion of pancreatic juice C. Bacterial infection D. Increased ability of the gastroduodenal mucosal barrier E. Increased secretion of secretin from the intestinal mucosa
B
A 32 year old female presents to her primary care physician with complaints of lack of energy, and constantly feeling cold. After some tests, it is determined that the patient has pernicious anemia due to a chronic atrophic gastritis that is characterized by the loss of parietal cells. Given that the patient is unable to properly absorb vitamin B12 due to the lack of intrinsic factor secretion from the lack of parietal cells, what biochemical functions will be hindered or greatly impaired in this patient? A. Isomerization of methylmalonyl Coenzyme A and conversion of homocysteine to cysteine B. Conversion of homocysteine to methionine and the isomerization of methylmalonyl coenzyme-A C. Conversion of homocysteine to methionine and the isomerization of methylmalonyl coenzyme-B D. Conversion of homocysteine to arginine and the isomerization of methylmalonyl coenzyme A E. Isomerization of methylmalonyl Coenzyme A and conversion of homocysteine to leucine
D
A 32-year-old woman presented to the clinic today with a chief complaint of fatigue and weakness. After further discussion, the patient admitted to being on a vegan diet for the last 6 months and she notes her symptoms have been worsening over the last 3 months. A blood sample was obtained and her serum ferritin level came back low at 10 μg/L. Her hemoglobin and hematocrit levels were low as well. Which other molecule would we expect a decrease in? A. Ferroportin B. FH₄ C. Inflammatory mediators D. Hepcidin E. Transcobalamin II
D
A 35-year-old male arrives at his primary care office complaining of fatigue, difficulty breathing and shortness of breath especially while working out. Upon the physical examination it was noted he was quite pale and is experiencing heart palpitations. The primary care physician suspects anemia but is unsure if the patient's anemia is due to erythrocyte destruction or decreased erythrocyte production. Which of the following laboratory evaluations would be helpful in this distinction? A. Nutritional Studies B. Hemoglobin C. Average Red Blood Cell Size D. Reticulocyte Count E. Red Blood Cell Count
E
A 35-year-old male has decided that he would like to lose weight. He plans to begin working out and to start a diet. He decides to track everything he eats for a week to get a baseline of what he is eating. The following is a breakdown of his average daily macronutrients: 70g of fat, 312g of carbohydrates, 1 drink of alcohol, and 156g of protein. He also consumed 4 glasses of water and 5g of sodium per day. Which of these is outside the recommendations set out in The Dietary Guidelines for Americans? A. 156g of protein (25% of total calories) B. 70g of fats (25% of total calories) C. 312g of carbohydrates (50% of total calories) D. 1 drink of alcohol E. 5g of sodium
D
A 35-year-old male presents to a physician with complaints of fatigue, nausea, abdominal pain, dyspnea, and exercise intolerance. The patient states that they were diagnosed with iron deficiency anemia previously and were advised to increase their iron intake with supplementation. He states that while the symptoms disappeared for a day or two, they quickly reappeared afterwards. You then decide to order a CBC to find out more about this patient. On the CBC most lab values look normal, however you note that WBC levels are very elevated, especially Neutrophil levels. What could be the most likely cause of this patient's symptoms? A. Occult Blood Loss leading to iron deficiency B. Ineffective Erythropoiesis leading to decreased iron absorption C. Decreased ferritin gene expression in leading to decreased storage of iron D. Helicobacter Pylori infection, leading to impaired iron absorption E. Intake of iron from non-heme sources leading to impaired iron absorption
B (Inferior esophageal sphincter. (Answer found on page 611) Rationale: This sphincter is located at the lower end of the esophagus. Its action is reinforced by the diaphragm. This sphincter creates a pressure difference between the esophagus and stomach that prevents reflux of gastric contents into the esophagus. Abnormal relaxation of this sphincter allows the acidic contents of the stomach to return into the esophagus. If this is not treated, it can lead to GERD. Therefore, the patient most likely has an abnormality in the inferior esophageal sphincter.)
A 37-year-old male presents to his primary care physician (PCP) for difficulty swallowing and chest pain. The patient states he "feels like food is stuck in his throat". After further evaluation, the PCP notices inflammation of the esophageal mucosa and diagnoses the patient with gastroesophageal reflux disease (GERD). Which of the following sphincters is most likely abnormally functioning in this patient? A) Pharyngoesophageal sphincter B) Inferior esophageal sphincter C) Pyloric sphincter D) Ileocecal sphincter E) Internal anal sphincter
C
A 37-year-old male suffered a spinal cord injury in a recent car accident. He came to the clinic complaining of difficulty defecating. Upon examination, the physician noticed that the spinal cord injury is somewhere between the conus medullaris and the brain. The physician explained that the difficulty in defecating is due to the loss of increased abdominal pressure and relaxation of the external anal sphincter. The patient is experiencing defecation difficulty due to the loss of: A. Enterogastric reflex B. Defecation reflex C. Voluntary aid to defecation D. Involuntary aid to defecation E. Ileogastric reflex
E (Rationale: E is the correct answer because the function of Goblet Cells is to produce mucus. Mucus has an important role is helping to lubricate the small intestine and help maintain a neutral environment from the stomach acid. Page Reference:Pages 627-630)
A 56-year-old man recently came to his Primary Care Physician (PCP) after experiencing severe heartburn and chest pain. After describing that he has been also having abdominal comfort, his PCP refers him to a Gastroenterologist which decides to do an endoscope to determine the cause of the etiology. Upon further inspection, the Gastroenterologist notices that his Small Intestine has started to become ulcerated. The man is given antibiotics to be treated for a possible H. Pylori infection. However, after a week of treatment, there is no improvement from his symptoms. Based on the man's symptoms which of the following could be defective cells to cause his symptoms? A. M Cells B. Enteroendocrine Cells C. Paneth Cells D. Enterocytes E. Goblet Cells
E
A 45-year-old female presents to the emergency department with complaints of fatigue, dyspnea, and pallor. The patient reports her fatigue is exacerbated by exercising and her complaints have been progressing gradually over the past couple weeks. The physician orders a CBC and notes the patient has a lower than normal reticulocyte count. The physician suspects hypoproliferative anemia and now orders a bone marrow examination. Which of the following potential findings would not be present on the patient's bone marrow examination? A. Marrow infiltration B. Marrow involvement with granulomatous disease C. Marrow aplasia D. Myelodysplasia E. Marrow hyperplasia
B
A 6-year-old female patient reports to urgent care with her mother who is worried because she has noticed that her daughter has been irritable and eating dirt frequently. Patient's lab work reveals normal WBC results however, a low reticulocyte count with MCV of 54 fL/cell is noted. Further analysis shows that the causative factor is failure of heme synthesis. Based on knowledge of hypoproliferative anemias, which of the following is the most likely cause of these results? A. Iron deficiency due to menstruation B. Iron deficiency due to dietary deficiency C. Early iron deficiency due to occult blood loss D. Microcytic anemia due to Thalassemia minor E.Iron deficiency due to Helicobacter pylori
D
A 60 year old female presents to the Emergency Department with complaints of upper abdominal pain that radiates to the back. She shares that the pain gets worse after she eats. A transabdominal ultrasound is performed and reveals a pancreatic duct blockage. A diagnosis of acute pancreatitis is made. This could be the result of: A. Decreased activity of enterokinase relative to pancreatic secretion enzymes B. Increased activity of trypsin inhibitor relative to pancreatic secretion enzymes C. Increased activity of trypsinogen relative to pancreatic secretion enzymes D. Decreased activity of trypsin inhibitor relative to pancreatic secretion enzymes E. Decreased activity of trypsinogen relative to pancreatic secretion enzymes
D
A 60-year-old alcoholic presents to the emergency room with intense abdominal pain which has progressed over the last two weeks. He is diagnosed with severe gastritis, a condition that is greatly exacerbated by the damage and reduced function of which cells? A. Parietal cells B. Chief cells C. G cells D. Mucous cells E. Serous cells
D
A 60-year-old female with a history of lupus presents to her rheumatology office. She complains of pallor and worsening fatigue since 2 weeks ago. A complete blood count is done, which shows her RBC, hemoglobin, and hematocrit values to be low. The remaining CBC values are normal. A LECOM student is rotating in the office and interviews the patient prior to the physician's evaluation. Upon giving report to the physician, the student concludes that the patient is anemic and considers a treatment plan including an iron supplement, ferrous sulfate, and Erythroid-stimulating agent (ESA). The physician agrees with this plan except she advises against the ESA prescription. What possible manifestation of ESA treatment is the physician most likely concerned about? A. Constipation B. Inhibition of DNA synthesis C. Diarrhea D. Deep vein thrombosis E. Pancytopenia
B
A 55-year-old female arrives at the ER with severe pancreatitis. During the initial evaluation, she claims to only drink alcohol socially once a month with her friends. After further investigation, it is found that she has a gallstone that is blocking the papilla of the Vater. The main concern with this finding is: A. The pancreas is releasing too much trypsin into the small intestines causing overactive enzyme production and digestion of the duodenum. B. Trypsin and other pancreatic enzymes are dammed up in the pancreas, triggering the activation of trypsin and therefore other enzymes, leading to pancreatic digestion. Pepsin is causing the pancreas to break down fat leading to a fatty pancreas. D. The patient is at a high risk of developing a peptic ulcer. Pancreatic lipase will start to digest the wall of the duodenum.
