Gastrointestinal System

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A 70-year-old male patient of yours enters your office for an appointment. Initial glances reveal that the patient has lost a considerable amount of weight since his last appointment, and there is a yellow pigment in his eyes commonly found in patients with jaundice. Review of the patient's medical history reveals that the patient has a long history of cigarette smoking. Further analysis discovers "hard, stellate, gray-white, poorly defined masses" and highly invasive neoplastic glands with extensive stromal reaction, both of which are concentrated near the head of the pancreas. A serology test indicates elevated serum levels of CEA and CA19-9 within the patient. What is the most likely diagnosis for this patient? A) Pancreatic carcinoma B) Acute Pancreatitis C) Chronic Pancreatitis D) Cholelithiasis (gallstones) E) Serous Cystadenoma (cystic neoplasm)

A 90-year-old patient develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. The patient takes the recommended adult dose but soon after taking the medication becomes very confused and disoriented. What is the likely cause of these signs of confusion? A) Diphenhydramine B) Acetaminophen C) Phenylephrine

A female patient comes into your office requesting a CT/MRI scan. The scans reveal small, benign, non-cirrhotic, central scars and tumor-like lesions with a normal liver spleen scan. What is the most appropriate diagnosis for this patient? A) Focal Nodular Hyperplasia (Liver Mass) B) Cholangiocarcinoma (CC) C) Liver Cell Adenoma (Hepatic Adenoma) D) Hepatocellular Carcinoma (Liver Mass) E) Metastatic Carcinoma

A female patient of yours comes into your office. During this appointment, it is discovered that there are large, multioculated cysts lined by columnar mucin-producing cells that don't communicate with the ductal system in the tail of the pancreas. The cysts themselves present themselves as slow-growing masses, and the patient does not report of any pain present. What is the most likely diagnosis for this patient? A) Mucinous cystic neoplasms "ovarian" stroma B) Pancreatic carcinoma C) Intraductal papillary mucinous neoplasms D) Cholelithiasis (gallstones) E) Solid pseudopapillary neoplasm

A parasitic disease that children mostly might contract from animals in petting zoos and chlorinated pools in waterparks: A) Crytosporidiosis (Cryptosporidium parvum) B) Giardiasis (Giardia duodenalis) C) A & B

A patient comes into your dental office with mildly painful "aphthous-like" lesions and oral lesions that erupt during gastrointestinal flare-ups that occur on the alveolar, labial, and buccal mucosa, as well as the soft palate, uvula, and retromolar trigone. These lesions are granular and have irregular margins. What is the most appropriate diagnosis for this patient's current condition? A) Ulcerative Colitis B) Hepatitis C) Alcoholic Liver Disease/Cirrhosis D) Crohn's Disease E) Peptic Ulcer Disease (PUD)

A patient comes into your office with chief complaints of flatulence and what can be described as "foul-smelling, bulky, explosive, often watery diarrhea" with lack of a high fever. There is very rarely any blood present in the stool, but it is "extra fatty" due to the presence of excessive lipids. The patient reported that these symptoms started shortly after a hiking trip in Pennsylvania in which they drank contaminated river water. What is the most appropriate diagnosis for this patient? A) Giardiasis B) Crytospordiosis C) Taeniasis D) Diphyllobothriasis infection E) Pinworms F) Toxocariasis G) Ascariasis

A patient comes into your office with complaints of dry, scaly skin and most importantly, night blindness. Which of the following conditions aligns most closely with the patient's symptoms? A) Vitamin A deficiency B) Hypervitaminosis A C) Scurvy D) Hypervitaminosis D

A patient comes into your office with soft bleeding gums, loose teeth, joint pains, bruising, and dry scaly skin. You notice that these symptoms are correlated with scurvy. What caused the patient's current symptoms? A) Vitamin C deficiency B) Vitamin B1 deficiency C) Vitamin B3 deficiency D) Vitamin B9 deficiency

A patient comes into your office. This patient's past medical history reveals a history of obesity and hyperlipidemia. With regards to social history, the patient does not consume alcohol on a consistent basis. The patient arrived to the office with no symptoms, but further analysis reveals steatosis of the liver with inflammation. What is the most likely diagnosis for this patient? A) Non-alcoholic fatty liver disease B) Alcoholic Liver Disease C) Primary Biliary Cholangitis D) Primary Sclerosing Cholangitis E) Liver Cell Adenoma (Hepatic Adenoma)

A patient comes to your office for an appointment. Results of their blood test indicate excessive accumulation of iron in the blood. This condition is characterized by micronodular cirrhosis, diabetes mellitus, and skin pigmentation. You inform the patient that treatment for this condition consists of phlebotomy. What is the most likely diagnosis for this patient? A) Hemochromatosis B) Focal Nodular Hyperplasia C) Hepatocellular Carcinoma D) Portal Hypertension E) Cirrhosis

A patient is referred to a gastoenterologist for evaluation of suspected small bowel bacterial overgrowth. Motility studies reveal slowed gastrointestinal transit during fasting. The patient's symptoms are most likely due to a deficit in which of the following substances? A) Motilin B) Nitric oxide (NO) C) CCK D) Vasointestinal Peptide (VIP) E) Secretin

All of the following decrease the rate of drug absorption *EXCEPT:* A) Decreased gastric pH B) Decreased absorptive surface C) Decreased blood flow D) Decreased GI motility

An endodontist is performing a root canal therapy on a 54-year-old man with a history of hypertension and gastroesophageal reflux disease. The patient indicates that their breast tissue has been enlarging over the last few months. The endodontist suspects that this is due to a medication-induced effect. Which one of the patient's medications would most likely cause this enlargement of the patient's breast tissue? A) Cimetidine B) Lansoprazole C) Sucralfate D) Misoprostol E) Methotrexate

Children in the U.S.A. suffer from sleeplessness when the female of this round worm migrates out of the colon to lay eggs. The parasite is: A) Enterobius vermicularis (pinworm infection) B) Toxocara cati - toxocariasis C) Toxocara canis - toxocariasis D) Ascaris lumbricoides - ascariasis

Congenital chloride diarrhea results from mutations in which transporter in the large intestine? A) Cl-/HCO3- exchanger B) Na+/K+ antiporter C) Cl- uniporter D) Na+/H+ exchanger

During exercise or hemorrhage, ____________________ activation can reduce splanchnic blood flow to 25% of baseline values A) alpha,1-adrenergic receptor B) alpha,2-adrenergic receptor C) beta,1-adrenergic receptor D) beta,2-adrenergic receptor

If vomiting occurs, secretin will not get released due to the loss of H+ from the stomach. This results in metabolic alkalosis due to the buildup of HCO3- in the blood. A) Both statements are true B) Statement one is true, statement two is false C) Statement one is false, statement two is true D) Both statements are false

Iron is absorbed primarily in which area of the intestines? A) Duodenum B) Jejunum C) Ileum D) Colon

Many of the other GI organs will have metabolic products going to the liver through the ______________ A) Portal Vein B) Celiac Artery C) Superior Mesenteric Artery D) Inferior Mesenteric Artery

Pancreatic juice is modified from the ductal cells and fluid is ____________ A) Isotonic B) Hypertonic C) Hypotonic

The tapeworm that causes neurocysticercosis is: A) Taenia solium (pig) B) Taenia saginata (cow) C) Diphyllobothrium latum (fish) D) A & B E) All of the above

What are the dental management considerations for Cimetidine (Tagamet)? A) Delayed liver metabolism of benzodiazepenes & reversible joint symptoms with preexisting arthritis B) Potentially increased serum salicylate levels if concurrent ASA C) Reduced absorption of ampicillin, keoconazole, & itraconazole D) Anorexia & dry mouth E) Increased concentration of benzodiazepenes, warfarin, & phenytoin F) Diarrhea & cramps

What is a unique feature of excitation contraction coupling in smooth muscles that is not found in striated muscles? A) Myosin light chain kinase (MLCK) phosphorylates myosin light chains thus increasing myosin ATPase activity B) Calcium enters the cytosol and binds to calmodulin C) Calcium-calmodulin complex activates myosin light chain kinase (MLCK) D) In the presence of actin, cross-bridges can form and filament sliding will proceed

What is the etiological agent of ascariasis? A) Ascaris lumbricoides B) Ascaris suum C) Parascaris equorum

What is the etiological agent of crytospordiosis? A) Cryptosporidium parvum B) Cryptosporidium hominis

What is the etiological agent of pork tapeworms? A) Taenia solium B) Taenia saginata

What is the function of nitric oxide with regards to smooth muscle contraction/relaxation? A) Induce relaxation of smooth muscle through increased cGMP production and subsequent myosin light chain phosphatase (MLCP) activation B) Induce contraction of smooth muscle through increased cGMP production and subsequent myosin light chain phosphatase (MLCP) inhibition C) Remove phosphate groups from myosin light chains to cause relaxation or prohibit continued contraction D) Remove phosphate groups from myosin light chains to increase myosin-ATPase activity and muscle tension subsequently

What is the largest tapeworms that can infect people, reaching lengths as long as 30 feet? A) Fish tapeworm B) Beef tapeworm C) Pork tapeworm

What is the mechanism of action of antacids? A) Increase gastric pH in stomach/duodenum in order to inhibit pepsin activity and neutralize gastric acids B) Inhibit the hydrogen-potassium-ATPase (proton pump) C) Dopamine D2 antagonist & the acceleration of gastric emptying D) Competitively block muscarinic acetylcholine receptors, thus decreasing salivary secretion during dental procedures E) Block parietal cell H2 receptors to inhibit basal and meal-induced acid secretion

What is the mechanism of action of linaclotide and plecanotide? A) Guanylate cyclase-C agonist to increase cGMP and promote chloride excretion to stimulate increased gastric motility B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) 5-HT4 agonist to increase acetylcholine release which increases colon muscle contractions and relaxation of circular muscles promoting evacuation D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Agonism of mu-opioid receptors at myenteric plexus

What is the mechanism of action of natalizumab and vedolizumab? A) Targets an integrin to prevent migration & cell/tissue adherence of inflammatory cells to vascular endothelium B) Activates peroxisome proliferator-activated receptors (PPAR) localized in the gut C) Inhibits folate synthesis, leading to T-cell apoptosis/death D) Targets IL-12 and IL-23 receptors, binding and induction of intracellular signaling E) Bind to soluble & membrane-bound TNF

What is the mechanism of action of ursodeoxycholic acid? A) Reduce the rate of cholesterol absorption reducing hepatic cholesterol secretion and breaking up existing cholesterol micelles enhancing excretion B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) Somatostatin analog, mimics action in order to decrease GI motility and gallbaldder contractility D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Used as replacement therapy for deficient exocrine pancreatic secretory disorders via a combination of lipase, protease, ad amylase

Which GI peptide secreted from X cells is responsible for increased food intake and increased growth hormone secretion from the hypothalamus? A) Ghrelin B) Motilin C) Pancreatic Polypeptide (PP) D) Enteroglucagon E) Glucagon-like Peptide-1 (GLP-1)

Which HCV genotype is the most prevalent & problematic in the United States due to low response to IFN-a based therapy? A) Type 1a/1b B) Type 2 C) Type 3 D) Type 4 E) Type 5

Which accurately describes a multi-unit smooth muscle innervation? A) Few gap junctions & most cells in the bundle are innervated (ex: ciliary muscle of eye & erector pili of skin) B) Varicosities are present so that the smooth muscle can behave as a syncytium (ex: GI, uterine, tunica media of blood vessels, urinary bladder)

Which artery supplies blood to the pancreas, and small & large intestines? A) Superior mesenteric artery B) Celiac artery C) Inferior mesenteric artery

Which branch of the enteric nervous system (ENS) is responsible for modifying GI motility? A) Myenteric/Auerbach plexus B) Submucosal/Meissner plexus

Which dosing regimen would you use to calculate neonate/child dosage if the child's weight is known? A) Young's Rule B) Clark's Rule C) Mosteller Body Surface Area (BSA)

Which drug is responsible for stimulating fetal lung maturation? A) Corticosteroids B) Phenobarbital C) Digoxin/Flecainide/Verapamil D) Antivirals

Which enteric virus has a vaccine available? A) Rotavirus B) Norovirus C) Adenovirus D) Astrovirus

Which enteric virus is the most common cause of gastroenteritis in children? A) Rotavirus B) Norovirus C) Adenovirus D) Astrovirus

Which fat-soluble vitamin listed below binds to specific nuclear receptors and modulates gene expression, leading to roles in the function of the retina and growth/differentiation of epithelial cells among others? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K

Which form of Taenia infections is found in the diagnostic stage? A) Gravid proglottids (containing eggs) B) Cysticerci in muscles

Which gastrointestinal reflex is integrated entirely within the ENS and is responsible for controlling GI secretion, peristalsis, mixing contractions, and local inhibitor effects? A) Local B) Regional C) Systemic

Which hepatitis vaccine is composed of killed viruses grown in cell cultures using human fibroblasts? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E

Which masticatory reflex uses muscle spindles found only in jaw closing muscles to maintain a resting masseter tone and keep the mouth shut? A) Myotatic Reflex B) Inverse Myotatic Reflex C) Low Threshold Mechanoreceptor Reflex D) High Threshold Mechanoreceptor Reflex

Which of the cytoprotective agents listed below decreases acid secretion and increases mucus secretion via PGE receptor (EP3) on parietal and epithelial cells, respectively? A) Misoprostol B) Pepto-Bismol (Colloidal bismuth subsalicylate) C) Sucralfate (Aluminum sucrose sulfate)

Which of the following FDA teratogenic risk categories would be classified to "studies indicating that risk of fetal harm is remote"? A) A B) B C) C D) D E) X

