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1. Peristaltic contractions occur in:
- A. The large intestine
- B. The small intestine
- C. The stomach
- D. The esophagus
- E. All of above
Which of the following are considered aggressive factors in the formation of peptic ulcers?
- A. H+
- B. Bicarbonate
- C. Mucus
- D. Prostaglandins
- E. None of the above
Which of the following representative G-I drugs decreases the hepatic metabolism of many other dugs?
- A. Cimetidine (H2 receptor antagonist)
- B. Misoprostol (prostaglandin analog)
- C. Omeprazole (proton pump inhibitor)
- D. Sodium bicarbonate (gastric antacid)
- E. Sucralfate (cytoprotective drug)
The following measures are necessary for the successful management of phenylketonuria, EXCEPT:
- A. Diagnosis within a few days of birth
- B. Complete removal of phenylalanine from diet
- C. Inclusion of tyrosine in diet, although tyrosine normally is not an essential amino acid
- D. Very strict control of diet during pregnancy of the PKU patient
- E. Avoidance of foods and drinks containing aspartame
5. The following statements can be made about glucose 6-phosphate, EXCEPT:
- A. It is the major regulatory point for entry into glycolysis
- B. It is converted to 6-phosphogluconate by an enzyme that may be deficient in millions of people
- C. It activates glycogen synthase
- D. It inhibits glycogen phosphorylase
- E. It is hydrolyzed by an enzyme present in the endoplasmic reticulum
Gram negative bacteria, secreting heat-stable and/or heat-labile enterotoxins, a major cause of traveler’s diarrhea:
- A. ETEC
- B. EAEC
- C. EPEC
- D. EHEC
Correct Answer: A
Rapid regulation of glucose metabolism is achieved by the following mechanisms, EXCEPT:
- A. Km of enzymes or transporters
- B. Phosphorylation and dephosphorylation of key enzymes
- C. Allosteric effectors
- D. Translocation of key proteins
- E. Gene expression control by diet or other environmental factors
Correct Answer: E
Which of the following statements is correct regarding the gross and histological liver lesions above ?
- A. Figs 1 and 3 show the gross and histological appearance of the liver of a patient who died of a acute hepatitis
- B. Figs 1 and 2 show the gross and typical histological appearance of a patient who died of terminally cirrhotic liver
- C. Figs 4 and 2 show the gross and histological appearance of a cirrhotic liver
- D. Figs 3 and 4 show the liver lesions of a patient who died of a hepatocellular carcinoma
- E. Figs 2 and 4 illustrate gross and histological liver lesions that can develop in patients as an outcome of the gross and histological liver lesions shown in Figs 1 and 3
All of the following organs can secrete bicarbonate into the lumen, EXCEPT?
- A. Stomach
- B. Pancreas
- C. Liver
- D. Small intestine
- E. A and D
Liver plays a major role in assisting other organs for the reasons given below, EXCEPT:
- A. Because its glucose transporter has a high Km, it takes in very little glucose when plasma glucose concentration is low
- B. It can convert fatty acids to glucose
- C. It lacks an en3-carbon precursors sent by other organs and return them as glucose
- E. It can used its stored glycogen to make glucose for other organs
Which of the following signs and symptoms in someone with occasional heartburns is alarming?
- A. Dysphagia
- B. Hemoptysis
- C. Hoarseness
- D. A and C
Which of the following molecules stimulates gastric acid secretion?
- A. HCl
- B. Acetylcholine
- C. Secretin
- D. Cholecystokinin
- E. Somatostatin
Which statement best describes vitamin B12?
- A. It is required for the regeneration of methionine from homocysteine
- B. It is required for transamination reactions
- C. It cannot be synthesized by animals but is abundant in green plants.
- D. It participates in numerous methylation reactions
- E. It is absorbed in the stomach
One of the conditions listed is not etiologically or clinically associated with gallstone disease.
- A. Acute pancreatitis
- B. Hyperandrogenism
- C. Obesity
- D. Biliary-enteric fistula
- E. Sepsis
In a prolonged fast, all the following happen EXCEPT:
- A. The body adapts to using its fat stores
- B. The liver exports ketone bodies and fatty acids
- C. Adipose tissue hydrolyzes triglycerides
- D. The liver stops providing glucose to other organs
- E. Muscle breakdown provides amino acids to the liver
In trying to explain how Statins (a class of drugs) function, your friend makes one error. Identify the erroneous statement.