B
A 56-year-old female presents to her primary care physician with complaints of feeling fatigue and a pale complexion. A complete blood count (CBC) is ordered, which reveals a low reticulocyte count and a MVC of <80 fL/cell. The patient is diagnosed with microcytic anemia. What is the leading cause of microcytic anemia? A. Vitamin B12 deficiency B. Iron deficiency C. Endocrinopathies D. Folate deficiency E. Lead poisoning
B
A 9-year-old male, accompanied by his mother, presents to his pediatrician with complaints of nausea, vomiting, abdominal pain, and a feeling of fullness after a few bites of food. The patient's mother explains that symptoms reduce after taking Pepto-Bismol, but relief does not last. A CBC reveals low RBC, hemoglobin, hematocrit, and reticulocyte counts. An esophagogastroduodenoscopy (EDG) is conducted and a biopsy is taken from the lining of the stomach. The cultured sample reveals oxidase-positive, urease-positive, gram-negative, spiral-shaped bacteria. In addition to administration of antibiotics, how is this patient best treated? A. Cobalamin, administered parenterally B. Iron supplements with ferrous sulfate, administered orally C. Vitamin B12, administered orally D. Folate, administered orally E. Erythroid-stimulating agents (ESAs), administered parenterally
A
A CBC is ordered for a 3-year-old patient at a clinic. The results come back showing a low reticulocyte count and a low MCV count. Based on the results, which of the following is a possible culprit of this patient's anemia? A. Lead poisoning B. Aplastic anemia C. Babesiosis infection D. G6PD deficiency E.Folate deficiency
A
A histology professor directs several second-year medical students to prepare three samples rich in Paneth cells. Sample 1 has undergone knock-out of a gene essential for the fusion of vesicles, Sample 2 has been treated with a drug that signals for apoptosis (programmed cell death) in Paneth cells, and Sample 3 is the control sample. Each sample is simultaneously inoculated with a species of bacteria normally found in the gut. Which of the following most likely describes the population of bacteria in Samples 1 and 2 as compared to the control? A. Increased in Sample 1, increased in Sample 2 B. Increased in Sample 1, decreased in Sample 2 C. Decreased in Sample 1, increased in Sample 2 D. Decreased in Sample 1, decreased in Sample 2 E. No change in Sample 1, increased in Sample 2 F. Increased in Sample 1, no change in Sample 2 G. No change in Sample 1, no change in Sample 2
A (We know that fecal transplant is to restore normal flora, and Paneth cells in the small intestine and colon are responsible for maintaining the health of normal flora.)
A mad scientist designs a self-replicating nanite that will only proliferate if injected into McDonald's big mac patties. Once eaten, the nanite remains undetected and will cause massive diarrhea and recurrent infection in their victims leading to acute hospitalization. The only treatment that seems to be effective for the symptoms is direct fecal transplant to the colon and small intestine. Which cells in the GI tract did these nanites target? A.Paneth cells B. Goblet cells C. Enteroendocrine cells D. Intermediate cells E. M-cells
D (BMI (Body mass index) is calculated based upon a person's weight and height. These values can demonstrate severe malnutrition to severe obesity. Marasmus is considered a protein-calorie deficiency that has 3 degrees of severity. Degree I: BMI = 17.0 - 18.4)
A 17-year old female presents to the hospital with complaints of fatigue, not enjoying activities that she used to, and overall malaise. Her parents noticed that she has gradually not been eating as much during dinner time or on weekends when they are present. This situation has been going on for about almost 3 months. The teenager insists she is eating enough food during the day yet, her calculated BMI is 18.3. Given this value, what range does she fall into and should there be a concern? A) No, she is underweight but healthy B) No, she is at a healthy weight C) Yes, she is slightly overweight/pre-obese D) Yes, she may have marasmus: degree I E) Yes, she may have marasmus: degree II
A (Peristalsis, the second type of contraction, involves coordinated action of both circular and longitudinal muscles layers and moves the intestinal contents distally)
Mr. Brown has come to the office with abdominal pain and distension. It has been determined that he has an ileus. This is most closely related to a temporary paralysis of what muscle or group of muscles? A. The muscularis Externa (the longitudinal and circular muscles). B. The Serosa C. The longitudinal Muscle D. The Circular Muscle E. The Muscularis Interna (the abdominus rectus and external anal sphincter).
B
The body's major fuel sources are macronutrients from our diets. Macronutrients are oxidized into CO2 and H2O releasing energy by the transfer of electrons to O2. Energy is expressed in kilocalories (kcal) and 1 kcal is the amount of energy needed to raise the temperature of 1 liter of water by 1 degree Celsius. Different fuel sources provide different amounts of energy per gram. Identify the correct list of fuel sources and the corresponding energy per gram obtained from each fuel source. Answer Choices: A. Carbohydrates 9 kcal/g, Proteins 4 kcal/gram, Fats 7 kcal/g B. Carbohydrates 4 kcal/g, Proteins 4 kcal/gram, Fats 9 kcal/g, and Alcohol 7 kcal/g C. Carbohydrates 9 kcal/g, Proteins 4 kcal/gram, Fats 7 kcal/g, and Alcohol 4 kcal/g D. Carbohydrates 9 kcal/g, Proteins 4 kcal/gram, Fats 7 kcal/g, and Alcohol 4 kcal/g E. Carbohydrates 4 kcal/g, Proteins 4 kcal/gram, Fats 9 kcal/g
B (Be careful with answer choice D (Posterior walls of the 4th ventricle) as in the textbook it mentioned it was in the lateral walls of the 4th ventricle. Answer choices A, C and E are distractor choices pertaining to different areas of the brain (cerebral cortex, Answer Choice A) and kidney (renal cortex, answer choice E). The option for the upper small intestine (answer choice C) is also a distractor due to if a student may quickly read the question and associate the initiation of vomiting to the upper small intestine, as this is incorrect. The answer is B (Brain Medulla) as aside from irritative stimuli in the GI tract, vomiting can also be caused by nervous signals arising in the brain.)
