Block 1 QuizAllison Gourley & Susan Rutherford

Which one of the following is true regarding the stomach?

• Parietal cells produce gastrin• It is involved in iron absorption• It is lined by squamous epithelium• Contains chief cells which secrete pepsinogen• Luminal pH is between 3 and 4

1.

What does the inferior mesenteric artery supply?

From the duodenum to the first two-thirds of the transverse colon

From the oesophagus to the duodenum, also the liver and stomach

From the splenic flexure to the first third of the rectum

The greater curvature of the stomach

The last two thirds of the rectum

2.

What is the function of chylomicrons?

• To move lipids from the adipocytes to the liver• To move lipids from the arterial walls to the liver• To move lipids from the gut to the liver • To move lipids from the liver to the adipocytes• To move lipids from the liver to the arterial walls

3.

Where is transitional epithelium found?

Antrum of stomach

Bladder

Bronchi

Liver

Oesophagus

4.

In which part of the GI tract are Brunner’s glands found?

• Duodenum• Ileum• Jejunum• Salivary glands• Stomach

5.

Which one of the following is true regarding the stomach?

• Parietal cells produce gastrin• It is involved in iron absorption• It is lined by squamous epithelium• Contains chief cells which secrete pepsinogen• Luminal pH is between 3 and 4

✔

What does the inferior mesenteric artery supply?

From the duodenum to the first two-thirds of the transverse colon

From the oesophagus to the duodenum, also the liver and stomach

From the splenic flexure to the first third of the rectum

The greater curvature of the stomach

The last two thirds of the rectum

✔

The coeliac axis supplies the liver and stomach, and from the oesophagus to the first half of the duodenum.

The second half of the duodenum to the first two-thirds of the transverse colon is supplied by the superior mesenteric artery.

The inferior mesenteric supplies the last third of the transverse colon (approximately from the splenic flexure) to the first third of the rectum.

The last two thirds of the rectum are supplied by the middle rectal artery.

The greater curvature of the stomach is supplied by branches of the splenic artery, which itself comes from the coeliac axis.

What is the function of chylomicrons?

• To move lipids from the adipocytes to the liver

• To move lipids from the arterial walls to the liver

• To move lipids from the gut to the liver • To move lipids from the liver to the

adipocytes• To move lipids from the liver to the arterial

walls

✔

Where is transitional epithelium found?

Antrum of stomach

Bladder

Bronchi

Liver

Oesophagus

✔

Transitional epithelium is found in the ureters and bladder.

A transitional epithelium is found in the bladder, the ureters and the renal pelvis.

The antrum of the stomach is formed of a simple cuboidal epithelium with deep pits and goblet (mucus) cells.

The bronchi are lined by a pseudostratified, ciliated epithelium.

The liver has a simple cuboidal epithelium formed of plated of hepatocytes.

The oesophagus has a stratified squamous epithelium.

In which part of the GI tract are Brunner’s glands found?

• Duodenum• Ileum• Jejunum• Salivary glands• Stomach

Brunner's glands tortuous coiled glands formed of secretory ductular cells that produce a highly alkaline fluid. This is used by the duodenum to neutralise incoming gastric acid. Brunner's glands are found relatively deep in the submucosa and are a prominent feature on histology - they are unique to

the duodenum.

✔

In which of the following conditions are you likely to find unconjugated

hyperbilirubinaemia?

• Cholelithiasis• Biliary atresia• Carcinoma of head of pancreas• Sickle cell anaemia• Cholecystitis

6.

What cells are responsible for drug metabolism in the liver?

• Zone I hepatocytes• Zone II hepatocytes• Zone III hepatocytes• Kuppfer cells• Stellate cells

7.

Which one of the following organs is in direct contact with the anterior surface of the left kidney, without being separated by the peritoneum?

• Duodenum• Jejunum• Pancreas• Spleen• Stomach

8.

In the pancreas, what is the role of delta cells?

• Produce glucagon• Produce insulin• Produce pancreatic polypeptide• Produce somatostatin• Produce trypsin

9.

What is the function of aldosterone within the renin-angiotensin-aldosterone system?

• Lowers blood pressure• Causes the kidney to excrete sodium and reabsorb

water• Causes the kidney to excrete sodium and reabsorb

potassium• Causes the kidney to excrete potassium and reabsorb

sodium• Aldosterone causes vasoconstriction of the afferent

arteriole

10.

In which of the following conditions are you likely to find unconjugated

hyperbilirubinaemia?