Which of the following conditions is caused by too little calcium? A) Osteomalacia B) Microcytic anemia C) Kidney/Biliary stones & peptic ulcers D) Hemochromatosis

Which of the following drugs inhibits cP450 enzymes, thus affecting the metabolism of other drugs? A) Cimetidine B) Omeprazole C) Glycopyrrolate D) Metoclopramide E) Plecanotide

Which of the following hormones is responsible for increased H+ secretion from the parietal cells? A) Gastrin B) CCK C) Secretin D) GIP

Which of the following is *NOT* involved in the defecation process? A) Relaxation of the distal colon and contraction of the internal anal sphincter B) Increased intrarectal pressures from increased volume C) Stimulation of the defecation reflex D) A more obtuse ano-rectal angle E) All of the above are involved in the defecation process

Which of the following is a correct difference between osmotic and secretory diarrhea? A) Osmotic diarrhea stops during fasting, whereas secretory diarrhea continues during fasting B) Osmotic diarrhea has normal stool osmolality, whereas secretory diarrhea has increased stool osmolality C) Secretory diarrhea has a larger fecal osmolal gap (FOG) D) Stool volume in osmotic diarrhea is greater than in secretory diarrhea E) All of the above

Which of the following minerals is influenced by the action of hepcidin? A) Iron B) Magnesium C) Calcium D) Copper

Which of the following paracrines secreted by ECL and mast cells within the GI is responsible for the stimulation of H+ secretion from parietal cells? A) Histamine B) Somatostatin C) Serotonin D) Gastrin

Which opioid agonist can cross the blood-brain barrier in high doses? A) Diphenoxylate HCL/atropine sulfate B) Loperamide

Which pathway of bile acid secretion involves secretin's role in the secretion of water, electrolytes, and HCO3- to neutralize intestinal acid? A) Independent Pathway B) Dependent Pathway

Which pathway of calcium absorption is predominant in the whole small intestine during high dieteary calcium and is characterized by calcium flowing between the cells through tight junctions to the hepatic portal veins? A) Paracellular Pathway B) Transcellular Pathway

Which phase of salivation is mediated by sight, aroma, or thought of a meal? A) Cephalic B) Oral C) Esophageal/Gastric

Which phase of swallowing is voluntary? A) Oral B) Pharyngeal C) Esophageal

Which phase of the giardiasis life cycle is considered "dormant" and is characterized by an ellipsoidal, smooth, well-defined wall? A) Cyst B) Trophozoite

Which region of the stomach typically has thin muscular walls in order to receive the food bolus (i.e., receptive relaxation), and is often found in what is considered the "storage area" of the stomach? A) Orad region B) Caudad region C) Pacemaker region

Which salivary gland is composed of serous cells and secretes aqueous fluid containing water, ions, and enzymes? A) Parotid gland B) Submandibular gland C) Sublingual gland

Which structural component of secretory IgA is responsible for holding the dimer of the antibody together? A) J chain B) Secretory component

Which transporter is responsible for absorbing glucose and galactose via Na+-driven secondary active transport in the small intestine? A) SGLT1 B) GLUT5 C) GLUT2

Which type of hepatitis is the most common vaccine preventable disease? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E

Which virulence factor of H. pylori is responsible for neutralizing stomach acid? A) Urease B) VacA C) CagA

With regards to drug-induced hepatic injury, which class of drugs can result in macrovescicular steatosis? A) Methotrexate B) Chlorpromanize C) Acetaminophen D) Salicylates E) Ethanol

_______ (aka "little gastrin") is secreted during the meal A) G17 B) G19 C) G23 D) G34

__________ are the chief functional cells of the liver and perform an astonishing number of metabolic, endocrine, and secretory functions A) Hepatocytes B) Hepatic stellate cells C) Kupffer cells D) Liver sinusoidal endothelial cells

_____________ are rhythmic contractions followed by relaxation that are involved in mixing and propulsion of chyme. This type of contraction requires a pacemaker and thus requires action potentials to initiate Ca2+ influx A) Phasic contractions B) Tonic contractions

_____________ hydrolyzes triacylglycerols (TAGs) in the digestion of lipids A) Pancreatic lipase B) Colipase C) Cholesterol ester hydrolase D) Phospholipase A2

_____________ is released by salivary glands to bind with cobalamin (vitamin B12) A) R-protein B) Cubulin C) Transcobalamin I/II D) Intrinsic Factor

_____________ release HCl and intrinsic factor (IF) A) Parietal cells B) Chief cells C) G-cells D) Mucus cells

T/F: Formal diagnosis of Gastroesophageal Reflux Disease (GERD) is made based on which criteria? (*SELECT ALL THAT APPLY*) A) pH B) Impedance testing C) Esophageal imaging D) Microscopic blood analysis

A & B

Which major factors listed below will slow or inhibit gastric emptying? (*SELECT ALL THAT APPLY*) A) Fats (mediated by CCK) B) H+ ions (mediated by reflexes of the ENS) C) Proteins (mediated by pepsinogen) D) HCO3- ions (mediated by pancreatic secretions)

A & B

Which of the following bacterial species only infects humans? (*SELECT ALL THAT APPLY*) A) Helicobacter pylori B) Vibrio cholerae C) Campylobacter jejuni D) Salmonella

A & B

Which serotypes of adenovirus can cause Acute Respiratory Distress (ARD)? (*SELECT ALL THAT APPLY*) A) Type 4 B) Type 7 C) Type 40 D) Type 41

A & B

Which cell(s) do viruses replicate in during progression of viremia hepatitis? (*SELECT ALL THAT APPLY*) A) Hepatocytes B) Hepatic stellate cells C) Kupffer cells D) Liver sinusoidal endothelial cells

A & C

Which substance(s) is/are required for the relaxation of the lower esophageal sphincter (LES) during swallowing so that receptive relaxation can occur? (*SELECT ALL THAT APPLY*) A) Nitric oxide (NO) B) Somatostatin C) Vasoactive Intestinal Peptide (VIP) D) Motilin

A & C

Which hormones stimulated by the sympathetic nervous system will decrease the frequency of spike potentials during the fasting state? (*SELECT ALL THAT APPLY*) A) Secretin B) Gastrin C) Motilin D) GIP

A & D

Which of the following laboratory tests would be used to diagnose crytosporidiosis? (*SELECT ALL THAT APPLY*) A) Identification of oocysts in the stool via acid fast stain B) Lack of increased PMN leukocytes in the stool C) Cysts in the stool D) Colonoscopy E) ELISA for antibodies F) MRI/CT brain scans G) Serology H) Tape test

A & E

Which of the following will induce/increase GI motility? (*SELECT ALL THAT APPLY*) A) Stretch B) Acetylcholine C) Norepinephrine D) Parasympathetic system E) Sympathetic system

A, B, & D

_____________ is a deficiency of apolipoprotein B resulting in inadequate absorption of lipids into the lymphatics

Abetalipoproteinemia

A female patient of yours comes to your office to have blood work done. Serological results indicate high titers of IgG as well as anti-nuclear antibodies, anti-smooth muscle antibodies, and anti-LKM (liver kidney microsomal type) antibodies. Based on your medical knowledge, you are aware that the patient will respond to immunosuppressive therapy. What is the most likely diagnosis for this patient? A) Non-alcoholic fatty liver disease B) Autoimmune hepatitis C) Primary Biliary Cholangitis D) Cirrhosis E) Liver Cell Adenoma (Hepatic Adenoma)

A patient comes into your office for an appointment. Analysis of your patient reveals mallory hyaline bodies and an initially enlarged, yellow, fatty liver which has progressed to become fibrotic, fatty, and shrunken. This is a mainly micronodular condition. What is the most likely diagnosis for this patient? A) Non-alcoholic fatty liver disease B) Alcoholic Liver disease C) Primary Biliary Cholangitis D) Primary Sclerosing Cholangitis E) Liver Cell Adenoma (Hepatic Adenoma)

A patient comes into your office for an appointment. Compared to the last appointment, you notice that the patient has lost a significant amount of weight, the patient seems highly discomforted/fatigued, and you noticed symptoms correlating with jaundice. Serological tests reveal normal serum levels of alpha fetoprotein (AFP). You determine this is adenocarcinoma of bile duct origin with extensive fibrosis. You also notice malignant & epithelial tumors. What is the most appropriate diagnosis for this patient? A) Focal Nodular Hyperplasia (Liver Mass) B) Cholangiocarcinoma (CC) C) Liver Cell Adenoma (Hepatic Adenoma) D) Hepatocellular Carcinoma (Liver Mass) E) Metastatic Carcinoma

All of the following will block prostaglandin production, resulting in decreased gastric mucus production, *EXCEPT:* A) NSAIDs B) Acetaminophen C) Aspirin D) Ethanol

An adolescent patient of yours comes into your office with chief complaints of "explosive, profuse, watery diarrhea" and abdominal cramps due to a type of toxin. The patient reports he began feeling ill after his school hosted a petting zoo, which resulted in an outbreak of similar symptoms among other kids in his school. Which condition is the most likely to be diagnosed to the young patient? A) Giardiasis B) Crytospordiosis C) Taeniasis D) Diphyllobothriasis infection E) Pinworms F) Toxocariasis G) Ascariasis

An older patient comes into your office with complaints of abdominal pain and pain in his left shoulder. The patient has an extended history of alcohol use according to his medical history. Fortunately for this patient, this is a reversible parenchymal injury associated with inflammation due to autodigestion, potential obstruction, or direct acinar cell injury. What is the most likely diagnosis for this patient? A) Pancreatic carcinoma B) Acute Pancreatitis C) Chronic Pancreatitis D) Cholelithiasis (gallstones) E) Serous Cystadenoma (cystic neoplasm)

Cholera toxin can increase cAMP and promote the secretion of ________ ions into the intestinal lumen which can lead to dehydration A) HCO3- B) Cl- C) H+ D) K+

How many stable serotypes of Hepatitis A are there? A) 0 B) 1 C) 2 D) 3

In an animal study of biliary secretion, the common hepatic duct of a rat is cannulated under anesthesia and a sample of bile is collected. Bile is also collected from the gallbladder. Compared to hepatic bile, the gallbladder bile would be expected to contain a reduced concentration of which of the following? A) Bile acids B) Cl- ions C) K+ ions D) H+ ions E) Ca2+ ions

Mr. Gill developed an acute flu-like illness with jaundice and fatigue a day after eating at a local eatery. It was determined he contracted Hepatitis A. Which of the following statements about Hepatitis A is most accurate? A) Hepatitis A is the primary cause of chronic liver disease and liver cancer in the U.S. B) Hepatitis A is preventable with a 2-dose vaccine series C) Hepatitis A infection is usually a co-infection with Hepatitis D D) Hepatitis A is typically a blood-borne infection

Mr. King has Crohn's disease. Which of the following characteristics of inflammatory bowel disease (IBD) are most closely related to Crohn's? A) Bloody diarrhea B) Presence of skip lesions in the terminal ileum C) Mucosal/submucosal hemorrhage D) Toxic megacolon and hemorrhage are common complications

The majority of the liver's blood supply comes from the _____________ A) Portal Vein B) Celiac Artery C) Superior Mesenteric Artery D) Inferior Mesenteric Artery

What are the dental management considerations for Nizatidine (Axid)? A) Delayed liver metabolism of benzodiazepenes & reversible joint symptoms with preexisting arthritis B) Potentially increased serum salicylate levels if concurrent ASA C) Reduced absorption of ampicillin, keoconazole, & itraconazole D) Anorexia & dry mouth E) Increased concentration of benzodiazepenes, warfarin, & phenytoin F) Diarrhea & cramps

What is the #1 method of transmission for Hepatitis B virus? A) Sexual transmission B) Transmission through the use of needles C) Vertical (mother-to-child) transmission

What is the #1 method of transmission for Hepatitis C virus? A) Sexual transmission B) Intravenous drug use C) Vertical (mother-to-child) transmission

What is the difference between cholesterol stones and pigment stones? A) Cholesterol stones may arise anywhere in the biliary tree B) Pigment gallstones are caused by calcium salts that cannot be solubilized C) Cholesterol stones are often as small, radio-opaque black stones D) Pigment stones are typically radiolucent, pale-yellow, round and hard stones E) Pigment stones only arise in the gallbladder

What is the etiological agent of beef tapeworms? A) Taenia solium B) Taenia saginata

What is the mechanism of action of alvimopan? A) Guanylate cyclase-C agonist to increase cGMP and promote chloride excretion to stimulate increased gastric motility B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) 5-HT4 agonist to increase acetylcholine release which increases colon muscle contractions and relaxation of circular muscles promoting evacuation D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Agonism of mu-opioid receptors at myenteric plexus

What is the mechanism of action of anti-inflammatory agents (sulfasalazine, balsalazide, olsalazine)? A) Targets an integrin to prevent migration & cell/tissue adherence of inflammatory cells to vascular endothelium B) Activates peroxisome proliferator-activated receptors (PPAR) localized in the gut C) Inhibits folate synthesis, leading to T-cell apoptosis/death D) Targets IL-12 and IL-23 receptors, binding and induction of intracellular signaling E) Bind to soluble & membrane-bound TNF

What is the mechanism of action of omeprazole? A) Increase gastric pH in stomach/duodenum in order to inhibit pepsin activity and neutralize gastric acids B) Inhibit the hydrogen-potassium-ATPase (proton pump) C) Dopamine D2 antagonist & the acceleration of gastric emptying D) Competitively block muscarinic acetylcholine receptors, thus decreasing salivary secretion during dental procedures E) Block parietal cell H2 receptors to inhibit basal and meal-induced acid secretion