The chemoreceptor "trigger" zone for initiation of vomiting by drugs or by motion sickness occurs in the: A. Cerebral Cortex B. Brain Medulla C. Upper Small Intestine D. Posterior walls of the 4th ventricle E. Renal Cortex
D (BMR is higher when an individual has a fever, as it increases by 7% with each degree increase (in Fahrenheit) in body temperature.)
Which of the following factors would indicate an individual having an increased Basal Metabolic Rate (BMR)? A. Hypothyroidism B. Increased Age C. Low muscle mass D. A fever E. Hot climate
B
A 53-year-old woman presents to the ER with difficulty breathing, fatigue on a normal gait and shortness of breath. History confirms she is a chronic alcoholic and has been diagnosed with a liver disease. A blood test was done to confirms her RBC count to be 3.5 * 1012/L (normal range 4.2-5.4 * 1012/L). Further blood smear confirms the formation of spherocytes resulting from spectrin deformation. What is the dx of the condition this patient might be suffering from? A. megaloblastic anemia B. non-megaloblastic anemia C. Iron deficiency induced anemia D. microangiopathic hemolysis E. Hypoproliferative anemia
A (sIgA immunoglobulins are critical for proper immunologic surveillance. sIgA prevents the attachment and invasion of bacteria and viruses into the mucosa by inhibiting motility and microbial aggregation. Additionally it can mask pathogen adhesion sites on the surface of the epithelium. Deficiency has the potential to cause recurring infection, though typically found in autoimmune diseases.)
A 12-year old male presents to his primary care physician with reports of diarrhea, fatigue, gas and bloating. The patient states the symptoms have been recurring over the past 3 years and is thought to be a food allergy. Which of the following could be deficient and cause recurring infections in the patient? A. sIgA B. pIgR C. dIgA* D. J chain E. IgG
D
A 37-year-old woman admitted to the hospital with a history of intermittent, burning epigastric abdominal pain that was moderately severe in intensity. The physician orders an endoscopy that reveals a peptic ulcer with acute complications. In severe cases of peptic ulcer, Vagotomy is performed by removing part of the vagus nerve that innervates gastric glands. The physician orders Selective Vagotomy and prescribes other medications to treat peptic ulcer complications. What would be the effect of vagotomy on gastric secretion? A. Constriction of blood vessels and increase in gastric secretions B. Dilation of blood vessels and increase in gastric secretions C.Stimulation of Sympathetic Nervous System (SNS) and increase in organic substance secretion rate with a little effect on enzyme output. D. Decrease activity of Parasympathetic Nervous System (PNS) and decrease in gastric secretion rate with a greater effect on enzyme output. E. Increase activity of Parasympathetic Nervous system (PNS) and increase in gastric secretion rate with a little effect on enzyme output.
B
A 38-year-old male presents to his primary care physician to discuss fatigue, dyspnea and heart palpitations. He admits his wife passed away 8 months ago and has been drinking more than usual (17 drinks per week). Patient has no significant past medical history. PCP finds no significant physical exam findings and orders a CBC. PCP suspects sideroblastic anemia or folate deficiency. Which of the following can be used to differentiate the two differential diagnoses? A) RBC B) MCV C) Hematocrit D) Methylmalonyl-CoA mutase E) Reticulocytes
B (Edema is the main indicator that distinguishes Kwashiorkor from Marasmus)
A 4-year old boy presents to the hospital with a pale face, unresponsive behavior, several skin lesions and appears severely malnourished. Past medical history states the patient has also been neglected and abused. Through further physical examination and lab work, what would help the physician confirm this case as kwashiorkor and not marasmus? A. The patient has high levels of albumin in the blood B. The patient has bipedal pitting edema and a bulging abdomen C. The patient has decreased body fat and skeletal muscle mass compared to last year D. The patient has a positive nitrogen balance E. The patient's protein intake is normal, but is unable to properly digest them
C
A 40 year old male presents to the clinic with a burning and gnawing abdominal pain that becomes more prominent after eating spicy, citrus heavy foods or drinking coffee. A CT scan is taken and gastric ulcers are identified in the patient. The most likely cause of these ulcers is due to: A. A defect in the CCK secretion mechanism from the upper small intestine B. A decrease in the vagal release of acetylcholine from the pancreas C. A decrease in the secretion of bicarbonate from the actions of secretin D. An increase in basic chyme traveling through the duodenum E. An increase in the secretion of bile from the liver
B (The development of atherosclerosis is mainly contributed by high concentration of LDL, or cholesterol, in blood. High content of saturated fats and trans fats in the diet is most likely to increase the circulatory levels of LDL cholesterol, leading to the buildup of atherosclerotic plaques inside lumen of arterial vessels.)
A 40-year-old male patient developed atherosclerotic plaques inside arterial vessels due to high concentration of LDL in blood. The physician would like to suggest a change in diet to reduce the concentration of LDL in this patient. Which of the following type of food should be restricted? A. Saturated and unsaturated fats B. Saturated and trans fats C. Trans fats and unsaturated fats D. High quality proteins E. Dark green leafy vegetables
B
A 40-year-old male patient presents to the Emergency Room with complaints of fatigue and a pallor appearance. He proceeds to be diagnosed with anemia. Lab results indicate a depressed reticulocyte count and a bone marrow examination is deemed unnecessary, confirming his anemia is due to: A. Immune Hemolysis B. Decreased RBC production C. Microangiopathic Hemolysis D. Internal Bleeding E. Increased erythropoietin production
B
A 43-year-old male presents to the emergency department with continuous vomiting and is in a state of whole-body metabolic alkalosis. It is later determined that he has a GI obstruction caused by fibrotic constriction resulting from ulceration. Where in the GI tract is this obstruction most likely located and what is causing his metabolic alkalosis? A. Below the duodenum; loss of H+ B. At pylorus; loss of H+ C. Distal end of the large intestine; loss of H+ D. Below the duodenum; loss of HCO3- E. At pylorus; loss of HCO3-
A
A 45 year old female presents to the urgent care feeling after lethargic for some time. She has a history of gastrectomy. Lab tests reveal Low Hemoglobin, Low MCV, Low MCH and High RDW levels. When a peripheral blood smear was conducted, a narrow rim of peripheral Hemoglobin is observed along with an enlarged zone of pallor. The patient also indicates she has meat and leafy greens in her diet almost daily. Which of the following is most likely causing her condition? A. Iron malabsorption B. Lacking enough dietary Iron C. Increased Iron requirement D. Other dietary contents E. H. Pylori Infection
A (the lack of ganglion cells in the myenteric plexus of the sigmoid colon. The patient's symptoms are associated with Megacolon ( also known as Hirschsprung's Disease) which occurs when constipation is so severe that bowel movements only occur once every several days or once a week. This can lead to an accumulation of fecal matter in the colon and can cause the colon to distend 3-4 inches. The lack of ganglion cells in the myenteric plexus of the sigmoid colon can prevent the defecation reflex and peristaltic movement in the large intestine causing severe constipation. Answers B, C and D are associated with diarrhea. Answer E is associated with malabsorption in sprue.)