- A. Most cells in the body obtain cholesterol by two mechanisms; from uptake of cholesterol-rich LDL and from synthesis of cholesterol within the cell.
- B. When cells accumulate excess cholesterol they respond by inhibiting the transcription of the genes encoding the LDL receptor and HMG-CoA reductase.
- C. The binding of Statins to HMG-CoA reductase in the liver results in inhibition of enzyme activity and a decrease in cholesterol synthesis.
- D. Patients taking Statins would be expected to have increased levels of the LDL receptor on the liver surface.
- E. Statin treatment is usually stopped after blood cholesterol levels fall below 150 mg/dl.
Which of the following enzymes doesn’t need activation after secretion?
- A. Pepsin
- B. Lipase
- C. Trypsin
- D. Carboxypeptidase
- E. Chymotrypsin
All of the following inhibit emptying of the stomach, EXCEPT:
- A. Acid duodenal contents
- B. Gastric distension
- C. Hyperosmolar solution in the duodenum
- D. Presence of fat in the duodenum
- E. Duodenal distension
The small intestine produces which of the following enzymes?
- A. Lipase
- B. Chymotrypsin
- C. Pepsin
- D. Enterokinase
- E. Carboxypeptidase
A 38 year old overweight woman is brought to the emergency room. She has severe abdominal pain, hypotension, bruising and oral bleeding. Two hours later she also shows bleeding from other mucosas, then goes into shock and in spite of support therapy dies 12 hours later. An autopsy is carried out. Fig. 1 is a photograph of the peritoneal fat (outlined). Fig. 2 is a photograph of the patient's pancreas. Which of the statements below is correct?
- A. The patient had a carcinoma of the pancreas that caused diseminated intravascular coagulation and was the cause of bleeding
- B. The patient had a pancreatic adenocarcinoma which obstructed the bile duct and caused the jaundice that lead to her death.
- C. The patient died from a common form of acute, fulminant hepatitis type A
- D. The patient died of liver cirrhosis. Cirrhosis causes Jaundice and this is why the pancreas and the peritoneal fat look yellow.
- E. The patient was not jaundiced. She had an acute pancreatitis with fat necrosis. Bleeding was due to Diseminated Intravascular coagulation, associated with this disease.
Which of the following statements best describes gluconeogenesis?
- A. Generates energy in the form of ATP
- B. Utilizes the unique enzyme, phosphofructokinase 1
- C. It is an important pathway in muscle
- D. Requires the action of glucose 6-phosphatase
- E. Occurs soon after feeding
Which of the following serologic markers is positive in someone who has immunity to hepatitis B through vaccination?
- A. Anti-HBc
- B. Anti-HBe
- C. Anti-HBs
- D. HBeAg
- E. HBcAg
Which of the following molecules is absorbed primarily in the ileum?
- A. Vitamin D
- B. Peptide
- C. Fatty acid
- D. Bile acid
- E. Glucose
Cholecystokinin (CCK) can have all of the following physiological effects, EXCEPT:
- A. Stimulation of bile production in the liver
- B. Stimulation of bile release from gallbladder
- C. Stimulation of relaxation of the Sphincter of Oddi
- D. Stimulation of the secretion of pancreatic enzymes
- E. Inhibition of gastric acid secretion
Type I diabetes differs from type II in the following respects, EXCEPT:
- A. There is less genetic predisposition to type I than to type II
- B. Type I is less common than type II
- C. Type I involves accumulation of VLDL whereas type II does not
- D. Type I is an autoimmune disease, whereas type II is not
- E. Insulin level is very low in type I but may be high in type II
One of the following statements about the urea cycle is incorrect. Identify the incorrect statement:
- A. Failure of the urea cycle is always an emergency
- B. The urea cycle is controlled by transcriptional regulation
- C. All reactions of the urea cycle occur in mitochondria
- D. Ornithine is an important participant in the cycle but is not used up
- E. The role of the urea cycle is to remove ammonia from the circulation
Which of these statements about Helicobacter pylori infection is incorrect?
- A. Once it overwhelms the pre-epithelial defense barrier, this intracellular microorganism invades the mucous neck cells causing chronic gastritis and ulceration.
- B. It produces cytotoxins that disrupt the tight junctions between gastric epithelial cells.
- C. One of the known outcomes of this infection is the development of gastric lymphoma
- D. Diagnosis of this infection is often reached by endoscopical biopsy and visualization of the microorganism with silver or Giemsa stains
- E. One of the known outcomes of this infection is the development of gastric adenocarcinima.
One statement about fatty acid metabolism is incorrect.