What is the most common cause of vitamin B1 (thiamine) deficiency in the U.S.? A) Poor diet B) Alcoholism C) Immunodeficiencies D) Genetics

Which GI peptide secreted from intestinal cells of the duodenum is responsible for increased GI motility? A) Ghrelin B) Motilin C) Pancreatic Polypeptide (PP) D) Enteroglucagon E) Glucagon-like Peptide-1 (GLP-1)

Which Hepatitis B (HBV) biomarker is a marker of high (active) infectivity? A) HBcAg B) HBeAg C) HBsAg

Which accurately describes a single-unit smooth muscle innervation (SUVSM)? A) Few gap junctions & most cells in the bundle are innervated (ex: ciliary muscle of eye & erector pili of skin) B) Varicosities are present so that the smooth muscle can behave as a syncytium (ex: GI, uterine, tunica media of blood vessels, urinary bladder)

Which area of the GI tract has the lowest rate of slow waves? A) Esophagus B) Stomach C) Duodenum D) Jejunum

Which area of the intestines is the MAJOR site for water, electrolyte, and nutrient absorption? A) Duodenum B) Jejunum C) Ileum D) Colon

Which artery supplies blood to the stomach and pancreas? A) Superior mesenteric artery B) Celiac artery C) Inferior mesenteric artery

Which branch of the enteric nervous system (ENS) is responsible for modifying secretions/blood flow relating to the GI system? A) Myenteric/Auerbach plexus B) Submucosal/Meissner plexus

Which dosing regimen would you use to calculate neonate/child dosage when the pediatric dose is known? A) Young's Rule B) Clark's Rule C) Mosteller Body Surface Area (BSA)

Which drug inducing fetal hepatic enzymes? A) Corticosteroids B) Phenobarbital C) Digoxin/Flecainide/Verapamil D) Antivirals

Which enteric virus is the most common cause of gastroenteritis in adults? A) Rotavirus B) Norovirus C) Adenovirus D) Astrovirus

Which etiological agent of toxocariasis comes from dogs? A) Toxocara cati B) Toxocara canis

Which fat-soluble vitamin listed below is converted to its physiologically active form, calcitriol, in the liver and kidneys to improve absorption and utilization of calcium and phosphorous required for normal bone and teeth formation? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K

Which form of Taenia infections is found in the infective stage? A) Gravid proglottids (containing eggs) B) Cysticerci in muscles

Which gastrointestinal reflex goes to the sympathetic ganglia and back to the GI tract, and includes the gastrocolic reflex, enterogastric reflex, and colonoileal reflex? A) Local B) Regional C) Systemic

Which hepatitis virus contains DNA as its genetic material? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E

Which masticatory reflex places pressure on the TMJ and periodontal ligament to inhibit jaw closing muscles and stimulate jaw opening muscles? A) Myotatic Reflex B) Inverse Myotatic Reflex C) Low Threshold Mechanoreceptor Reflex D) High Threshold Mechanoreceptor Reflex

Which nerve innervates the skeletal muscles of the external anal sphincter? A) Pelvic Nerve B) Pudendal Nerve C) Vagus Nerve D) Celiac Nerve

Which of the cytoprotective agents listed below chelates with proteins in the ulcer to form a protective barrier & bactericidal effects (H. pylori)? A) Misoprostol B) Pepto-Bismol (Colloidal bismuth subsalicylate) C) Sucralfate (Aluminum sucrose sulfate)

Which of the following FDA teratogenic risk categories would be classified for "no controlled studies to demonstrate risk"? A) A B) B C) C D) D E) X

Which of the following bacterial species is spread through the ingestion of water contaminated with the organism and is rarely transmitted by human-to-human transmission (i.e., fecal-oral route)? A) Helicobacter pylori B) Vibrio cholerae C) Shigella spp. D) None of the above

Which of the following conditions is caused by too little iron? A) Osteomalacia B) Microcytic anemia C) Kidney/Biliary stones & peptic ulcers D) Hemochromatosis

Which of the following drugs may affect the bioavailability and metabolism of oral drugs due to altered gastric pH and inhibition of CYP2C19, respectively? A) Cimetidine B) Omeprazole C) Glycopyrrolate D) Metoclopramide E) Plecanotide

Which of the following events would cause hyperchloremic metabolic acidosis with a normal anion gap? A) Loss of Cl- relative to HCO3- B) Loss of HCO3- relative to Cl- C) Loss of both Cl- and HCO3- relative to protein and phosphates D) Increased Cl- and HCO3- to compensate for lost protein, phosphates, citrate, and sulfate

Which of the following hormones is responsible for the release of pancreatic enzymes and HCO3- secretion, and delayed gastric emptying? A) Gastrin B) CCK C) Secretin D) GIP

Which of the following is a distinguishing characteristic between cysts and trophozoites of Giardia species? A) Cysts are half-pear shaped B) Trophozoites have two parabasal bodies C) Trophozoites have two thick walls designed to survive harsh conditions D) Cysts have 8 flagella and 2 nuclei

Which of the following paracrines secreted by D cells is responsible for inhibiting H+ secretions and inhibiting secretion of other GI hormones? A) Histamine B) Somatostatin C) Serotonin D) Gastrin

Which of the following species is *NOT* a zoonosis that is found in animal reservoirs and is transmitted through contaminated food? A) Campylobacter jejuni B) Shigella spp. C) Enterohemorrhagic E. coli (O157:H7) D) Salmonella spp.

Which of the following statements correctly describes a difference between smooth muscle cells and skeletal/cardiac muscle cells? A) Smooth muscles have a fast rate of contraction B) Smooth muscles lack T-tubules C) Smooth muscles have troponin present in their filaments D) Smooth muscles have a defined sarcomere structure E) Smooth muscles typically have more than 1 nuclei per cell

Which organism attach to epithelial cells in the host and multiply rapidly by schizogony, giving rise to several daughter cells that release merozoites to continue the life cycle? A) Giardia B) Cryptosporidium C) Taenia D) Diphyllobothrium

Which organism's pathogenesis consists of mild villous atrophy, enlargement of the crypt cells, and infiltration of inflammatory cells in the luminal propria (with potential inflammation of the gall bladder in certain cases)? A) Giardia B) Cryptosporidium C) Taenia D) Diphyllobothrium

Which pathway of bile acid secretion involves re-secretion of recycled bile salts and secretion of de novo bile acids in order to osmotically draw water and electrolyte into biliary canaliculus, thus increasing the flow of bile acid secretion? A) Independent Pathway B) Dependent Pathway

Which pathway of calcium absorption is predominant primarily in the duodenum during low dietary calcium and occurs in the presence of calcitriol whose synthesis is stimulated by parathyroid hormone (PTH)? A) Paracellular Pathway B) Transcellular Pathway

Which phase of salivation consists of mechanical stimulation of the oral cavity? A) Cephalic B) Oral C) Esophageal/Gastric

Which region of the stomach typically has thick muscular walls to produce the contractions necessary for mixing and digestion food, and is often found in what is considered the "mixing and trituration area" of the stomach? A) Orad region B) Caudad region C) Pacemaker region

Which salivary gland is composed of a mix of serous and mucus cells, with the mucous cells secreting mucin glycoproteins for lubrication? A) Parotid gland B) Submandibular gland C) Sublingual gland

Which source of secretion is the primary method for neutralizing gastric acid from the stomach and accounts for 40% of total HCO3- secretion in the small intestine? A) Brunner's gland B) Duodenal bicarbonate secretion C) Fluid secreted by the Crypts of Lieberkuhn

Which structural component of secretory IgA is responsible for making IgA more resistant to acid degradation in the intestinal lumen? A) J chain B) Secretory component

Which transporter is responsible for absorbing fructose in the apical membrane in the small intestine via facilitated diffusion? A) SGLT1 B) GLUT5 C) GLUT2

Which virulence factor of H. pylori is responsible for inducing pores in epithelial cells in order to inject the toxin? A) Urease B) VacA C) CagA

With regards to drug-induced hepatic injury, which class of drugs can result in cholestasis? A) Methotrexate B) Chlorpromanize C) Acetaminophen D) Salicylates E) Ethanol

________ is an incretin released from K cells of upper intestine that stimulates the pancreatic beta-cells to release insulin via the inhibition of the anorexigenic hormone leptin (naturally suppresses hunger/digestion and is produced from adipose tissue) A) VIP B) GIP C) GLP D) NO

___________ stimulates the pelvo-pelvic reflex in the process of defecating/voiding A) Guanosine B) Adenosine C) Tyrosine D) Cytosine

____________ is a receptor in the ileum which binds intrinsic factor and allows for the uptake of vitamin B12 A) R-protein B) Cubulin C) Transcobalamin I/II D) Intrinsic Factor

____________ is a reflex that would cause for the ileocecal valve to relax and the urge to defecate shortly after ingesting a meal. This reflex is also described as the filling of the stomach that will increase distal motor activity in the colon to promote defecation A) Ileocecal Reflex B) Gastrocolic Reflex C) Enterogastric Reflex D) Vagovagal Reflex

____________ is activated by trypsin and displaces bile salts to help pancreatic lipase to perform function A) Pancreatic lipase B) Colipase C) Cholesterol ester hydrolase D) Phospholipase A2

____________ release pepsinogen A) Parietal cells B) Chief cells C) G-cells D) Mucus cells

_____________- is co-secreted with insulin in order to slow gastric emptying and secretion A) CCK B) Amylin C) Secretin D) Pramlintide

______________ maintain a constant level of contraction and thus do not require a pacemaker or action potentials to initiate Ca2+ influx A) Phasic contractions B) Tonic contractions

______________ phase of gastric secretion is the biggest contributor to HCl secretion and is stimulated by distension of the stomach, small peptides, and amino acids A) Cephalic B) Gastric C) Intestinal

______________: contain M cells which are the inductive sites for production of IgA-committed (switched) B-cells A) Bone Marrow B) Peyer's Patches C) Spleen D) Thymus

_______________ is a disorder of swallowing (dysphagia) in which the lower esophageal sphincter (LES) fails to relax (likely due to lack of nitric oxide) and there is impaired peristalsis in the lower 2/3 of the esophagus. A) Zollinger-Ellison Syndrome B) Achalasia C) Gastroesophageal Reflux Disease (GERD) D) Peptic Ulcer Disease (PUD)

_______________ is caused by the presence of non-absorbable solute in the lumen of the intestine (i.e., lactase deficiency will result in lactose staying in the lumen and retaining water with it). A) Decreased absorptive surface area B) Osmotic diarrhea C) Secretory diarrhea

_______________ reduces the surface tension of gas bubbles making them easier to pass during burping A) Cimetidine B) Simethicone C) Aluminum hydroxide D) Magnesium hydroxide E) Pepto-Bismol

What is the net result of pancreatic secretions? (*SELECT ALL THAT APPLY*) A) Secretion of H+ B) Absorption of H+ C) Secretion of HCO3- D) Absorption of HCO3-

B & C

Which hormones stimulated by the parasympathetic nervous system will increase the frequency of spike potentials during the fasting state? (*SELECT ALL THAT APPLY*) A) Secretin B) Gastrin C) Motilin D) GIP

B & C

Which of the following classes of antimimetic drugs is typically indicated for nausea induced by motion sickness? (*SELECT ALL THAT APPLY*) A) Serotonin (5HT3) antagonists (Ondansetron) B) Muscarinic antagonists (Hyoscine) C) Histamine-1/Muscarinic Antagonists (Diphenhydramine) D) Corticosteroids (Dexamethasone) E) Neurokinin-1 Antagonists (Aprepitant) F) Dopamine-2 antagonists (Promethazine) G) Cannabinoid-1 Agonists (Dronabinol)

B & C

Which of the following laboratory tests would be used to diagnose giardiasis? (*SELECT ALL THAT APPLY*) A) Identification of oocysts in the stool via acid fast stain B) Lack of increased PMN leukocytes in the stool C) Cysts in the stool D) Colonoscopy E) ELISA for antibodies F) MRI/CT brain scans G) Serology H) Tape test

B & C

Which of the following are the typical symptoms of Gastroesophageal Reflux Disease (GERD)? (*SELECT ALL THAT APPLY*) A) Chest pain B) Heartburn C) Cough/wheeze D) Hoarseness E) Regurgitation

B & E

______________ is a standard tool used for the identification of potentially inappropriate medications in older adults

Beer's Criteria

____________ is an eating disorder with significant associated physical complications, including damage to the dental enamel and dentin (due to chronic exposure of acid to the teeth), and reduced salivary capacity along with gland enlargement

Bulimia Nervosa

A 30-year-old woman comes to the doctor's office complaining of progressively worsening difficulties with swallowing. A manometric study is conducted to examine pressure generation along the length of her esophagus. This test reveals that contractions in response to a swallow are poorly synchronized and pressure in the lower esophageal sphincter remains elevated. What is the most likely diagnosis? A) Gastroesophageal Reflux Disease (GERD) B) Hiatal Hernia C) Achalasia D) Esophageal Cancer E) Barrett's Esophagus

A female patient comes into your office with chief complaints of abdominal pain/discomfort that occurs episodically. She was recently admitted to the hospital due to shock and hemorrhage as a result of her current condition. The liver tumors in this condition are typically benign & non-cirrhotic. What is the most appropriate diagnosis for this patient? A) Focal Nodular Hyperplasia (Liver Mass) B) Cholangiocarcinoma (CC) C) Liver Cell Adenoma (Hepatic Adenoma) D) Hepatocellular Carcinoma (Liver Mass) E) Metastatic Carcinoma

A male patient of yours enters your office, where it is discovered that large masses are present in the head of the pancreas and arise in a large pancreatic duct. In this certain condition, the IPMNs lack the dense "ovarian" stroma and the masses can be bening or malignant based on the tissue invasion. What is the most likely diagnosis for this patient? A) Mucinous cystic neoplasms "ovarian" stroma B) Pancreatic carcinoma C) Intraductal papillary mucinous neoplasms D) Cholelithiasis (gallstones) E) Solid pseudopapillary neoplasm

A middle-aged, female patient of yours comes into your office with GI issues. Serological tests yield a high amount of anti-mitochondrial antibodies in the serum. Further analysis reveals the present of non-suppurative, granulomatous destruction of medium-sized bile ducts. Unfortunately, this disease can progress to cirrhosis and liver failure, resulting in death. What is the most likely diagnosis for this patient? A) Non-alcoholic fatty liver disease B) Autoimmune hepatitis C) Primary Biliary Cholangitis D) Alpha-1 Antitrypsin Deficiency E) Liver Cell Adenoma (Hepatic Adenoma)

A patient comes into your dental office with complaints of poor oral hygiene and various soft tissue conditions including glossitis, angular cheilitis, candidiasis, and jaundiced mucosa. In addition, the patient also exhibits gingival bleeding, ecchymoses, and petechiae as well as enlargement of the parotid gland. What is the most appropriate diagnosis for this patient's current condition? A) Ulcerative Colitis B) Hepatitis C) Alcoholic Liver Disease/Cirrhosis D) Crohn's Disease E) Peptic Ulcer Disease (PUD)

A patient comes into your office with complaints of abdominal pain, fever, and most importantly, blood and pus in stool. The patient reports that this disease started after eating undercooked poultry. You determine that this pathogen invaded in the epithelial cells in the small and large intestines. Which of the following is most likely responsible for this patient's current symptoms? A) Helicobacter pylori B) Vibrio cholerae C) Campylobacter jejuni D) Shigella spp.