A 45 year old male presents to the clinic with complaints of constipation and abdominal bloating that started 1 month ago. He states that he has only been having one bowel movement per week. During the physical exam, abdominal tenderness is noted and a recent abdominal X Ray shows distention of the colon. Which of the following could be causing his symptoms? A. Lack of ganglion cells in the myenteric plexus of the sigmoid colon B. Nervous tension stimulating the parasympathetic nervous system C. Ulceration of the large intestine D. Inflammation of the large intestine due to a virus or bacteria E. Malabsorption of fats, proteins, and carbohydrates
B
A 45 year old male that has recently been diagnosed with pernicious anemia would be least likely to exhibit which one of the following characteristic alterations? A. Atrophic glossitis B. Decreased serum levels of homocysteine and methylmalonic acid C. Demyelination of the dorsal and lateral spinal tracts D. Fundic gland atrophy E. Hypersegmented neutrophils
C
A 47 year old male patient presents to the emergency room complaining of constant diarrhea, abdominal pain, and generalized weakness and fatigue. The patient states that he has Crohn's disease so he cannot absorb certain foods and medications properly. He states for the past year he has been drinking more alcohol, and eating more processed foods and less fruits and vegetables due to his wife's passing. Upon physical examination, it is noted that his abdomen is distended and tender, and he has slight scaling on his lips and corners of his mouth. His lab tests indicate that he has a severe reduction of erythrocytes, WBCs, and platelets, his MCV is 112fL/cell (Normal: 80-95fL/cell) and his Hb levels are normal. What is the most likely cause of his symptoms and appropriate treatment? A- Nonmegaloblastic macrocytic anemia - 1000ug cobalamin oral dose daily B- Microcytic anemia - 1000ug cobalamin parenterally 4-8 doses/week C- Megaloblastic anemia - 1000ug cobalamin parenterally 4-8 doses/week D- Normocytic Anemia - 1000ug- cobalamin parenterally 1 dose/ week E- Megaloblastic Anemia- 1000ug cobalamin parenterally 1 dose/week
A
A 48 year old man presents to his primary care physician with complaints of lethargy, impaired memory, a sore tongue, and a tingling feeling in his extremities. The physician determines that the patient has megaloblastic anemia due to folate deficiency and prescribes weekly parenteral therapy of vitamin B9. After weeks of treatment, many of the patient's symptoms resolve except for the impaired memory and the feeling of pins and needles. Which of the following is the most likely reason why his neurological symptoms have not diminished? A. He actually has vitamin B12 deficiency and methylmalonyl-CoA mutase is dysfunctional B. He actually has vitamin B12 deficiency and homocysteine-methionine methyltransferase is dysfunctional C. He does have vitamin B9 deficiency but the neurological manifestations are always irreversible D. He does have vitamin B9 deficiency but methylmalonyl-CoA mutase remains dysfunctional E. He actually has vitamin B12 deficiency but the neurological manifestations are always irreversible F. He does have vitamin B9 deficiency but homocysteine-methionine methyltransferase remains dysfunctional
B
A 5-year-old male child presents to the clinic because his parents have noted him to be fatigued and state that he has started to look more pale recently. Lab evaluation including CBC and reticulocyte count indicate that the child has low MCV, low MCH and low reticulocyte count. A peripheral blood smear reveals small, hypochromic red blood cells. His WBC count results are normal. What kind of anemia is suspected, and what could be the cause? A. Macrocytic anemia; vitamin B12 deficiency B. Iron deficiency anemia; mutations that disable TMPRSS6 C. Pernicious anemia; infection D. Iron deficiency anemia; hepcidin activity is inappropriately low E. Megaloblastic anemia; folic acid deficiency
D
A 51 year old female visits her primary care physician because she has been feeling fatigued for the past 2 months. She has also lost 7 pounds during this time period and indicates she has slight difficulty in breathing and has abdominal pain. Her diet consists of leafy vegetables, fruits, fish, and meat. However, she has breast cancer and as a part of her treatment she is taking Methotrexate. The physician orders a CBC and nutritional panel. Results indicate the patient is deficient in folate. The physician informs the patient that she has megaloblastic anemia. What led the patient to be folate deficient? A) Patient's chemotherapy is destroying parietal cells and causing folate deficiency. B) Malabsorption of folate C) Methotrexate acts as a direct agonist and mimic folate deficiency D) Methotrexate acts as a direct antagonist and mimic folate deficiency E) Methotrexate stimulates bone marrow and increases RBC production
B (The gastrectomy removed parts of the stomach where parietal cells are commonly found. In the absence of parietal cells, intrinsic factor is not secreted, causing a decrease in Vit B12 absorption, and ultimately pernicious anemia. Lack of intrinsic factor is the most common cause of vitamin B12 deficiency.)
A 52 year old male reports to his primary care physician with reports of fatigue, weight loss, and general weakness. The symptoms began 12 weeks ago, and have gotten gradually worse. The patient has a history of stomach cancer. Notably, he had a partial gastrectomy, in which a large portion of the fundus and body were surgically removed. After reviewing bloodwork, the physician suspects pernicious anemia. What effect could the gastrectomy have had that led to these symptoms? a) Decreased number of parietal cells, increased intrinsic factor secretion, and increased Vit B12 absorption b) Decreased number of parietal cells, reduced intrinsic factor secretion, and decreased Vit B12 absorption c) Decreased number of chief cells, reduced intrinsic factor secretion, and decreased Vit B12 absorption d) Decreased number of chief cells, leading to an increase of pepsinogen production, and decreased Vit B12 absorption e) The gastrectomy is not relevant. The patient is likely lacking in beneficial gram negative gut bacteria (such as H. Pylori), leading to peptic ulcers and anemia.