- A. Beta-oxidation requires that fatty acids in the cytosol be activated to fatty acyl- CoA before they can be transferred across both the outer and inner mitochondrial membranes
- B. Beta-oxidation of fatty acids in the liver is increased in fasting, starvation and in Type 1 diabetes.
- C. During starvation, the brain obtains energy by taking up and metabolizing ketone bodies and fatty acids from the blood.
- D. Ketone bodies are water soluble so they are not transported in lipoproteins.
- E. In the fed state, malonyl CoA generated in the liver inhibits the transfer of acyl-CoAs into the mitochondria, thus inhibiting beta-oxidation.
Colon cancer is more likely to occur in individuals with:
- A. Irritable bowel syndrome
- B. Crohn’s disease
- C. Diverticulitis
- D. Ulcerative colitis
Which of the following organisms is not a food-poisoning pathogen?
- A. Clostridium difficile
- B. Clostridium botulinum
- C. Listeria monocytogenes
- D. Staphylococcus aureus
Which statement best describes protein metabolism?
- A. Proteins are the best source of energy
- B. Protein malnutrition is very rare in the USA
- C. Proteins have a low turnover rate
- D. All food proteins are equally good
- E. Protein in the diet provides essential amino acids
TRUE or FALSE: The right half of this cartoon represents a hepatic acinus. Severe anemia can result in coagulative necrosis in zone 1
Correct Answer: False
Which of the statements below regarding the Disse space is correct?
- A. It is where the exocrine function of the hepatocyte takes place.
- B. It is where the Kupffer cells reside and carry out their functions
- C. It is the site where the secretion of prothrombin by the hepatocyte takes place.
- D. The hepatocyte apical cell wall is in intimal contact with this space.
- E. It contains blood
One statement is incorrect about the absorption of dietary lipids and their subsequent metabolism.
- A. Uptake of cholesterol from the diet requires a specific transporter protein (called NPC1L1) that is localized to the surface of enterocytes.
- B. The drug Ezetimibe blocks the diffusion of dietary fatty acids from the intestinal lumen into the enterocyte.
- C. Hydrolysis of triglycerides in the core of chylomicrons results in the release of fatty acids and glycerol.
- D. The liver contains cell surface receptors that bind to chylomicron remnants and internalize them into the cell.
- E. In a normal person, both chylomicrons and chylomicron remnants are absent from the blood after a 12 hour fast.
Which of the statements below about ischemic bowel disease is incorrect?
- A. It can often occur during the course of a chronic progressive diverticulitis.
- B. It can occur in patients with vegetative endocarditis
- C. It can be a complication of left atrial fibrillation with thrombo-embolism
- D. It can result from thrombosis of a mesenteric artery
- E. It is more common in the elderly than in the young
The gross and histological lesions shown above consist of necrosis of the colonic mucosa with acute fibrino-hemorrhagic exudate with pseudomembrane formation. Which of the following statements is correct regarding the likely etiology of this lesion?
- A. It is the typical lesion of celiac sprue
- B. It is the typical lesion found in Patients with ulcerative colitis
- C. It is the typical lesion found in patients with intestinal tuberculosis
- D. It is the typical lesion found in patients with Clostridium difficile infections
- E. It is the typical lesion caused by Clostridium botulinum infections
Which of the abnormalities below occurs as a consequence of hepatic failure?
- A. hyperalbuminemia
- B. Hypo gamma globulinemia
- C. hemolysis
- D. Coagulopathy
- E. Chronic venous congestion and edema in the lower extremities
Which of the diseases in this list is characterized by the formation of "skip" lesions?
- A. Celiac sprue
- B. Crohn's disease
- C. Autoimmune gastritis
- D. Barrett's disease
- E. Ulcerative colitis
The significance of Barrett’s esophagus is:
- A. Infection with Helicobacter pylori
- B. Potential for malignant transformation
- C. Predisposition for hiatal hernia development
- D. None, it is an incidental finding during endoscopy
Different lipoproteins have been associated with various diseases, or appear to protect people from certain diseases. Which statement is incorrect?
- A. Blood HDL levels are usually higher in pre-menopausal women than in men of a similar age.
- B. HDL levels are generally increased significantly in individuals who exercise strenuously each week.
- C. HDL is produced in the plasma from LDL.
- D. Patients with Familial Hyperlipidemia (FH) have LDL levels that are often in excess of 500 mg/dl.
- E. HDL is the smallest sized lipoprotein, but it does contain some cholesterol.