A patient comes into your office with tooth decay and muscle weakness. Further testing reveals that the patient has osteomalacia (softening of the bone). Which of the following conditions most likely caused the progression of this disease in the patient? A) Vitamin A deficiency B) Hypervitaminosis A C) Vitamin D deficiency D) Hypervitaminosis D

A patient is being treated with chemotherapeutic agents and has been experiencing severe nausea and vomiting. Which of the following agents might the oncologist prescribe for this patient that blocks the Neurokinin-1 receptor? A) Dexamethasone B) Ondansetron C) Aprepitant D) Octreotide E) Plecanatide

A patient visits the dental clinic for an amalgam restoration and indicates that they have developed peptic ulcer disease due to H. pylori infection. In addition to antimicrobial therapy, what other pharmacotherapeutics is the patient most likely taking? A) Pancrelipase B) Metoclopramide C) Omeprazole D) Adalimumab E) Bethanechol

An older patient comes into your office with complaints of steatorrhea (reduced absorption of lipids), diabetes, and pancreatic calcification. According to the patient's medical history, he has a very extended history of long-term alcohol abuse. Unfortunately for this patient, there is irreversible destruction of exocrine parenchyma, fibrosis, and pancreatic insufficiency. This patient can be treated via pancreatic duct drainage or Whipple Resection designed to relieve the pain. What is the most likely diagnosis for this patient? A) Pancreatic carcinoma B) Acute Pancreatitis C) Chronic Pancreatitis D) Cholelithiasis (gallstones) E) Serous Cystadenoma (cystic neoplasm)

Cryoglobulinemic vasculitis is a form of inflammation affected the blood vessels caused by the deposition of abnormal proteins called cryoglobulins in the blood vessels. It affects the skin and causes a rash. This is the most common extrahepatic manifestation in which type of hepatitis infection? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E

During bile salt recycling, bile salts are largely recovered by the ____________ A) Duodenum B) Jejunum C) Ileum D) Colon

Enterokinase is freed from the brush border of crypt cells by the presence of _______ A) Trypsinogen B) Pepsinogen C) Bile salts D) Carbohydrates

In infants, defecation often follows a meal. The cause of colonic contractions in this situation is _____________ A) Histamine B) Increased circulating levels of CCK C) The gastrocolic reflex D) Increased circulating levels of somatostatin E) The enterogastric reflex

Ms. Butterworth is a morbidly obese woman with hypertension and type 2 diabetes requiring insulin and hyperlipidemia. Which of the following causes of non-viral hepatitis is she of greatest risk of developing? A) Toxic hepatitis B) Alcoholic hepatitis C) Non-alcoholic steatohepatitis D) Auto-immune hepatitis

The most cases of toxocariasis in the U.S. come from ___________ A) Contaminated food B) Human-to-human transmission C) Pets D) Drug use

What is a common symptom of chronic giardiasis and crytosporidiosis infections? A) Neuropathies B) Constipation C) Malabsorption D) Abdominal Distension

What is the function of myosin light chain phosphatase (MLCP)? A) Induce relaxation of smooth muscle through increased cGMP production and subsequent myosin light chain phosphatase (MLCP) activation B) Induce contraction of smooth muscle through increased cGMP production and subsequent myosin light chain phosphatase (MLCP) inhibition C) Remove phosphate groups from myosin light chains to cause relaxation or prohibit continued contraction D) Remove phosphate groups from myosin light chains to increase myosin-ATPase activity and muscle tension subsequently

What is the mechanism of action of methotrexate? A) Targets an integrin to prevent migration & cell/tissue adherence of inflammatory cells to vascular endothelium B) Activates peroxisome proliferator-activated receptors (PPAR) localized in the gut C) Inhibits folate synthesis, leading to T-cell apoptosis/death D) Targets IL-12 and IL-23 receptors, binding and induction of intracellular signaling E) Bind to soluble & membrane-bound TNF

What is the mechanism of action of metoclopramide? A) Increase gastric pH in stomach/duodenum in order to inhibit pepsin activity and neutralize gastric acids B) Inhibit the hydrogen-potassium-ATPase (proton pump) C) Dopamine D2 antagonist (blocks negative regulator of gastric motility) & the acceleration of gastric emptying D) Competitively block muscarinic acetylcholine receptors, thus decreasing salivary secretion during dental procedures E) Block parietal cell H2 receptors to inhibit basal and meal-induced acid secretion

What is the mechanism of action of octreotide? A) Reduce the rate of cholesterol absorption reducing hepatic cholesterol secretion and breaking up existing cholesterol micelles enhancing excretion B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) Somatostatin analog, mimics action in order to decrease GI motility and gallbaldder contractility D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Used as replacement therapy for deficient exocrine pancreatic secretory disorders via a combination of lipase, protease, ad amylase

What is the mechanism of action of prucalopride? A) Guanylate cyclase-C agonist to increase cGMP and promote chloride excretion to stimulate increased gastric motility B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) 5-HT4 agonist to increase acetylcholine release which increases colon muscle contractions and relaxation of circular muscles promoting evacuation D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Agonism of mu-opioid receptors at myenteric plexus

What is the most physiologic form of constipation treatment? A) Exercise B) Discontinuation of any unnecessary drugs C) Bulk forming agents (e.g. psyllium, bran, etc.) D) Stimulant or saline cathartics

What is the stimulus of defecation? A) Constriction of the internal anal sphincter B) Decreased intrarectal pressures from decreased volume C) Increased intrarectal pressures from increased volume D) Decreasing the ano-rectal angle (making it more acute)

Which Hepatitis B (HBV) biomarker is a marker of current infection? A) HBcAg B) HBeAg C) HBsAg

Which area of the GI tract has the highest rate of slow waves? A) Esophagus B) Stomach C) Duodenum D) Jejunum

Which area of the intestines is a reserve for absorption of bile and vitamin B12 (aka cobalamin), and can also absorb short chain fatty acids? A) Duodenum B) Jejunum C) Ileum D) Colon

Which artery supplies blood to the transverse and descending colon plus the rectum? A) Superior mesenteric artery B) Celiac artery C) Inferior mesenteric artery

Which condition has the highest rate of H+ secretion due to unhindered gastrin release caused by a lack of negative feedback pathways, resulting in increased H+ release and increased parietal cell mass? A) Gastroesophageal Reflux Disease (GERD) B) Peptic Ulcer Disease (PUD) C) Zollinger-Ellison Syndrome D) Steatorrhea

Which condition is typically called "bacillary dysentery" because it is not usually diarrhea? A) Peptic ulcers B) Cholera C) Shigellosis D) Salmonella

Which digestive enzyme is released from the pancreas in the inactive form? A) Amylase B) Lipase C) Protease

Which drug is used in the treatment of fetal cardiac arrhythmias? A) Corticosteroids B) Phenobarbital C) Digoxin/Flecainide/Verapamil D) Antivirals

Which enteric virus has over 50 human stereotypes and can cause gastroenteritis and/or Acute Respiratory Distress (ARD)? A) Rotavirus B) Norovirus C) Adenovirus D) Astrovirus

Which fat-soluble vitamin listed below acts as an antioxidant to prevent lipid peroxidation of polyunsaturated fatty acids in cellular membranes by scavenging for free radicals? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K

Which gastrointestinal reflex is processed in the CNS and will control overall activity of the GI system (i.e., vagus nerve, pain reflexes, and defecation reflexes)? A) Local B) Regional C) Systemic

Which hormone is responsible for increasing intracellular Ca2+, resulting in exocytosis of pancreatic digestive enzymes? A) Gastrin B) Somatostatin C) CCK D) Secretin

Which masticatory reflex places pressure on the dorsum of the tongue to stimulate jaw closing and seal the oral cavity in preparation for swallowing? A) Myotatic Reflex B) Inverse Myotatic Reflex C) Low Threshold Mechanoreceptor Reflex D) High Threshold Mechanoreceptor Reflex

Which of the cytoprotective agents listed below forms a physical, viscous, gel-like coating over ulcers? A) Misoprostol B) Pepto-Bismol (Colloidal bismuth subsalicylate) C) Sucralfate (Aluminum sucrose sulfate)

Which of the following FDA teratogenic risk categories would be classified as "administer only if benefit outweighs risk"? A) A B) B C) C D) D E) X

Which of the following bacterial species grows best at 42 degrees Celsius, and is considered microaerophilic? A) Helicobacter pylori B) Vibrio cholerae C) Campylobacter jejuni D) Shigella spp.

Which of the following bacterial species is a zoonotic species that utilizes poultry and cattle as reservoirs? A) Helicobacter pylori B) Vibrio cholerae C) Campylobacter jejuni D) Shigella spp.

Which of the following components in serology is a marker of recovery of Hepatitis B (HBV) immunity? A) Hepatitis B Surface Antigen (HBsAg) B) Hepatitis B e Antigen (HBeAg) C) Hepatitis B Surface Antibody (HBsAb) D) Hepatitis B e Antibody (HBeAb)

Which of the following conditions is caused by too much calcium? A) Osteomalacia B) Microcytic anemia C) Kidney/Biliary stones & peptic ulcers D) Hemochromatosis

Which of the following hormones is a key ENS transmitter for peristalsis? A) Histamine B) Somatostatin C) Serotonin D) Gastrin

Which of the following hormones stimulated by H+ and fatty acids is responsible for increasing both pancreatic and biliary HCO3- secretion, as well as decreased H+ secretion from the parietal cells? A) Gastrin B) CCK C) Secretin D) GIP

Which of the following paracrines secreted by ECL cells works through the ENS system and will generally increase gastric motility and secretion? A) Histamine B) Somatostatin C) Serotonin D) Gastrin

Which of the following species makes a Shiga-like toxin encoded by a phage, typically resulting in bloody diarrhea? A) Campylobacter jejuni B) Shigella spp. C) Enterohemorrhagic E. coli (O157:H7) D) Salmonella spp.