D (Beriberi is a Thiamine deficiency that displays the following symptoms: Edema (specifically for wet beriberi), anorexia, weight loss, apathy, decrease in short-term memory, confusion, irritability, muscle weakness and an enlarged heart)
A 52-year-old male rushes into the ER severely disoriented. Upon physical examination, his lower extremities are very swollen. As the physician questions the patient on his medical history, the patient displays an elevated level of irritability and ongoing confusion. A variety of tests are done immediately. After looking at his Chest X-Ray, the patient has an enlarged heart. Based on these symptoms and findings gathered, what is the diagnosis of this patient? A) Folate deficiency B) Choline deficiency C) Ariboflavinosis D) Beriberi E) Pantothenic acid deficiency
A
A 53-year-old female patient with chronic illness arrives at her primary physician's office complaining of exhaustion. She states that she is one month out from a recent hospital admission to manage the symptoms of her condition, and that in an effort to make healthier choices while at home, she has been adding spinach and lean meat to her diet. After her exam, her physician orders a CBC, which shows low hemoglobin and hematocrit, and on a follow up serum iron test, observes that her serum iron is still low despite her dietary changes. Her physician then orders serum Ferritin and Total Iron Binding Capacity tests, which are high and low respectively. Her physician then suggests erythropoietin as a possible treatment for her exhaustion. What chronic illness does this patient most likely have? A. Adenocarcinoma of the right breast B. Peptic Ulcer Disease C. Rheumatoid Arthritis D. Bacterial Endocarditis E. Crohn's Disease
B
A 72 year old male presents to their primary care office after having previously been diagnosed with macrocytic anemia in the ER 2 days ago. The primary care provider runs further testing and concludes that the patient has a vitamin B12 deficiency secondary to pernicious anemia. What lab test would you most likely expect to be elevated? A. Methionine B. Homocysteine C. Succinyl CoA D. Deoxythymidine monophosphate E. Cobalamin
B (Summary of aspirin effects: Aspirin inhibits PGE2 activity which will lead to decreased secretion of bicarbonates and a thinner mucous layer)
A 62-year old man undergoes an upper endoscopy after complaints of stomach pain. The patient has a family history of cardiovascular disease and his mother passed away from myocardial infarction at 58. The patient reports having taken baby aspirin daily, but has not in the past week in preparation for this procedure. Upon entering the stomach, several gastric ulcers were found and the physician recommends staying off aspirin for the time being and for a repeat endoscopy in three months. What is aspirin affecting that is most likely causing the gastric ulcers? A) Inhibits the production of mucous by surface mucous cells, leading to abrasion by food material B) Suppresses PGE2 activity, decreasing the capabilities of gastric cytoprotection C) Suppresses NO activity, decreasing the capabilities of gastric cytoprotection D) Inhibits differentiation of stem cells in the isthmus into surface mucous cells E) Directly interferes with the hydrophilic properties of the gastric mucosa
E
A 64-year old female patient presents to the physician with jaundice, glossitis, and neurologic abnormalities. The physician orders a CBC for the patient and discovers that the MCV is greater than 100 fL/cell, indicating megaloblastic anemia. What is the patient deficient in, and what is the enzyme that is most likely responsible for the neurological manifestations in this patient? A. Cobalamin deficiency; all enzymes are functioning properly B. Folate deficiency; Homocysteine-methionine methyltransferase C. Folate deficiency; Methylmalonyl-coA mutase D. Cobalamin deficiency; Homocysteine-methionine methyltransferase E. Cobalamin deficiency; Methylmalonyl-coA mutase
D
A 64-year-old male presents to his primary care physician with shortness of breath. The patient reports feeling weak and disoriented when walking for long distances or when performing any physical activity. A complete blood count (CBC) is ordered and a hemoglobin value of 12 g/dL (normal for male: 14-18 g/dL) is reported. The patient is diagnosed with iron deficiency anemia. Which of the following is most likely concerning the structure and function of hemoglobin? A. Maternal hemoglobin and fetal hemoglobin are identical in structure. B. Adult Hemoglobin is composed of a single alpha and a single beta chain. C. Sickle Cell Disease increases the ability of hemoglobin to bind to oxygen. D. The protoporphyrin molecule of hemoglobin is complexed with iron. E. Mutated hemoglobin chains have been shown to increase erythrocyte survival.
E (The tumor initially obstructed the patient's small intestine, which resulted in an antiperistaltic reflux, resulting in vomiting of poorly-absorbed gastric contents, water, and electrolytes, leading to excessive dehydration. However, the tumor moved to the large intestine and the patient also had symptoms of constipation and a lag period in vomiting while the colon filled with chyme. Therefore, it is most likely that the patient showed symptoms of small intestinal blockage, which was then followed by large intestinal blockage. Answer choice A accounts for the symptoms the patient presented with (large intestine blockage), but not the history of the symptoms that occurred before (small intestine blockage). Answer choice B accounts for the history (small intestine blockage), but not the symptoms or the location of the tumor (large intestine blockage). Answer choice C reverses the symptoms of small versus large intestinal blockage. Answer choice D reverses the metastatic movement of the tumor, which would provide the wrong chronology for the patient's symptoms. Answer choice F reverses both the metastatic movement and symptoms of small versus large intestinal blockage.)
A 64-year-old male presents with severe abdominal pain, cramps, and vomiting. The patient was diagnosed with Crohn's disease at the age of 16, and has a history of heavy drinking. Two weeks ago, the patient experienced acute, intense vomiting, fatigue, and severe dehydration, which then went away. More than a week later, the patient began experiencing constipation, and later began vomiting again, but with no dehydration. An X-ray was taken of his GI tract, and a tumor was found to have metastasized to the distal end of his large intestine, obstructing the movement of chyme from the colon to the rectum. How do these findings explain the biphasic nature of the patient's symptoms (initial vomiting, fatigue, and dehydration versus the constipation and vomiting that occurred later) ? A. The patient developed a benign tumor in his large intestine, resulting in constipation and vomiting. B. The patient developed a benign tumor in his small intestine, resulting in vomiting and dehydration. C. The patient developed a malignant tumor in his small intestine, resulting in constipation and vomiting, which then moved to his large intestine, resulting in vomiting and dehydration. D. The patient developed a malignant tumor in his large intestine, resulting in constipation and vomiting, which then moved to his small intestine, resulting in vomiting and dehydration. E. The patient developed a malignant tumor in his small intestine, resulting in vomiting and dehydration, which then moved to his large intestine, resulting in constipation and vomiting. F. The patient developed a malignant tumor in his large intestine, resulting in vomiting and constipation, which then moved to his small intestine, resulting in vomiting and dehydration.
A
A 65-year-old patient has been admitted to the hospital due to dizziness, fatigue, and increased heart rate. After further testing, it has been determined that due to a Vitamin B12 Deficiency, he is suffering from Pernicious Anemia. Which of the following can cause Pernicious Anemia? A. Intrinsic factor deficiency B. Absence of Type 1 autoantibodies C. Absence of Type 2 autoantibodies D. Alcoholism E.Pregnancy
D
A 66 year old woman with a history of hypercholesterolemia presents to her PCP with a chief complaint of fatigue, pallor, and peripheral neuropathy that has been ongoing for three months. Upon further questioning, she reveals that she has been on a macrobiotic diet for her hypercholesterolemia, which consists of only plant based foods, for more than five years. Her CBC shows an HGB of 6.7 g/dL. Her MCV is at 125 fL/cell. What is the cause of her deficiency and how can it be treated? A. Iron, eating red meat B. Iron, eating green leafy vegetables C. Intrinsic factor, consuming vitamin K D. Intrinsic factor, administering B12 E. Iron, blood transfusion
B
A 67 year old male arrives in the doctor's office looking pale, complaining about shortness of breath, and having increased fatigue during short walks. Patient notes he was a severe alcoholic and had to have a gastrectomy two years ago due to perforations within his stomach wall. Lab tests were done and indicated a low reticulocyte count and hypersegmented neutrophils. What is the patient's condition and what nutrient is he deficient in? A. Megaloblastic Anemia; Vitamin B6 deficiency B. Megaloblastic Anemia; Vitamin B12 deficiency C. Microcytic Anemia; Vitamin B6 deficiency D. Microcytic Anemia; Vitamin B12 deficiency E. Megaloblastic Anemia; Vitamin C deficiency
B
A 70 kg man comes into the clinic with hypoglycemia between meals. The patient is eating a well-balanced diet and has no known medical problems. What fuel store in this patient is not functioning properly? A. The patient has a deficiency in utilizing protein B. The patient's glycogen is not functioning properly C. The patient's fat stores are not being mobilized D. The patient needs to eat more frequently to maintain blood glucose E. There is an issue with too little insulin secretion
C
A 70-year-old female presents to her primary care physician with fatigue, glossitis, and pallor. After reviewing laboratory results, she is diagnosed and treated for pernicious anemia. Which of the following would be expected regarding the environment of the stomach in this patient? A. Increased secretions by parietal cells. B. Gastric atrophy and a lower than normal pH of gastric secretions. C. Gastric atrophy and a higher than normal pH of gastric secretions. D. Decreased receptors for intrinsic factor on the surface of the antrum. Increased absorption of Vitamin B12.