• Cholelithiasis• Biliary atresia• Carcinoma of head of pancreas• Sickle cell anaemia• Cholecystitis

Unconjugated hyperbilirubinaemia is caused by pre-hepatic pathology.In hereditary spherocytosis, the liver is unable to cope with the breakdown of red blood cells as occurs in sickle cell, hereditary spherocytosis.

✔

What cells are responsible for drug metabolism in the liver?

• Zone I hepatocytes• Zone II hepatocytes• Zone III hepatocytes• Kuppfer cells• Stellate cells

✔

Functional Zonation of Liver Lobules

Zone I periportal hepatocytes:

most oxygenated, specialize in

oxidative metabolism,

gluconeogenesis and urea

synthesis.

Zone II

Zone III pericentral hepatocytes:

least oxygenated, specialize in drug

metabolism, glycolysis and

lipogenesis.

IIIIII

Which one of the following organs is in direct contact with the anterior surface of the left kidney, without being separated by the peritoneum?

• Duodenum• Jejunum• Pancreas• Spleen• Stomach

The only retroperitoneal structure given in the answers is the pancreas, the body of which is in direct approximation to the anterior surface of the left kidney. The adrenal gland and colon are also in direct contact with the anterior surface of the left kidney.

✔

In the pancreas, what is the role of delta cells?

• Produce glucagon• Produce insulin• Produce pancreatic polypeptide• Produce somatostatin• Produce trypsin

✔

What is the function of aldosterone within the renin-angiotensin-aldosterone system?

• Lowers blood pressure• Causes the kidney to excrete sodium and reabsorb

water• Causes the kidney to excrete sodium and reabsorb

potassium• Causes the kidney to excrete potassium and reabsorb

sodium• Aldosterone causes vasoconstriction of the afferent

arteriole

10.

✔

What is metaplasia?

• Acquisition of growth-promoting mutations• Change of one fully differentiated epithelium for

another• Increase in size of epithelial cells• Invasion of neoplastic cells• Normal division of epithelial cells

11.

In relation to the kidney, which of the following is virtually impermeable to water?

• Ascending limb of the Loop of Henle• Descending limb of the Loop of Henle• Collecting duct• Distal convoluted tubule• Proximal convoluted tubule

12.

A 25 year old female presents to A&E complaining of dysuria and pain in her back, moving into her groin. She is pyrexial and you suspect a diagnosis of pyelonephritis. As part of the examination, you ballot the kidneys. At what vertebral level do the kidneys normally lie?

• T11-L1/2. The right kidney is lower than the left• T11-L1/2. The right kidney is higher than the left• T11-L2/3. The right kidney is lower than the left• T11-L2/3. The right kidney is higher than the left• Both kidneys are found at T11-L1.

13.

• De Quervain’s thyroiditis• Dietary iodine insufficiency• Grave’s disease• Hashimoto’s thyroiditis• Pituitary tumour

A 43 year old woman presents with a 6 month history of symptoms suggestive of thyroid disease. These include weight loss, diarrhoea, heat intolerance and irritability. On examination you find a goitre and exophthalmos. Which of the following is the most likely cause?

14.

A woman presents with a 5 day history of itching, redness and unusual discharge from her vagina. You suspect Trichomoniasis.

What specific inflammatory cell would you expect to be raised as a result of parasitic infection?

• Basophil• B cell lymphocyte• Neutrophil• Eosinophil• Macrophage

15.

What is metaplasia?

• Acquisition of growth-promoting mutations• Change of one fully differentiated epithelium for

another• Increase in size of epithelial cells• Invasion of neoplastic cells• Normal division of epithelial cells

✔

In relation to the kidney, which of the following is virtually impermeable to water?

• Ascending limb of the Loop of Henle• Descending limb of the Loop of Henle• Collecting duct• Distal convoluted tubule• Proximal convoluted tubule

✔

A 25 year old female presents to A&E complaining of dysuria and pain in her back, moving into her groin. She is pyrexial and you suspect a diagnosis of pyelonephritis. As part of the examination, you ballot the kidneys. At what vertebral level do the kidneys normally lie?

• T11-L1/2. The right kidney is lower than the left• T11-L1/2. The right kidney is higher than the left• T11-L2/3. The right kidney is lower than the left• T11-L2/3. The right kidney is higher than the left• Both kidneys are found at T11-L1.

✔

A 43 year old woman presents with a 6 month history of symptoms suggestive of thyroid disease. These include weight loss, diarrhoea, heat intolerance and irritability. On examination you find a goitre and exophthalmos. Which of the following is the most likely cause?