Which of the following splanchnic vessels is *NOT* part of the portal triad in the liver? A) Vena cava B) Hepatic artery C) Hepatic vein D) Portal vein

Which of the following water-soluble vitamins is an essential co-factor in hydroxylation and reduction reactions and is essential for healthy teeth, gums and bones, as well as helping with would healing and tissue scarring? A) Vitamin B1 B) Vitamin B3 C) Vitamin C D) Vitamin B9

Which of the following will inhibit the release of gastrin from G cells? A) Increased pH of gastric acid B) Bombesin (BB) C) Somatostatin D) Phenylalanine & Tryptophan

Which of the following would occur during defecation? A) Defecation is stimulated by a decrease in intrarectal pressure B) Defecation can occur when the vagus nerve is stimulated C) Defecation can be withheld by voluntary control D) Pelvic nerve efferents will stimulate internal anal sphincter via acetylcholine prior to defecation

Which of the following would occur in a patient that had cholera? A) Hypertension upon onset of disease B) Decreased aldosterone production over course of disease C) Increased luminal chloride concentration D) Increase in plasma sodium osmolarity

Which of the following would occur under a high salivary flow rate? A) Saliva will be isotonic to plasma B) Parasympathetic activity will be turned "off" C) Sodium concentration will be higher in saliva compared to low saliva flow D) HCO3- concentration will be lower in saliva compared to low saliva flow

Which phase of pancreatic secretion has the largest percentage of maximum enzymatic secretion? A) Cephalic B) Gastric C) Intestinal

Which phase of salivation helps to clean dentition and oral cavity? A) Cephalic B) Oral C) Esophageal/Gastric

Which transporter is responsible for bringing glucose, galactose, and fructose into the portal circulation via facilitated diffusion? A) SGLT1 B) GLUT5 C) GLUT2

Which type of Hepatitis infection is associated with high percentage of chronic cases, significant increases in cancer risk, and high risks of cirrhosis? This hepatitis infection has become a major cause of mortality in HIV-infected populations and is a major cause of liver transplantation in the United States A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E

Which type of tapeworm can potentially develop into neurocysticercosis, in which the larva infects the brain and can cause seizures and acquired epilepsy for people in developing countries? A) Fish tapeworm B) Beef tapeworm C) Pork tapeworm

Which virulence factor of H. pylori is only present in strains from people with ulcers? A) Urease B) VacA C) CagA

With regards to bile, all of the following are reabsorbed by the gallbladder mucosa *EXCEPT:* A) Water B) Na+ C) Ca2+ D) HCO3-

With regards to drug-induced hepatic injury, which class of drugs can result in centriobular necrosis? A) Methotrexate B) Chlorpromanize C) Acetaminophen D) Salicylates E) Ethanol

_______ is an incretin released from I cells of the upper and lower intestines in a biphasic manner that stimulates the pancreatic beta-cells to release insulin A) VIP B) GIP C) GLP D) NO

__________ signals through the Gs cascade and activates adenylyl cyclase to generate cAMP in parietal cells A) Somatostatin B) Prostaglandins C) Histamine D) Acetylcholine E) Gastrin

_____________ are specialized macrophages located in the liver lining the walls of the sinusoids that form part of the reticuloendothelial system (RES) A) Hepatocytes B) Hepatic stellate cells C) Kupffer cells D) Liver sinusoidal endothelial cells

_____________ is a reflex that can slow the rate of gastric emptying and increases duodenal activity distal to the stimulus. This reflex is stimulated by the presence of H+ ions and has both a short loop (within ENS, serotonin) and a long loops (CNS, acetylcholine). A) Ileocecal Reflex B) Gastrocolic Reflex C) Enterogastric Reflex D) Vagovagal Reflex

_____________ phase of gastric secretion is the smallest contributor to HCl secretion and is mediated by products of protein digestion A) Cephalic B) Gastric C) Intestinal

______________ is a binding protein which will help transport and deliver vitamin B12 in the blood and tissues A) R-protein B) Cubulin C) Transcobalamin I/II D) Intrinsic Factor

_______________ are found in the GI and serve as the pacemaker cells A) SA nodal cells B) Chief cells C) Interstitial cells of Cajal (ICCs) D) ECL cells

_______________ results in volume contraction and a decrease in arterial pressure. It is caused by the cholera toxin, which binds Gs to activate adenylate cyclase and increase cAMP, which leads to increased Cl- excretion into the GI lumen which is subsequently followed by increased Na+ and H2O in the GI lumen which overwhelms the large intestines A) Decreased absorptive surface area B) Osmotic diarrhea C) Secretory diarrhea

_________________ is often rare, but can result in mild hemolytic anemia, neuropathies, decreased sexual vitality, and muscle degeneration A) Vitamin A deficiency B) Vitamin D deficiency C) Vitamin E deficiency D) Vitamin K deficiency

__________________ converts cholesterol esters to free fatty acids and cholesterol A) Pancreatic lipase B) Colipase C) Cholesterol ester hydrolase D) Phospholipase A2

Which serotypes of adenovirus can cause gastroenteritis? (*SELECT ALL THAT APPLY*) A) Type 4 B) Type 7 C) Type 40 D) Type 41

C & D

What are the dental management considerations for Proton Pump Inhibitors (PPI)? (*SELECT ALL THAT APPLY*) A) Delayed liver metabolism of benzodiazepenes & reversible joint symptoms with preexisting arthritis B) Potentially increased serum salicylate levels if concurrent ASA C) Reduced absorption of ampicillin, keoconazole, & itraconazole D) Anorexia & dry mouth E) Increased concentration of benzodiazepenes, warfarin, & phenytoin F) Diarrhea & cramps

C & E

_______________ is the area of integration in the brain which receives the multiple stimuli eventually leading to the act of emesis (vomiting)

Chemoreceptor Trigger Zone (CTZ)

_________________ is the formation of gallstones in the gallbladder and ducts due to highly concentrated cholesterol present in the bile

Cholelithiasis

In breast milk, _____________ is rich in secretory IgA and passively protects infant intestinal tract

Colostrum

________________ is an inappropriate decrease from the normal frequency of defecation

Constipation

________________ is a condition that can cause increases in pancreatic juice viscosity and this can result in the malabsorption of nutrients

Cystic Fibrosis

______________ is a genetic disorder where a dibasic amino acid transporter in the GI and kidney which will increase excretion of cysteine in the urine

Cystinuria

A 50-year-old man comes to see his clinician complaining of severe epigastric pain, frequent heartburn, and unexplained weight loss of 20 lbs. over a 6-month period. He claims to have obtained no relief from over-the-counter H2 antihistamine drugs. He is referred to a gastroenterologist, and upper endoscopy reveals erosions and ulcerations in the proximal duodenum and an increased output of gastric acid in the fasting state. The patient is most likely to have a tumor secreting which of the following hormones? A) Secretin B) Somatostatin C) Motilin D) Gastrin E) CCK

A 70-year-old patient was being treated for bacterial pneumonia. Patient has now developed bloody diarrhea, spike in fever, and started to show generalized constitutional symptoms of being unwell. Which of the following organisms might be the cause for this diarrhea? A) Salmonella Typhi B) Amoeba C) Enterohemorrhagic E. coli D) Clostridia difficile E) Shigella

A 76-year-old patient with a history of hypertension, type 2 diabetes, and coronary artery disease. Medications include lisinopril, metformin, multivitamins, and atenolol. The patient visits the dentist due to a terrible tooth ache that has persisted for two weeks. The dentist discovers significant tooth decay and restores the tooth. Which pain medication would be best for the dentist to prescribe for this aging adult? A) Ibuprofen B) Celecoxib C) Acetaminophen/hydrocodone D) Acetaminophen

A male patient comes into your office for an appointment. Analysis of your patient reveals inflammation, fibrosis, and dilation of the intra- and extra-hepatic ducts with no bile duct damage or periductal granulomas. This disease is often associated with chronic ulcerative colitis, and P-ANCA in the vast majority of cases. What is the most likely diagnosis for this patient? A) Non-alcoholic fatty liver disease B) Autoimmune hepatitis C) Primary Biliary Cholangitis D) Primary Sclerosing Cholangitis E) Liver Cell Adenoma (Hepatic Adenoma)

A patient comes into your dental office with atypical mucosal ulcerations and diffuse swelling of the lips and cheeks (orofacial granulomatosis). The patient also has linear mucosal ulcers with hyperplastic margins or papulonodular "cobblestone" proliferations of the mucosa on the buccal vestibule and soft palate. What is the most appropriate diagnosis for this patient's current condition? A) Ulcerative Colitis B) Hepatitis C) Alcoholic Liver Disease/Cirrhosis D) Crohn's Disease E) Peptic Ulcer Disease (PUD)

A patient comes into your office complaining of a fever that has manifested throughout the past week. The patient reports no contaminated food or drinks that were consumed as far as they know, but they do report that their parents have also been experiencing similar fevers. You determine that this is a systemic infection, in which the organism invaded the M cells of the small intestine, and have replicated in macrophages found in the spleen and the liver. Which of the following is the most appropriate diagnosis for this patient? A) Peptic ulcers B) Cholera C) Shigellosis D) Typhoid Fever

A patient comes into your office with a fever, feelings of nausea, severe weight loss, and pain in their upper right quadrant. Further analysis of the patient's gall bladder reveals that it is enlarged, tense, and bright red with a lumen that is filled with turbid bile. You determine that this disease was caused by obstruction of the cystic duct by gallstones. What is the most likely diagnosis for this patient? A) Pancreatic carcinoma B) Serous Cystadenoma (cystic neoplasm) C) Chronic Pancreatitis D) Acute Calculous Cholecystitis E) Chronic Cholecystitis

A patient comes into your office with an increased resistance to blood flow in a particular organ. The consequences of this condition include ascites, portosystemic shunts, congestive splenomegaly, and hepatic encephalopathy. What is the most likely diagnosis for this patient? A) Hemochromatosis B) Focal Nodular Hyperplasia C) Hepatocellular Carcinoma D) Portal Hypertension E) Cirrhosis

A patient comes into your office with chief complaints of upper abdominal pain and general fatigue. Histological analysis of the patient's liver reveals trabecular, sinusoidal, and pseudoacinar cell patterns as well as bile production by tumor cells and cirrhosis in adjacent liver parenchyma. Serological analysis of the patient's blood reveals elevated serum levels of alpha fetoprotein (AFP). You notice malignant & cirrhotic tumors in the patient's liver. What is the most appropriate diagnosis for this patient? A) Focal Nodular Hyperplasia (Liver Mass) B) Cholangiocarcinoma (CC) C) Liver Cell Adenoma (Hepatic Adenoma) D) Hepatocellular Carcinoma (Liver Mass) E) Metastatic Carcinoma

A patient comes into your office with complaints of blood, pus, and mucous in the stool. No contaminated food was consumed as far as the patient knows, and they most likely received it from one of their classmates at school. You determine that this pathogen invades epithelial cells in the colon and polymerize host actin, resulting in colonic ulcers that cause the blood and mucous in the stool. Which of the following is most likely responsible for this patient's current symptoms? A) Helicobacter pylori B) Vibrio cholerae C) Campylobacter jejuni D) Shigella spp.

A patient comes into your office with complaints of what they describe as "watery, rotten-egg smelling diarrhea" that they noticed after eating eggs and drinking raw milk for breakfast. You determine that this organism invaded the ileum and you assure this patient that this organism typically stays in the gut and normally doesn't enter the blood stream. Which of the following is most likely responsible for this patient's symptoms? A) Campylobacter jejuni B) Shigella spp. C) Enterohemorrhagic E. coli (O157:H7) D) Salmonella spp.

A patient of yours comes to your office to have blood work done. Serological results reveal markedly low levels of a certain glycoprotein encoded by the PiMM gene and is typically synthesized by the liver. Given that this is an autosomal recessive disorder, liver transplantation is the only treatment. What is the most likely diagnosis for this patient? A) Non-alcoholic fatty liver disease B) Autoimmune hepatitis C) Primary Biliary Cholangitis D) Alpha-1 Antitrypsin Deficiency E) Liver Cell Adenoma (Hepatic Adenoma)

A scientist studies the regulation of gastric motility by placing a pressure sensor in the stomach of a mouse that remotely reports intragastric pressure over time. She notes that gastric pressures seldom rise above the levels that breach the lower esophageal sphincter, even when the stomach is filled with a meal and its volume is expanded considerably as a result. The physiological gastric pressure response to feeding could be partially inhibited experimentally by all of the following pharmacological agents *EXCEPT:* A) Cholinergic antagonist B) Nitric oxide synthase inhibitor C) CCK antagonist D) Histamine antagonist E) VIP antagonist

Choose the correct adverse effect and drug-drug interaction due to pharmacologic replacement treatment for pancreatic secretory disorders. A) Black discoloration of the tongue; increases biotransformation of other drugs B) Red discoloration of body fluids; decreases absorption of drugs C) QT-wave prolongation; decreases biotransformation of other drugs D) Diarrhea; binds to cations such as calcium and iron E) Lupus-like syndrome; antagonist of eluxadoline

How does hepcidin prevent iron overload? A) Downregulating DMT1 activity B) Inhibiting iron release from macrophages C) Block ferroportin activity D) All of the above

In smooth muscle morphology, the dense bodies contain ___________ for thin filament attachment. A) Troponin B) Tropomyosin C) Myosin D) Alpha-actinin

Migrating Motor Complexes (MMCs) are initiated by which hormone? A) Gastrin B) Secretin C) Somatostatin D) Motilin

Ms. Bismol is a 1 pack-per-day smoker, drinks 3-4 beers a day, and recently has been taking naproxen around the clock for her chronic back pain. She started having gnawing vague pain in her abdomen that gets worse with eating and dark stools. You suspect she has peptic ulcer disease (PUD). Which of the following is true about PUD? A) The diagnostic test of choice is a serologic/blood test for H. pylori B) The Urea Breath test is useful for diagnosing PUD, but is unable to detect clearance of H. pylori after treatment C) It's likely not a gastric ulcer since the pain usually improves with eating D) She will likely need a multi-drug regimen with antibiotics and a proton pump inhibitor (PPI)

Ms. Marks recently finished a 7-day course of clindamycin for bacterial vaginosis. Over the past 3 days she has been having increasing watery and loose stools with a foul odor. You suspect she has pseudomembranous colitis. Which of the following statements is most accurate about pseudomembranous colitis? A) Her treatment would likely include 30+ days of IV metronidazole or vancomycin B) The diagnostic test of choice is a colonoscopy with colon biopsy C) The most likely cause is an overgrowth of H. pylori bacteria in her bowel D) The colitis and diarrhea are caused by enterotoxins made by the bacteria

Osmotic diarrhea is indicated when fecal osmolal gap is ___________ A) > 25 mOsm/kg B) > 50 mOsm/kg C) > 75 mOsm/kg D) > 100 mOsm/kg

Patient presents with heartburn, regurgitation of gastric acid and contents, and has to take lot of acid neutralizers. Which of the following is the most likely underlying etiology? A) Odynophagia B) Dysphagia C) Tracheoesophageal fistula D) Hiatal Hernia E) Melena

Pernicious anemia is a vitamin B12 deficiency which lacks __________ released by the stomach. A) R-protein B) Cubulin C) Transcobalamin I/II D) Intrinsic Factor