D (The case study is describing hypertrophic pyloric stenosis. In a normal GI system, the sphincters can physiologically relax when nitric oxide (NO) is present, and this gas is often available when it's produced by nitric oxide synthase (NOS). However, in this patient's case, she has a deficiency in NOS and is not able to have her pyloric sphincter relax. The main tissue present around sphincters and valves are circular smooth muscles, which are often thickened at these locations in the GI tract. Due to lack of nitric oxide production, the circular smooth muscle in her pyloric sphincter will have muscle spasms and subsequent stenosis that will cause the patient to have projectile vomiting and dehydration as an associated symptom.)
A mother brings her newborn child to the pediatrician for excessive vomiting. The mother notes that her baby vomits every time after a meal and has been losing weight and been more lethargic since the onset of her symptoms. During the physical examination, the pediatrician notes the newborn's dry and wrinkled skin and easily palpable 'olive' present in the right upper quadrant of the patient's abdomen. The pediatrician suspects a possible diagnosis and orders ultrasonography to confirm. If the ultrasonography confirms the pediatrician's suspected diagnosis, which of the following predominant tissues are not functioning correctly due to this condition? A. Mesothelium B. Stratified squamous epithelium C. Mesentery tissue D. Circular smooth muscle E. Adventitia
C
A patient comes into urgent care. He is a 36-year-old male and his chief complaint is that his most recent stools have been "floaters" which he read somewhere online means that he potentially has some form of gastric infection. Examination of the stool shows that in fact there is a higher than usual fat salts in the stool. The attending physician calls it steatorrhea and suspects that it is due to a Tropical Sprue. What would be the primary concern if this condition is left to become more severe? A. The patient will lose weight due to the decreased digestion of fat. B. The patient will become constipated as less fat is reabsorbed by his colon. C. The patient's condition will worsen with more inflammation of his intestinal tract leading to impaired absorption of other biological compounds. D. The patient will have increased levels of cholesterol due to increased loss of fat salts in his stool. E. The decrease of fat absorption will lead to decreased secretion of HCl in the stomach.
D
A patient presents to the clinic with loss of breath, pale skin, and cold hands and feet. Upon receiving results, the patient is diagnosed with early iron deficiency. Which of the following characteristics were seen in the red blood cells? a) Macrocytosis b) Hypochromia c) Microcytosis d) Normocytic e) Megaloblastic macrocytosis
D
A patient presents to the primary care physician with symptoms of suspected anemia and their lab work shows low reticulocyte count and low MCV. Which of the following is most likely the cause of the anemia. A) GI Bleed B) Vitamin B-12 Deficiency C) Sickle Cell Disease D) Iron Deficiency E) A medication impacting DNA synthesis
D (The plicae circulares are circular folds that appear as a series of ridges that extend around the lumen. Not unlike villi and microvilli, they primarily function to increase surface area and promote absorption. Although they can be found throughout the length of the small intestine, they are plentiful in the duodenum and relatively sparse throughout the ileum.)
A patient presents with a recent history of fatigue, generalized weakness and weight loss. Upon investigation, ulcerative degradation is identified on folded ridges of the luminal surface in the small intestine. Which of the following best matches the affected tissue the intestinal section it's found in? a. Villi; Duodenum b. Plicae circulares; Ileum c. Microvilli; Ileum d. Plicae circulares; Duodenum e. Villi; Jejunum f. Microvilli; Duodenum
A (1690 calories. The caloric contents of dietary fuels are carbohydrate and protein - 4 kcal/g, Fat - 9 kcal/g, and alcohol - 7 kcal/g. Her total caloric consumption on a Friday would equal (250 g of carbohydrates * 4 kcal/g) + (40 g of protein * 4 kcal/g) + (20 g of fat * 9 kcal/g) + (50 g of alcohol * 7 kcal/g) = 1690 calories.)
A patient visits her primary care doctor for an annual check-up. Her current daily dietary intake consists of 250 grams of carbohydrate, 40 grams of protein, and 20 grams of fat. She also states that, on Friday's, she likes to consume a few alcoholic beverages, which amount to 50 additional grams of alcohol. What is her total caloric consumption on a Friday when she consumes alcohol in addition to her normal dietary intake? A. 1690 calories B. 1340 calories C. 1480 calories D. 3290 calories E. 2300 calories
D
A researcher is testing a new drug designed to target bile secretion. After treating mice with the new drug, the researcher observes a marked decrease in the amount of bile present in the duodenum after a high-fat meal, however, fat absorption does not seem to be drastically inhibited. Furthermore, after extended periods of treatment with the drug, the mice begin to develop peptic ulcers in the upper portion of their small intestine. What might be an explanation for the observed effects of the drug in these mice? A. The drug inhibits CCK from stimulating gallbladder contraction B. The drug increases the effects of Ach on the gallbladder C. The drug prevents the conversion of cholesterol to bile salts in the liver D. The drug inhibits the effects of secretin on the bile ducts in the liver E. The drug increases the effects of Ach on the bile ducts in the liver
B
A young woman (5'4" tall, 1.6 m) who has a sedentary job and does not exercise, consulted a physician about her weight, which was 127 lbs. (58 kg). The patient's dietary history indicates that she eats approximately 100g of carbohydrate, 30g of protein and 40 g of fat daily. Answer the following questions: Q. Which of the following is true regarding the patient? A. DEE is 1,670; Her BMI is 27 and she is healthy B. DEE is 1,628; Her BMI is 22 and she is healthy C. DEE is 1,628; Her BMI is 22 and she is underweight D. DEE is 1,670; Her BMI is 27 and she is overweight E. DEE is 1,428; Her BMI is 16 and she is underweight
E
Amanda recently noticed that her mouth has felt more dry than normal, making it hard to swallow. She decides to see her primary care physician, who suggests she chew on gum or use hard candy to increase her salivation. What will happen to the ion concentrations in her saliva during maximal salivation? A. Increase in Na+ concentration, decrease in Cl- concentration B. Decrease in Na+ concentration, decrease in Cl- concentration C. Increase in K+ concentration, decrease in HCO3- concentration D. Decrease in K+ concentration, increase in HCO3- concentration E. Increase in Na+ concentration, increase in Cl- concentration
B
An elderly patient presents to the clinic with complaints of fatigue and lightheadedness along with pain and swelling in her joints. The patient states she was diagnosed with rheumatoid arthritis a few months ago and has been taking medication to manage her joint pain. A CBC was ordered and the results showed a low reticulocyte count with an MCV of 92 fL/cell. Which of the following is likely to be true regarding the patient? A. The patient's ferritin levels are reduced B. The patient has low serum iron levels with reduced iron-binding capacity C. The patient has low serum iron levels with normal iron-binding capacity D. The patient has elevated EPO levels E. The patient is deficient in vitamin B12
D
At a follow-up visit with her Primary Care physician, a patient is informed that her laboratory results indicate that she has microcytic anemia. The physician further explains that her anemia is likely due to a defect in her globin protein synthesis. Which of the following best explains the cause of her disease? A. Lead Poisoning B. Sideroblastic Anemia C. Occult Blood loss D. Thalassemia minor E. Folate deficiency
D (trypsin is the active form of trypsinogen and is responsible for converting pancreatic zymogens to their active forms. Trypsinogen is activated by stimulated enterokinase found within the glycocalyx.)