The rate-limiting enzyme in the biosynthesis of bile salts is: A) 6a/b-hydroxylase epimerase B) 7a-dehydroxylase C) Cyp2c70 D) Cholesterol 7a-hydroxylase

What are the dental management considerations for Famotidine (Pepcid)? A) Delayed liver metabolism of benzodiazepenes & reversible joint symptoms with preexisting arthritis B) Potentially increased serum salicylate levels if concurrent ASA C) Reduced absorption of ampicillin, keoconazole, & itraconazole D) Anorexia & dry mouth E) Increased concentration of benzodiazepenes, warfarin, & phenytoin F) Diarrhea & cramps

What is the etiological agent of diphyllobothriasis infection? A) Diphyllobothrium ursi B) Diphyllobothrium lanceolatum C) Diphyllobothrium dalliae D) Diphyllobothrium latum

What is the etiological agent of giardiasis? A) Giardia beckeri B) Giardia bovis C) Giardia irarae D) Giardia lamblia

What is the mechanism of action of lubiproston? A) Guanylate cyclase-C agonist to increase cGMP and promote chloride excretion to stimulate increased gastric motility B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) 5-HT4 agonist to increase acetylcholine release which increases colon muscle contractions and relaxation of circular muscles promoting evacuation D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Agonism of mu-opioid receptors at myenteric plexus

What is the mechanism of action of propantheline and glycopyrrolate? A) Increase gastric pH in stomach/duodenum in order to inhibit pepsin activity and neutralize gastric acids B) Inhibit the hydrogen-potassium-ATPase (proton pump) C) Dopamine D2 antagonist & the acceleration of gastric emptying D) Competitively block muscarinic acetylcholine receptors, thus decreasing salivary secretion during dental procedures E) Block parietal cell H2 receptors to inhibit basal and meal-induced acid secretion

What is the mechanism of action of ustekinumab? A) Targets an integrin to prevent migration & cell/tissue adherence of inflammatory cells to vascular endothelium B) Activates peroxisome proliferator-activated receptors (PPAR) localized in the gut C) Inhibits folate synthesis, leading to T-cell apoptosis/death D) Targets IL-12 and IL-23 receptors, binding and induction of intracellular signaling E) Bind to soluble & membrane-bound TNF

What would cause hepcidin to be released by the liver? A) High plasma iron bound to transferrin B) High iron stores C) Inflammation D) All of the above

Which action would cause the generation/mediation of spike potentials in GI motility? A) Closing of potassium channels B) Opening of fast calcium-sodium channels C) Opening of potassium channels D) Opening of slow calcium-sodium channels

Which disease is mostly asymptomatic, but can result in complications such as altered GI functions, Vitamin B12 deficiency, and gall bladder disease? A) Giardiasis B) Crytospordiosis C) Taeniasis D) Diphyllobothriasis infection E) Pinworms F) Toxocariasis G) Ascariasis

Which drug is used to decrease/eliminate viral transmission from mother to fetus? A) Corticosteroids B) Phenobarbital C) Digoxin/Flecainide/Verapamil D) Antivirals

Which enteric virus typically has a "star-like" pattern of negatively-stained electron micrograph virions? A) Rotavirus B) Norovirus C) Adenovirus D) Astrovirus

Which enterogastrone contracts the gall bladder and inhibits the Sphincter of Oddi during digestion, allowing bile to flow into the duodenal lumen for the digestion and absorption of lipids? A) Secretin B) Nitric oxide C) Norepinephrine D) CCK

Which fat-soluble vitamin listed below is necessary for the biosynthesis of several clotting factors (II, VII, IX, X) and antagonizes the anticoagulant effects of warfarin? A) Vitamin A B) Vitamin D C) Vitamin E D) Vitamin K

Which hepatitis type is co-infected with HBV because it needs the HBV envelope (HBsAg) due to its lack of surface antigen? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E

Which hormone is stimulated by H+ and increases cAMP levels in pancreatic ductal cells to cause the secretion of both Na+ and HCO3-? A) Gastrin B) Somatostatin C) CCK D) Secretin

Which major GI organ is responsible for the synthesis of bile acids? A) Gallbladder B) Pancreas C) Small intestine D) Liver

Which masticatory reflex is caused by nociceptive/painful stimuli, resulting in rapid jaw opening and ridding the oral cavity of harmful substances? A) Myotatic Reflex B) Inverse Myotatic Reflex C) Low Threshold Mechanoreceptor Reflex D) High Threshold Mechanoreceptor Reflex

Which of the following FDA teratogenic risk categories would be classified as "positive evidence of fetal risk; life-threatening benefit"? A) A B) B C) C D) D E) X

Which of the following class of drugs is key in the treatment and management of Gastroesophageal Reflux Disease (GERD)? A) NSAIDS B) Penicillins C) Macrolides D) Proton Pump Inhibitors (PPIs)

Which of the following conditions is caused by too much iron? A) Osteomalacia B) Microcytic anemia C) Kidney/Biliary stones & peptic ulcers D) Hemochromatosis

Which of the following conditions leads to hypercalcemia and parathyroid hormone suppression? A) Vitamin A deficiency B) Hypervitaminosis A C) Vitamin D deficiency D) Hypervitaminosis D

Which of the following drugs blocks the H2 receptors on parietal cells, resulting in lower acid release into the lumen of the stomach? A) Pramlintide B) Prazole C) Omeprazole D) Cimetidine

Which of the following enterogastrones is responsible for release of enzymes from acinar cells of the pancreas? A) Secretin B) Nitric oxide C) Norepinephrine D) CCK

Which of the following features is associated with primary sclerosing cholangitis? A) Portal-based granuloma B) Positive antimicrobial antibody titer C) Positive anti-nuclear antibody titer D) Frequent association with ulcerative colitis

Which of the following forms of carbohydrates can *NOT* be absorbed by the small intestine? A) Glucose B) Galactose C) Fructose D) Sucrose

Which of the following hormones is responsible for increased insulin secretion from beta-cells, as well as decreased gastric H+ secretion and delayed gastric emptying? A) Gastrin B) CCK C) Secretin D) GIP

Which of the following is a method of transmission for Hepatitis A? A) Close personal contact B) Contaminated food/water C) Bood exposure D) All of the above

Which of the following is indicative of liver damage if high amounts are detected in the blood stream? A) IgG anti-HAV B) IgM anti-HAV C) HAV in stool D) ALT/AST (alanine/aspartate amino transferase)

Which of the following laboratory tests would be used to diagnose diphyllobothriasis infections? A) Identification of oocysts in the stool via acid fast stain B) Lack of increased PMN leukocytes in the stool C) Cysts in the stool D) Colonoscopy E) ELISA for antibodies F) MRI/CT brain scans G) Serology H) Tape test

Which of the following statements is true concerning small intestine motility? A) Motility during the fed state is mediated by migrating motor complexes (MMCs) B) Acetylcholine will decrease the number of spike potentials to cause a decrease in small intestine motility C) Villus motility plays no role in small intestine motility D) The fed state is mediated by segmentation and peristalsis

With regards to drug-induced hepatic injury, which class of drugs can result in microvescicular steatosis? A) Methotrexate B) Chlorpromanize C) Acetaminophen D) Salicylates E) Ethanol

__________ (aka "big gastrin") is secreted between meals A) G17 B) G19 C) G23 D) G34

__________ can stimulate Na+ absorption and K+ secretion in the distal colon A) CCK B) Adenosine C) Negative lumen potential D) Aldosterone

___________ activates M3 receptors on parietal cells to increase IP3 + DAG, which eventually leads to increased intracellular calcium A) Somatostatin B) Prostaglandins C) Histamine D) Acetylcholine E) Gastrin

___________ can inhibit myosin light chain phosphatase (MLCP), thus resulting in increased smooth muscle contraction A) Nitric oxide B) cGMP C) Ca2+/Calmodulin complex D) Rho kinase

____________ is a long reflex involved in the process of receptive relaxation which is mediated by both the afferent and efferent limbs of the vagus nerve. This reflex stimulates the release of neutrotransmitters vasointestinal peptide (VIP) and nitric oxide (NO) for smooth muscle relaxation (i.e., drop in intragastric pressure), as well as receives sensory information from stretch receptors to subsequently stimulate gastrin release from G cells. A) Ileocecal Reflex B) Gastrocolic Reflex C) Enterogastric Reflex D) Vagovagal Reflex

____________ is a secondary manifestation of Zollinger-Ellison Syndrome, in which high amounts of H+ entering the duodenum will overwhelm the HCO3- and inactivate pancreatic enzymes, thus preventing digestion of lipids. A) Gastroesophageal Reflux Disease (GERD) B) Peptic Ulcer Disease (PUD) C) Zollinger-Ellison Syndrome D) Steatorrhea

____________ typically results in hemorrhagic diseases in newborns, postoperative bleeding, and hematuria A) Vitamin A deficiency B) Vitamin D deficiency C) Vitamin E deficiency D) Vitamin K deficiency

______________ is an increase in motor activity distal (caudad) to a distending or irritating stimulus while decreasing proximal (orad) motor activity, resulting in an increased ability to get rid of the digested meal while not adding any "new" food material. This reflex is stimulated by stretch receptors that become activated in the myenteric plexus A) Vago-vagal reflex B) Enterogastric reflex C) Gastrocolic reflex D) Entero-enteric reflex

______________ is the most important enzyme in converting pancreatic trypsinogen into trypsin and is located at the brush border of Crypts of Liberkuhn cells A) Intestinal amylase B) Aminopeptidase C) Intestinal lipase D) Enterokinase

_______________ is necessary for exocytosis of chylomicrons into the lymphatics A) Phospholipid B) Lysolechithin C) Cholesterol ester D) Apolipoprotein B

_______________ may lead to pernicious anemia due to the absence of intrinsic factor from gastric parietal cells A) Vitamin B1 deficiency B) Vitamin B3 deficiency C) Vitamin B9 deficiency D) Vitamin B12 deficiency

________________ is activated by trypsin and converts phospholipid to lysolecithin and fatty acids A) Pancreatic lipase B) Colipase C) Cholesterol ester hydrolase D) Phospholipase A2

_________________ is caused by duodenal tumors that secrete gastrin and inactivate pancreatic enzymes A) Gastroesophageal Reflux Disease (GERD) B) Peptic Ulcer Disease (PUD) C) Irritable Bowel Syndrome (IBS) D) Zollinger-Ellison Syndrome

Which amino acids are the most potent stimuli for gastrin secretion? (*SELECT ALL THAT APPLY*) A) Valine B) Cysteine C) Methionine D) Phenylalanine E) Tryptophan

D & E

A 33-year-old woman comes into your office with chief complaints of abdominal discomfort. It is discovered that there are large (~ 9 cm) cysts that are encapsulated, hemorrhagic, and necrotic. This condition was caused because the B-catenin/adenomatous polyposis coli genetic pathway is altered. Fortunately for the patient, surgical resection yields an excellent prognosis. What is the most likely diagnosis for this patient? A) Mucinous cystic neoplasms "ovarian" stroma B) Pancreatic carcinoma C) Intraductal papillary mucinous neoplasms D) Cholelithiasis (gallstones) E) Solid pseudopapillary neoplasm

A long-standing patient in your practice has battled alcohol use disorder over the last 5 years. At their last appointment, you notice that the patient's abdomen is quite rotund and they are quite confused. The next week you learn that the patient was hospitalized and given lactulose. What is the mechanism of action of lactulose? A) Activates Type-2 Chloride channels B) Activates guanylate cyclase stimulator C) Antagonizes H2-receptors D) Stimulant laxative E) Non-absorbable osmotic laxative

A patient comes into your office with chief complains of abdominal pain, feelings of nausea, excessive vomiting, and a sudden intolerance to fatty foods. Further analysis revealed an enlarged, opaque, gray-white gallbladder with thickened walls as well as marked fibrosis, inflammation, and most importantly, Rokitansky-Aschoff sinuses. What is the most likely diagnosis for this patient? A) Pancreatic carcinoma B) Serous Cystadenoma (cystic neoplasm) C) Chronic Pancreatitis D) Acute Calculous Cholecystitis E) Chronic Cholecystitis

A patient comes into your office with no specific signs or symptoms. However, further analysis of the patient does indicate bridging fibrous septa, parenchymal nodules created by regeneration, and architectural disruption of the liver. What is the most likely diagnosis for this patient? A) Hemochromatosis B) Focal Nodular Hyperplasia C) Hepatocellular Carcinoma D) Portal Hypertension E) Cirrhosis

A patient comes to your dental office with various oral manifestations and symptoms, such as xerostomia, rampant caries, oral candidiasis, enamel erosion from regurgitation, erythema multiforme, pale mucosa, mucosal ulcerations, and gingival bleeding/petechiae. All of these are side effects resulting from medications the patient is taking to manage pain as a result of their current condition. What is the most appropriate diagnosis for this patient's current condition? A) Ulcerative Colitis B) Hepatitis C) Alcoholic Liver Disease/Cirrhosis D) Crohn's Disease E) Peptic Ulcer Disease (PUD)

All of the following will enhance the uptake of iron absorption *EXCEPT:* A) Erythropoiesis B) Vitamin C C) Dietary protein D) Hypoxia E) Other divalent metals (Cu2+, Zn2+, Mg2+, Ca2+, etc.)

An elderly female patient comes into your office, where it is discovered that she has small cysts present in her pancreas that contain clear fluid and are lined by cuboidal epithelium without atypia. Fortunately for this patient, surgical resection is curative. What is the most likely diagnosis for this patient? A) Pancreatic carcinoma B) Acute Pancreatitis C) Chronic Pancreatitis D) Cholelithiasis (gallstones) E) Serous Cystadenoma (cystic neoplasm)

In a study of the secretion of gastrointestinal hormones, portal concentrations are measured in a rat during luminal perfusion of buffered salt solutions at various pH levels. Which of the following hormones will increase during perfusion with a buffered solution at pH 3.0? A) CCK B) Gastrin C) GIP D) Motilin E) Secretin

Jaundice can occur due to an excess of _____________ A) Urobilinogen B) Biliverdin C) Stercobilin D) Urobilin E) Bilirubin

What is the correct sequence of the formation and excretion of bile pigments? 1. Biliverdin is converted to bilirubin 2. Urobilinogen is either excreted in urine, or oxidized to urobilin and stercobilin which are excreted in feces 3. Bilirubin glucuronide is converted to urobilinogen by intestinal bacteria 4. Cells of the reticuloendothelial system (RES) degrade hemoglobin to form biliverdin 5. Bilirubin is extracted from blood by the liver and conjugated to glucuronide A) 1, 2, 3, 4, 5 B) 1, 4, 5, 3, 2 C) 4, 5, 1, 3, 2 D) 4, 3, 1, 5, 2 E) 4, 1, 5, 3, 2

What is the mechanism of action of cimetidine and famotidine? A) Increase gastric pH in stomach/duodenum in order to inhibit pepsin activity and neutralize gastric acids B) Inhibit the hydrogen-potassium-ATPase (proton pump) C) Dopamine D2 antagonist & the acceleration of gastric emptying D) Competitively block muscarinic acetylcholine receptors, thus decreasing salivary secretion during dental procedures E) Block parietal cell H2 receptors to inhibit basal and meal-induced acid secretion

What is the mechanism of action of infliximab? A) Targets an integrin to prevent migration & cell/tissue adherence of inflammatory cells to vascular endothelium B) Activates peroxisome proliferator-activated receptors (PPAR) localized in the gut C) Inhibits folate synthesis, leading to T-cell apoptosis/death D) Targets IL-12 and IL-23 receptors, binding and induction of intracellular signaling E) Bind to soluble & membrane-bound TNF

What is the mechanism of action of loperamide? A) Guanylate cyclase-C agonist to increase cGMP and promote chloride excretion to stimulate increased gastric motility B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) 5-HT4 agonist to increase acetylcholine release which increases colon muscle contractions and relaxation of circular muscles promoting evacuation D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Agonism of mu-opioid receptors at myenteric plexus

What is the mechanism of action of pancrelipase? A) Reduce the rate of cholesterol absorption reducing hepatic cholesterol secretion and breaking up existing cholesterol micelles enhancing excretion B) Peripheral mu-opioid receptor antagonist to increase gastric motility C) Somatostatin analog, mimics action in order to decrease GI motility and gallbaldder contractility D) Activation of type 2 chloride channel & enhanced secretion of chloride to stimulate gastric motility E) Used as replacement therapy for deficient exocrine pancreatic secretory disorders via a combination of lipase, protease, ad amylase

Which FDA-approved HCV drug is a nucleotide analogue HCV NS5B polymerase inhibitor with similar in vitro activity against all HCV genotypes? A) Mavyret B) Vosevi C) Epclusa D) Zepatier E) Sovaldi

Which GI peptide secreted from L cells of the small intestine is responsible for increased insulin secretion from beta-cells in the pancreas? A) Ghrelin B) Motilin C) Pancreatic Polypeptide (PP) D) Enteroglucagon E) Glucagon-like Peptide-1 (GLP-1)

Which cells are responsible for the release of GIP? A) G cells B) I cells C) S cells D) X cells E) K cells

Which disease manifests most commonly as an itchy anal region which leads to difficulty in sleeping and restlessness? This disease is typically spread among school-aged children and can result in a secondary bacterial infection due to the irritation and scratching of the anal area. A) Giardiasis B) Crytospordiosis C) Taeniasis D) Diphyllobothriasis infection E) Pinworms F) Toxocariasis G) Ascariasis

Which hepatitis type is self-limited, mostly caused due to contaminated water, and it especially dangerous in pregnant women? A) Hepatitis A B) Hepatitis B C) Hepatitis C D) Hepatitis D E) Hepatitis E

Which is the only drug type that has increased oral absorption in neonates compared to older children and adults? A) Acetaminophen B) Phenobarbital C) Phenytoin D) Sulfonamides E) Penicillins

Which of the following FDA teratogenic risk categories would be classified as "contraindicated in pregnancy & planning pregnancy"? A) A B) B C) C D) D E) X

Which of the following are systemic causes of constipation? A) Starvation B) Dehydration C) General surgical procedures D) Opioid drug use E) All of the above

Which of the following describes the pathogenesis of Helicobacter pylori in the development of gastric ulcers? A) Release of cytotoxins (e.g. CagA toxin) B) Converts urea to NH3 via urease, which alkalinizes the local environment to allow bacterium to survive C) Inhibits somatostatin secretion from D cells, resulting in increased gastrin secretion from G cells D) Damage mucosa allowing H+ ions to leak out of GI lumen, resulting in increased gastrin secretion E) All of the above

Which of the following drugs has limited bioavailability due to poor oral absorption? A) Loperamide B) Lactulose C) Prucalopride D) Diphenoxylate HCL E) Eluxadoline

Which of the following is *NOT* true for the diagnosis of hepatitis caused by hepatitis viruses? A) Acute infections can be diagnosed by the detection of IgM in serum B) Past infections can be diagnosed by the detection of IgG in serum C) Stool samples can be utilized to detect virus earlier by RT-PCR D) Serum ALT (alanine aminotransferase) levels can indicate hepatitis and liver damage E) In the clinic, cell culture is routinely used to grow virus and make diagnoses

With regards to drug-induced hepatic injury, which class of drugs can result in both acute and chronic hepatic fibrosis/cirrhosis? A) Methotrexate B) Chlorpromanize C) Acetaminophen D) Salicylates E) Ethanol

_____________ activates CCKB receptors to also increase intracellular calcium A) Somatostatin B) Prostaglandins C) Histamine D) Acetylcholine E) Gastrin

A patient comes into your office with symptoms that align with clinical presentations of visceral larval migrans (i.e., fever, coughing, liver inflammation) and ocular larva migrans (elevated granulomas of the disc or retina). What is the most appropriate diagnosis for this patient? A) Giardiasis B) Crytospordiosis C) Taeniasis D) Diphyllobothriasis infection E) Pinworms F) Toxocariasis G) Ascariasis

What are the dental management considerations for Misoprostol (Cytotec)? A) Delayed liver metabolism of benzodiazepenes & reversible joint symptoms with preexisting arthritis B) Potentially increased serum salicylate levels if concurrent ASA C) Reduced absorption of ampicillin, keoconazole, & itraconazole D) Anorexia & dry mouth E) Increased concentration of benzodiazepenes, warfarin, & phenytoin F) Diarrhea & cramps

Which of the following laboratory tests would be used to diagnose neurocysticercosis? A) Identification of oocysts in the stool via acid fast stain B) Lack of increased PMN leukocytes in the stool C) Cysts in the stool D) Colonoscopy E) ELISA for antibodies F) MRI/CT brain scans G) Serology H) Tape test

T/F: A common characteristic between skeletal, cardiac, and smooth muscle is the presence of sarcomeres in histological images for each type of muscle

FALSE *Smooth muscle does NOT have a true sarcomere* like that of cardiac and skeletal muscle

T/F: Past infections of Hepatitis A is determined by the detection of HAV-IgM in serum

FALSE - *Acute* infection: detection of *HAV-IgM* in serum - *Past* infection: detection of *HAV-IgG* in serum

T/F: Longitudinal muscles of GI structures tend to be thicker and are more densely innervated than circular muscles

FALSE - *Circular muscles:* thick, more densely innervated - *Longitudinal muscles:* thin, contains few nerve fibers

T/F: Cell cultures are often used in the detection and diagnosis of Hepatitis A

FALSE - *Difficult to grow in cell culture*

T/F: Internal anal sphincter is under voluntary control

FALSE - *EXTERNAL* anal sphincter is under voluntary control

T/F: Patients with mild, moderate, or severe IBD can all be treated in the dentist's office

FALSE - *MILD:* dental care in the dentist's office - *MODERATE/SEVERE:* poor candidates for dental care and should be referred to their physician

T/F: Dental treatment must be altered for patients who currently have chronic hepatitis or in those who have recovered from hepatitis

FALSE - *No alterations* in dental treatment plan

T/F: Spike potentials are tonic contractions of the GI that help to maintain baseline tension

FALSE - *SLOW WAVES* are tonic contractions of the GI that help to maintain baseline tension - Slow waves are *NOT* action potentials

T/F: Segmentation contractions are designed to propel the material forward, whereas peristalsis contractions serve to mix and expose gastric materials to enzymes

FALSE - *Segmentation contractions:* serve to mix and expose gastric materials to enzymes (this does *NOT* move the material forward) - *Peristalsis contractions:* designed to propel the material forward

T/F: Pelvic nerve innervates the upper GI tract

FALSE - *Vagus nerve* innervates upper GI - *Pelvic nerve* innervates lower GI

T/F: Norepinephrine will increase the number of spike potentials and generate smooth muscle tension, whereas acetylcholine will decrease spike potentials and tension will be decreased

FALSE - Acetylcholine: *increase the number of spike potentials* and generate smooth muscle tension - Norepinephrine: *decrease spike potentials* and tension will be decreased

T/F: Antacids composed of only magnesium cause constipation

FALSE - Antacids composed of only *aluminum* cause *constipation* - Antacids composed solely of *magnesium* cause *diarrhea*

T/F: Vaccines injected at intravenous systemic locations induce secretory IgA activation

FALSE - Antigen *presented at mucosal surfaces* induce sIgA - Antigens injected intravenously induce *serum IgG or IgM*

T/F: There is increased splanchnic blood flow (postprandial hyperemia) in between meals

FALSE - Between meals --> *DECREASED* splanchnic blood flow - Digestion --> *INCREASED* splanchnic blood flow (postprandial hyperemia)

T/F: CCK increases the rate of gastric emptying

FALSE - CCK *slows* the rate of gastric emptying

T/F: CCKA receptors can bind both gastrin and CCK

FALSE - CCK*A*: selective for CCK - CCK*B*: can bind both gastrin and CCK

T/F: Colonocytes found in the large intestines will absorb fluid and electrolytes due to the expression of digestive enzymes

FALSE - Colonocytes do *NOT* express digestive enzymes because absorption of nutrients ends at the ileum

T/F: GI anatomy only contains parasympathetic stimulation, and the digestion process fluctuates depending on frequency of propagation of parasympathetic action potentials

FALSE - Contains innervation for *BOTH* parasympathetic (e.g. vagus, pelvic nerves) and sympathetic systems - Contains intrinsic innervation from enteric nervous system (submucosal and myenteric plexuses)

T/F: HCO3- secretion is high at low salivary flow rates

FALSE - HCO3- secretion is *selectively* stimulated when parasympathetic system is turned on (i.e., high salivary flow rates)

T/F: Patients with IgA deficiency have a high mortality rate

FALSE - IgA-deficient patients survive due to *compensation by IgM and IgG*

T/F: Immune defense to helminth infections is through the production of IgA

FALSE - Immune defense is through the production of *IgE*, and action of *mast cells and eosinophils*

T/F: Higher concentrations of Cl- are found during high pancreatic flow rates relative to HCO3-

FALSE - Low flow rates: *Cl-* - High flow rates: *HCO3-*

T/F: Migrating motor complexes (MMCs) are found throughout the entire GI tract from the stomach to the colon

FALSE - MMCs do *NOT* occur in the colon

T/F: Neurons provide true synapses to the GI smooth muscle structures despite the presence of varicosities

FALSE - Neurons do *NOT* make true synapses on GI smooth muscle and instead *release neurotransmitters from varicosities along the length of the axon* - *NOTE:* No recognizable endplates or postsynaptic specializations (e.g., synaptic clefts)

T/F: Histamine-2 receptor (H2R) blockers are generally more effective in reducing acid secretion into the stomach than proton pump inhibitors (PPIs)

FALSE - PPIs *much more effective* than H2R blockers in reducing acid secretion into stomach because proton pumps on parietal cells can still secrete H+ even if H2R blockers are administered due to Ach and gastrin stimulations via M3 and CCK-B receptors, respectively

T/F: Patients with untreated alcoholic liver disease are still able to receive elective out-patient dental care

FALSE - Patients with untreated alcoholic liver disease are *NOT candidates* for elective out-patient dental care

T/F: Pepsin is essential for normal protein digestion

FALSE - Pepsin is *NOT* essential for normal protein digestion because *enterokinase can convert trypsinogen to trypsin* resulting in activation of other peptidases that can digest proteins

T/F: Reduction in splanchnic blood flow is mediated by the parasympathetic division of the ANS

FALSE - Reduction in splanchnic blood flow is mediated by the *sympathetic division of the ANS*

T/F: A patient's acute symptoms are often indicative of the etiology or specific type of hepatitis they have

FALSE - There is *no way* to detect the etiology or specific type of hepatitis from the acute symptoms

T/F: Vitamins provide extra energy and help people feel better

FALSE - Vitamins *cannot* provide extra energy because they do not provide ATP to the body

T/F: Alcohol-based hand sanitizers can be used in the prevention of Cryptosporidium infections

FALSE Alcohol-based hand sanitizers are *ineffective* against Cryptosporidium infections

T/F: CCK gets released due to the presence of triacyl glycerols (TAGs)