Christine is a 23-year-old medical student, who recently began her module on the gastrointestinal system. She is interested in clarifying the process of protein digestion in the pancreas after the stimulation of mucosal cells. Which of the following enzymes is directly responsible for activating pancreatic zymogens (proenzymes) to their enzymatic form for proper digestion and absorption? A. Enterokinase B. Chymotrypsinogen C. Elastase D. Trypsin E. Phospholipase A2
B
John, a 55-year-old male schedules a routine appointment with his Primary Care Physician. He tells his doctor that recently he has been experiencing some abdominal discomfort. For this he has been taking tums as well as aspirin for ingestion. John used to be an alcoholic but is now 6 months sober, he also smokes about 2 packs of cigarettes a week. Due to John's abdominal pain and indigestion, what component of his stomach is most likely damaged and causing these symptoms? A- Oxyntic glands B- Gastric barrier C- Mucosal neck cells D- Chief cells E- Parietal cells inability to maintain Na/K pump
B
Which is responsible for the transport of oxygen? A) spectrin B) hemoglobin C) myoglobin D) ankyrin E) leukocytes
B
Which layer of the Small Intestine is matched with its correct function: A. Mucosal Epithelium - houses circular and longitudinal muscle, controls peristalsis B. Mucosal Lamina Propria - houses Gut-Associated Lymphoid Tissue and initiates immune response C. Serosa - houses D cells which secrete Somatostatin D. Muscularis Externa - houses an array of intestinal cells such as Enterocytes, Goblet cells, Paneth cells, and M cells E. Submucosa - is present in the duodenum and secretes highly acidic glycoproteins
C
In what way is Methotrexate able to cause megaloblastic anemia? A. By trapping folate within the liver B. By inhibiting adequate folate absorption C. By inhibiting folate metabolism D. By causing excessive urinary loss E. By causing an increase in serum homocysteine levels
C
Lucas, a sailor that is at sea for months at a time, presents to his primary care physician complaining of easy bruising and bleeding as well as joint pain. Upon further examination his doctor revealed his vitamin C levels were incredibly low. Lucas explains that because he is at sea for extended periods of time, he does not have access to citrus fruits, broccoli, spinach, and some other foods that could boost his vitamin C. What condition is associated with Vitamin C deficiency? A. Beri Beri B. Kwashiorkor C. Scurvy D. Pellagra E. Rickets
B (A buildup of the inactive trypsinogen will eventually overcome the trypsin inhibitors in the pancreas and said trypsinogen will be converted to the active trypsin. Trypsin will activate the other zymogens and a self-destructive cycle will ensue. Why not A? This is because the inactive form builds up, not the active Trypsin. (Page 835))
Michael has been feeling ill for some time. Consequently, he decides to go to the doctor's office and see what's wrong. He's been a heavy drinker and smoker for most of his adult life. After a series of tests, his physician diagnoses him with chronic pancreatitis. Which substance has been built up for this to occur? A. Trypsin B. Trypsinogen C. Chymotrypsin D. Chymotrypsinogen E. Enterokinase
C (Histamine H2 receptor-antagonist drugs do block attachment of histamine to its receptors in the gastric mucosa, and does suppress intrinsic factor production.)
Mr. Ford, a 55-year-old male, comes into the clinic with complaints of shortness of breath, fatigue, and weight loss. Mr. Ford reveals that he has recently moved into the area, and previously he has been taking OTC medication for his GERD for over 10 years recommended to him by his friend. Mr. Ford's bloodwork shows signs of anemia, vitamin B12 deficiency, low intrinsic factor levels, and no indication of H. pylori antibodies. The physician then determines that Mr. Ford's previous medication was the cause of his symptoms. Which of the following medications and mechanisms of action would appropriately explain Mr. Ford's symptoms? A. Proton Pump Inhibitors (e.g. omeprazole and lansoprazole) block attachment of histamine to its receptors in the gastric mucosa, suppressing gastric acid and intrinsic factor production B. Proton Pump Inhibitors (e.g. omeprazole and lansoprazole) inhibit H+/K+-ATPase in treatment of GERD, suppressing gastric acid and intrinsic factor production C. Histamine H2 receptor-antagonist drugs (e.g. ranitidine (Zantac)) block attachment of histamine to its receptors in the gastric mucosa, suppressing gastric acid and intrinsic factor production D. Histamine H2 receptor-antagonist drugs (e.g. ranitidine (Zantac)) inhibit H+/K+-ATPase in treatment of GERD, suppressing gastric acid and intrinsic factor production E. Nonsteroidal anti-inflammatory drug and blood thinners (e.g. Aspirin) disrupts the stomach lining and reduces of gastric mucosal blood flow.
B (In Zollinger-Ellinson Syndrome, overproduction of gastrin by gastrin-secreting tumors in the duodenum or pancreatic islet leads to the excessive secretion of HCl by parietal cells. This causes gastric or duodenal ulcers in many cases.)
Mr. Smith, a 62-year-old male presents to the clinic complaining of intermittent, burning epigastric pain and diarrhea. The pain has progressively worsened but is improved with the ingestion of food. He reveals he has not seen a physician in many years as he does not like going to the doctors. After running some tests, he was diagnosed with a duodenal ulcer, secondary to Zollinger-Ellinson Syndrome. Mr. Smith's symptoms are likely due to excessive HCl secretion, which is most likely caused by overproduction of which hormone? A. Pepsinogen B. Gastrin C. Secretin D. Somatostatin E. Cholecystokinin
D (Intragastric pressure increases due to the stomach being squeezed between the diaphragm and the abdominal muscles. The hyoid bone and larynx are both being raised in order to pull the upper esophageal sphincter open. The glottis closes to prevent vomitus flow into the lungs. E is incorrect because a deep breath is one of the first effects of the vomiting act. (pg 837))
Once the vomiting center has been sufficiently stimulated, which of the following occurs during the vomiting act? A. Decrease in intragastric pressure B. Lowering of the hyoid bone and larynx to push the upper esophageal sphincter open C. Opening of the glottis D. Lifting of the soft palate to close the posterior nares E. Shallow breath
C (Activation of HCL secretion is dependent on three types of receptors, Acetylcholine M3, histamine H2, and gastrin receptors. Atropine will only block acetylcholine M3 receptors on parietal cells, it does not affect histamine H2 receptors or gastrin receptors. Therefore, if there is gastrin secretion there will be parietal cell stimulation and HCL production.)