FALSE CCK does *NOT* get released due to the presence of TAGs

T/F: Slow waves of GI motility are influenced by nerves or hormonal input

FALSE Slow waves of GI motility are *NOT* influenced by nerves or hormonal input

T/F: Whenever a meal is ingested, the venous blood will be acidic

FALSE - *ALKALINE* - When a meal is ingested, parietal cells secrete H+ into the GI lumen, thus resulting in HCO3- being pumped into the venous blood in a phenomenon known as *"Alkakine Tide"*

T/F: As chewing is a repetitive process, much of the CNS circuitry is confined to the medulla oblongata

FALSE - *BASAL GANGLIA*

T/F: Adult Body Surface Area (BSA) > Child BSA

FALSE - *Child BSA > Adults BSA* - BSA is *INVERSELY* proportional to length

T/F: Cryptosporidium species divide via binary fission

FALSE - *Giardia trophozoites* divide by binary fission

T/F: In the older adult, fat-soluble drugs have a decreased volume of distribution

FALSE - *INCREASED* volume of distribution

T/F: Somatostatin and prostaglandins (PGE2) are major stimulatory signals for H+ secretion in the stomach

FALSE - *INHIBITORY* signals

T/F: Acinar cells in salivary glands produce the initial saliva which is hypertonic to the plasma

FALSE - *ISOTONIC*

T/F: Regulation of saliva secretion is hormonally mediated

FALSE - *NEURALLY* mediated

T/F: CD4+ T-cells have a suppressive phenotype and keep the mucosal immune response from over responding to the bacterial load in the gut

FALSE - *Regulatory T-cells (Treg)*

T/F: Toddlers may have longer elimination half-lives of drugs than older children/adults

FALSE - *SHORTER*

T/F: Pharyngeal phase is rapid due to smooth muscle contraction

FALSE - *SKELETAL* muscle contraction

T/F: Cholera toxin disrupts protein synthesis by disrupting the structure of the 28S ribosome

FALSE - *Shiga toxin* - *Shiga toxin:* disrupts protein synthesis by disrupting the structure of the 28S ribosome - *Cholera toxin:* increases cAMP production, disrupting ion flow and leading to water outflow

T/F: The presence of fat in the distal small intestine will stimulate pancreatic secretion

FALSE - *inhibit* - Mediators for this is *Peptide YY* by endocrine cells of the ileum and *somatostatin*

T/F: The thickness of unstirred water layer in the GI mucosa is directly proportional to how vigorously the contents are being mixed

FALSE - *inversely proportional* - Thicker unstirred water layer = decreased mixing of chyme - Faster chyme flow = thinner unstirred water layer

T/F: Absorbed fluid in the intestines is always hyperosmotic

FALSE - *isosmotic*

T/F: All solutions secreted into the lumen of the small intestine are hypotonic

FALSE - *isotonic*

T/F: Highest infections of astrovirus occur during dry, summer seasons

FALSE - *winter*, *rainy season*

T/F: During the fed state, periodic gastric contractions can occur called migrating myoelectric complexes (MMC's) and are mediated by motilin

FALSE - During the *FASTING* state - FASTING state: *MMC's* - FED state: *Segmentation* & *peristalsis*

T/F: IgA offers complete protection to patients with giardiasis

FALSE - IgA offers protection, but *incomplete* - Relapse can occur because of *antigenic variation* - Increased incidence in immunodeficient patients

T/F: Secretory IgA production is mostly T-cell independent

FALSE - T-cell *dependent*

T/F: Secretory IgA production to indigenous flora of the gut is T-cell dependent

FALSE - T-cell *independent*

T/F: When gastrin is released from G cells, the hormone goes directly into the stomach acid

FALSE - goes into the *SYSTEMIC CIRCULATION*

T/F: Gravid proglottid segments of tapeworms that have reached the end of the worm only have the digestive system remaining

FALSE - only have the *reproductive tract* left (lost digestive system)

T/F: There is a vaccine for Hepatitis C

FALSE - there is *no* vaccine for Hep. C

T/F: Aspirin should be used to manage pain in patients with Inflammatory Bowel Disease (IBD)

FALSE - use *acetaminophen* - *AVOID* aspirin

T/F: Aspirin should be used to manage pain in patients with Peptic Ulcer Disease (PUD)

FALSE - use *acetaminophen* - *AVOID* aspirin

T/F: Vitamins can replace food

FALSE - vitamins *CANNOT* replace food - Food is essential for the absorption of vitamins and supplements should be taken with a meal

_____________ can be used to determine whether diarrhea is secretory or osmotic, and can be calculated by the following equation: Stool osmolality - 2[Stool Na+ + Stool K+]

Fecal Osmolal Gap (FOG)

A patient comes into your office complaining of intestinal blockage and eosinophilic pneumonitis (Loeffler's Syndrome). These symptoms align with heavy infections in patients with which disease? A) Giardiasis B) Crytospordiosis C) Taeniasis D) Diphyllobothriasis infection E) Pinworms F) Toxocariasis G) Ascariasis

Which of the following laboratory tests would be used to diagnose toxocariasis? A) Identification of oocysts in the stool via acid fast stain B) Lack of increased PMN leukocytes in the stool C) Cysts in the stool D) Colonoscopy E) ELISA for antibodies F) MRI/CT brain scans G) Serology H) Tape test

______________ is a term used to describe abnormally slow gastric emptying and is typically found in patients with obesity, and both Type 1 and Type 2 diabetes

Gastroparesis

__________________ is a condition in which gastric retention occurs with delayed gastric emptying without any obstructions

Gastroparesis

Which of the following laboratory tests would be used to diagnose pinworm infections? A) Identification of oocysts in the stool via acid fast stain B) Lack of increased PMN leukocytes in the stool C) Cysts in the stool D) Colonoscopy E) ELISA for antibodies F) MRI/CT brain scans G) Serology H) Tape test

Contractions of this discontinuous muscle layer causes the large intestine to form bulges known as ___________

Haustra

_________________ is a condition that can occur if digestive enzymes become activated while in the acinar cells of the pancreas

Pancreatitis

_____________ is inhibition of intestinal motility after a surgical procedure, and is thought to occur by activation of opioid receptors or increased discharge of noradrenergic fibers in the splanchnic nerves

Paralytic Ileus

____________ is a term that describes a wave of smooth muscle contractions in the GI tract

Peristalsis

__________________________ is the inhibition of the lower esophageal sphincter (LES) and lowering of tension during swallowing

Receptive Relaxation

_____________ is caused by antral systole, and is a process in which chyme re-enters the stomach from the duodenum in order to get further reduction in particle size and more mixing

Retropulsion

________________ is a condition caused by drug toxicity in children resulting in progressive encephalopathy with hepatic dysfunction

Reye Syndrome

_____________ is a term that describes the arrangement of GI smooth muscle innervation in which one neuron can influence many effector cells through the presence of varicosities that release neurotransmitters along the length of the axon rather than at synaptic clefts

Synapse en passant

In the large intestine, longitudinal muscle layer is arranged in 3 discrete striped called _______________

Teniae coli

T/F: 90% of Hepatitis B cases in children become chronic

True

T/F: A diagnostic test for H. pylori is based on urease activity in which CO2 generated from urea enters the blood and is expired by the lungs

True

T/F: A high caloric/dense meal will slow the rate of gastric emptying in order to avoid saturation of absorptive mechanisms in the remaining GI tract

True

T/F: Alpha-adrenergics can vasoconstrict blood flow and decrease volume and enzyme content of saliva

True

T/F: Ascaris lumbricoides is the largest nematode parasitizing the human intestine

True

T/F: B cells that are switched to IgA have adhesion molecules and chemokine receptors on their surface that allow them to home to mucosal surfaces

True

T/F: Bacteroides is the most common bacterial species in the GI microbiome

True

T/F: Both asexual and sexual reproduction of Cryptosporidium occurs in the host (humans/animals) intestine

True

T/F: Breathing is inhibited during the pharyngeal phase of swallowing

True

T/F: Ca2+-ATPase pumps in smooth muscle cells are constitutively active, meaning that they are never turned off and constantly pump Ca2+ out of the cytosol

True

T/F: Dental management should be the same for patients with Ulcerative Colitis and Crohn's Disease

True

T/F: Divalent Metal Transporter 1 (DMT1), which is typically involved in the absorption of iron, is competitively inhibited by Ca2+ or other divalent ions

True

T/F: Elective dental care is ok in patients with alcohol-induced cirrhosis of the liver if their condition is stable

True

T/F: Elective dental procedures are ok for patients that are in remission for inflammatory bowel disease (IBD)

True

T/F: Excitatory junctional potentials (EJPs) can be summated to induce action potentials in smooth muscle

True

T/F: Exercising too soon after a meal and hemorrhage can reduce splanchnic blood flow and result in underperformance of exercising skeletal muscle groups

True

T/F: Gastroesophageal Reflux Disease (GERD) can occur if the intrathoracic pressure increases (i.e., become less negative)

True

T/F: Giardia cysts are hardy and designed to survive several months in cold water

True

T/F: HBV or HCV associated cirrhosis and ascites (an abnormal accumulation of serous fluid in the abdominal cavity) can result in hepatocellular carcinoma

True

T/F: Hepatitis C virus (HCV) infection is 3-5x more common than HIV infection in the United States

True

T/F: If lipid absorption is compromised, it can result in certain fat-soluble vitamin deficiencies because fat-soluble vitamins also need lipids for adequate absorption

True

T/F: In sodium absorption in the intestines, water will follow absorbed Na+ to maintain osmotic balance

True

T/F: In the pancreas, the acinar cells release enzymes while the centroacinar cells secrete water and HCO3-

True

T/F: In the small intestines, the frequency of the basic electrical rhythm (BER) established by the interstitial cells of Cajal (ICCs) is highest in the duodenum and steadily decreases as it travels through the jejunum and ileum subsequently

True

T/F: Interstitial cells of Cajal (ICCs) generate the slow waves of GI motility and are abundant in the myenteric plexus

True

T/F: Lipids contained in chylomicrons are able to bypass hepatic portal circulation and drain into intestinal lymphatics

True

T/F: Lower pH will inhibit the release of gastrin in the GI

True

T/F: NSAIDs (aspirin/ibuprofen) should generally be avoided in patients with severe liver disease

True

T/F: Nausea and emesis (vomiting) are two distinct, separate physiological processes

True

T/F: Nematode (round worms) infection is related to both the number and the infective stages encountered

True

T/F: Once the saliva leaves the duct of salivary glands, it is hypotonic to that of plasma

True

T/F: Pathophysiology concerning emesis (vomiting) or diarrhea can influence overall body pH

True

T/F: Pepsinogen becomes less active when patients take proton pump inhibitors (PPIs) due to less H+ secreted into the stomach

True

T/F: Pinworm infections can spread via human-to-human transmission (fecal-oral route)

True

T/F: Pregnant women are more susceptible to folate (vitamin B9) deficiency due to an increase number of rapidly proliferating cells present

True

T/F: Routine dental care is ok for patients with Peptic Ulcer Disease (PUD)

True

T/F: Segmentation contractions constitute the principal motor activity in the small intestine

True

T/F: Smooth muscle tension is myogenic and generated through the opening of L-type calcium channels

True

T/F: The Hepatitis B vaccine also protects against Hepatitis D viral infections

True

T/F: The birth dose of hepatitis B vaccine is an important part of preventing long-term illness in infants and the spread of hepatitis B in the United States

True

T/F: The disease cholera cannot persist in humans without presence of the cholera toxin

True

T/F: The enteric nervous system (myenteric and submucosal plexuses) are innervated by both the parasympathetic and sympathetic nervous systems

True

T/F: The enteric nervous system can function in the absence of extrinsic/autonomic innervation

True

T/F: The ileocecal valve is tonically contracted to prevent reflux

True

T/F: The main mechanism of diarrhea treatment is to inhibit the crypt cell cAMP pathway

True

T/F: The majority of pancreas activity is exocrine function

True

T/F: The most common jaw opening force is gravity

True

T/F: The net result of large intestinal absorption and secretion is NaCl absorption and K+/HCO3- secretion

True

T/F: The principal activity of the small and large intestine is to reabsorb NaCl and water

True

T/F: The rate of gastric emptying is chyme-dependent

True

T/F: The secretory component of secretory IgA originates as a poly-Ig receptor on the basolateral end of mucosal epithelial cells that covalently dimeric IgA before being endocytosed and subsequently released into the GI lumen

True

T/F: The unstirred water layer (a hypothetical layer of water overlaying the GI mucosa) will be a barrier to absorption of all materials, especially fat

True

T/F: The vast majority of bacteria in the GI microbiome are anaerobic, Gram-negative bacilli

True

T/F: There are no chronic infections associated with Hepatitis A virus

True

T/F: There is a low level of activity in all afferent and efferent nerves during rest of the mandible

True

T/F: Though smooth muscle contractions do not consume as much ATP as striated muscles, all three muscle types (skeletal, cardiac, and smooth) have nearly equal tension development when normalized for cross-sectional area

True

T/F: Two major indications for use of laxatives are postoperative ileus and constipation

True

T/F: Unlike the small intestine, segmentation rate increases as it progresses through the colon to allow for the reabsorption of fluid

True

T/F: Vitamins are essential and/or medically advisable when deficiencies are likely to occur

True

T/F: With regards to dental manifestations, Gastroesophageal Reflux Disease (GERD) should not be presumed at the exclusion of other possible etiologies, especially if there is a lack of typical GERD symptoms

True

T/F: With regards to intestinal motility in the fed state, increased fat in the small bowel slows the transit rate due to the high caloric content

True

______________ is a term in which increased abdominal pressure increases tension on the colonic and rectal mechanoreceptors in the process of defecating

Gastrointestinal System

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