Parietal cells play a significant role during digestion, especially in producing gastric juice (HCL). If a patient is taking Atropine which is a muscarinic antagonist, for her heart condition, what will happen to the production of HCL by these cells after she takes the medication and eats a meal? A. Blocks the overall activity of parietal cells. B. Atropine is directed to the receptors on cardiac cells, parietal cells will not be effected C. Blocks vagal stimulation on parietal cells but does not block Gastrin secretion. D. Inhibit histamine H2 receptors, block HCL production E. Atropine will act as an inhibitor on all receptors of parietal cells that stimulate HCL secretion
D
Patient X is a long-time volunteer for a study researching a new drug that inhibits secretion of specific pancreatic enzymes responsible for digestion of various macronutrients. After four years of taking oral drug supplements Patient X has developed various symptoms resembling megaloblastic anemia, most often caused by a deficiency in Vitamin B12 due to malabsorption in the GI tract. Lack of digestion in the proximal duodenum of which complex would most likely result in this specific defect? A. Ileal mucosal cells B. Transcobalamin II C. Protein-bound cobalamin D. Haptocorrin-cobalamin complex E. Transcobalamin III
D (This is the CORRECT answer because the lower esophageal sphincter is located at the lower end of the esophagus; its action is reinforced by the diaphragm that surrounds this part of the esophagus as passed into the abdominal cavity. It creates a pressure difference between the esophagus and stomach that prevents reflux of gastric contents into the esophagus. The esophageal cardiac glands are similar to the cardiac glands in the stomach but are more concentrated towards the terminal part of the esophagus. The mucous produced by these glands is slightly acidic and serves to lubricate the luminal wall. They protect the esophagus from regurgitated gastric contents. This combination is correct)
Paul, a 45 year-old male, was hanging out with his college buddies at their reunion. They had a man cave potluck where everyone bought midnight cravings. Paul had pizza, burgers, and a spicy-jalapeno dip. As the night progressed the buddies had drinks when suddenly Paul started to feel a burning sensation in his chest. His worried friends drove him to the ER with suspicions of a heart attack. After all the EKG readings were normal, the doctor performed an endoscopy. Paul's endoscopy results showed defects with the mechanisms in the terminal parts of his esophagus. The doctor diagnosed Paul with pyrosis and warned him about his food intake. What sphincter and gland dysfunction caused Paul's pyrosis? A. Pyloric sphincter, Esophageal glands proper B. Pharyngoesophageal sphincter, Fundic glands C. Internal anal sphincter, Pyloric glands D. Lower esophageal sphincter, Esophageal cardiac glands E. Ileocecal valve, Cardiac glands
B
Sarah presents to the clinic with diarrhea, abdominal pain, and fatigue. CT scan shows inflammation of the small intestine and medical records indicate that Sarah has been losing weight. What is the most likely explanation for her symptoms? A. Decreased activity of parietal cells B. Decreased activity of Brunner glands C. Decreased levels of CCK D. Increased activity of S cells in the duodenum E. Increased activity of goblet cells in the small intestine
E
Sarah, a healthy 27-year-old soon-to-be mother in her 3rd trimester and a High school English teacher, was on her way to her OB/GYN for her weekly visits. Her current condition (pregnancy) had ignited within Sarah a desire to be fully informed about her and the baby's health. This drive has led her to research online to great lengths about medical conditions during pregnancy and converse with her doctor about her findings and doubts. The topic of today's discussion with Dr. West will be dietary requirements because an online article informed Sarah that during the period of pregnancy and lactation, a variation in nitrogen balance could be observed. Which of the following 'nitrogen balance' states could be expected in Sarah's current condition? A) Negative nitrogen balance - Dietary N < Excreted N B) Positive nitrogen balance - Dietary N < Excreted N C) Nitrogen balance - Dietary N = Excreted N D) Negative nitrogen balance - Dietary N > Excreted N E) Positive nitrogen balance - Dietary N > Excreted N
C
Which of the following describes megaloblastic anemia? A. Autosomal dominant disorder caused by mutations that affect the red cell membrane skeleton. B. Caused by antibodies against normal red cell constituents or antigens modified by haptens. C. Impairment of DNA synthesis that leads to ineffective hematopoiesis and distinctive morphologic changes, including abnormally large precursors and red cells. D. Autosomal recessive disorder resulting from a mutation in 𝛃-globin that causes deoxygenated hemoglobin to self-associate into long polymers that distort the cell. E. X-linked disorder caused by mutations that destabilize G6PD, making red cells susceptible to oxidant damage
C
When analyzing Kevin's diet, it showed that he consumed an average of 200 g of carbohydrates, 25 g of protein, and 35 grams of fat each day. As well as on the weekend, Kevin had a few alcoholic drinks that were 25 grams in total. Approximately how many calories were consumed on the weekdays by Kevin compared to the weekends? A) Weekday is 1,145 total calories, Weekend is 1,370 total calories B) Weekday is 2,040 total calories, Weekend is 2,215 total calories C) Weekday is 1,215 total calories, Weekend is 1,390 total calories D) Weekday is 2,115 total calories, Weekend is 2,215 total calories E) Weekday is 1,215 total calories, Weekend is 1,315 total calories
D (Secretin in S-cells in duodenum for Pancreatic bicarbonate ion secretion and inhibit Gastric acid secretion.)
When chyme first enters the duodenum, the enteroendocrine cell detects low pH secrete which hormone and for what purpose? A. CCK in the I cells in duodenum and jejunum to signal Gallbladder contraction, Pancreatic Growth and inhibit Gastric emptying. B. Gastrin in the G cells in the stomach to stimulate Gastric Acid Secretion. C. CCK in S cells in duodenum to secrete Pancreatic enzyme secretion and facilitate gastric acid Secretion. D. Secretin in the S cells in duodenum for Pancreatic bicarbonate ion secretion and inhibit Gastric acid secretion. E. Somatostatin, D cells in mucosa to inhibit Gastrin release.
C (The failure of the stomach to secrete HCl refers to the disorder achlorhydria. This lack of HCl secretion indicates an issue with the parietal cells of the GI tract which also secrete intrinsic factor. Intrinsic factor is essential for the absorption of Vitamin B12. Due to the lack of intrinsic factor, and therefore Vitamin B 12 absorption, pernicious anemia can develop due to the decreased production of red blood cells, whose maturation requires Vitamin B 12. Choice A is incorrect because the decreased function of the gastroduodenal mucosal barrier is referring to the development of a peptic ulcer. Choice B is incorrect because the loss of function in a segment of the gut can lead to constipation. Choice D is incorrect because the blockage of the papilla of Vater refers to the blocking of the pancreatic duct, leading to pancreatitis. Choice E is incorrect because the lack of dietary vitamin K can lead to issues with blood coagulation, not destruction or lesser formation of red blood cells.)
Which of the following instances can lead to the development of pernicious anemia? A. Decreased function of the gastroduodenal mucosal barrier B. Loss of function in a segment of the gut C. Failure of the stomach to secrete HCl D. Blockage of the papilla of Vater E. Lack of dietary Vitamin K
B (Malabsorption in the small intestine is generally classified under the term "sprue", A, C, D, and E are all the same condition in which gluten is able to destroy the intestinal enterocytes absorption capability by dulling the villi/microvilli. B (ulceration) is the formation of ulcers which is most commonly caused by either excess secretion of acid/pepsin or the diminished ability of the mucosal barrier to protect against stomach acid. Ulcers are most commonly related to an imbalance in acidity rather than an issue in absorption.)
Which of the following is not a condition caused by malabsorption in the small intestine? A. Tropical Sprue B. Ulceration C. Celiac disease D. Gluten enteropathy E. Idiopathic sprue
D (Antispasmodic drugs. A, B, C, and F are all diseases that are associated with preventing normal swallowing and E is the state of being under deep anesthesia during surgery, which is linked with vomiting on the surgical table if the patient is not cared for properly. Antispasmodic drugs are used to relax smooth muscle to prevent the contraction of the lower esophageal sphincter (aka A. achalasia). P833)
Which of the following would not prevent the normal swallowing mechanism? A. Achalasia B. Muscle Dystrophy C. Encephalitis D. Antispasmodic drugs E. Deep anesthesia F. Botulism