• De Quervain’s thyroiditis• Dietary iodine insufficiency• Grave’s disease• Hashimoto’s thyroiditis• Pituitary tumour

These symptoms suggest thyrotoxicosis. The only answer that fits is Grave’s disease, where autoantibodies stimulate the thyroid TSH receptor.

✔

A woman presents with a 5 day history of itching, redness and unusual discharge from her vagina. You suspect Trichomoniasis.

What specific inflammatory cell would you expect to be raised as a result of parasitic infection?

• Basophil• B cell lymphocyte• Neutrophil• Eosinophil• Macrophage✔

A patient presents with polyuria, polydipsia and weight loss. She complains that she is waking up over night needing to use the toilet.

What is a normal urine output per day?

• 800mL• 1000mL• 1250mL• 1500mL• 2000mL

16.

FiO2 0.21pH 7.54 (7.35 – 7.45)PaO2 7.8 kPa (11 – 15 kPa)PaCO2 3.9 kPa (4.6 – 6.4 kPa)HCO3

- 25mmol/l (22 – 30 mmol/l)

• Metabolic Acidosis• Metabolic Alkalosis• Respiratory Acidosis• Respiratory Alkalosis• Respiratory Acidosis with compensation

A patient presented to A+E with shortness of breath. You decide to do an ABG. What type of acid base imbalance does this patient have?

17.

A 54 year old presents in clinic with a swelling in his right groin. On examination the swelling is superior and medial to the pubic tubercle. It is non-tender, easily reducible and has a positive cough impulse. An inguinal hernia is suspected.

What is the anatomical structure that sits above the mid-point of the inguinal ligament?

• External iliac artery• Femoral nerve• Deep inguinal ring• Inferior epigastric vessel• Superficial inguinal ring

18.

A 78-year old man has chronic kidney disease due to his poorly controlled diabetes. His current eGFR is 32 ml/min/1.73m2. What stage of kidney disease is he?

• Stage 1• Stage 2• Stage 3a• Stage 3b• Stage 4• Stage 5

19.

A 43 year old female presents to her GP complaining of heartburn. She suffers from back pain for which she regularly takes ibuprofen. What medication should you prescribe?

• Sodium alginate• Magnesium hydroxide• Loperamide• Lactulose• Omeprazole

20.

A patient presents with polyuria, polydipsia and weight loss. She complains that she is waking up over night needing to use the toilet.

What is a normal urine output?• 800mL• 1000mL• 1250mL• 1500mL• 2000mL✔

Below is an arterial blood gas (ABG) result taken just before patient was started on treatment. What type of acid-base balance disorder does this patient have?

FiO2 0.21pH 7.54 (7.35 – 7.45)PaO2 7.8 kPa (11 – 15 kPa)PaCO2 3.9 kPa (4.6 – 6.4 kPa)HCO3

- 25mmol/l (22 – 30 mmol/l)

• Metabolic Acidosis• Metabolic Alkalosis• Respiratory Acidosis• Respiratory Alkalosis• Respiratory Acidosis with compensation✔

In response to low oxygen in the arterial blood, this patient increased their respiratory rate, the increased ventilation caused ‘blowing off’ of carbon dioxide from the lungs leading to reduced CO2 in the blood. Reduced CO2 in the blood leads to an increase in pH. There is no evidence of compensation as bicarbonate remains in the normal range.

A 54 year old presents in clinic with a swelling in his right groin. On examination the swelling is superior and medial to the pubic tubercle. It is non-tender, easily reducible and has a positive cough impulse. An inguinal hernia is suspected.

What is the anatomical structure that sits above the mid-point of the inguinal ligament?

• External iliac artery• Femoral nerve• Deep inguinal ring• Inferior epigastric vessel• Superficial inguinal ring

The mid-point of the inguinal ligament is defined as the mid-point between the ASIS and Pubic tubercle. It is commonly used to find the area of the deep inguinal ring.

✔

A 78-year old man has chronic kidney disease due to his poorly controlled diabetes. His current eGFR is 32 mL/min/1.73m2. What stage of kidney disease is he?

• Stage 1• Stage 2• Stage 3a• Stage 3b• Stage 4• Stage 5

✔

A 43 year old female presents to her GP complaining of heartburn. She suffers from back pain for which she regularly takes ibuprofen. What medication should you prescribe?

• Sodium alginate• Magnesium hydroxide• Loperamide• Lactulose• Omeprazole

20.

✔

A 19 year old man who suffers from depression is admitted to hospital following a suspected paracetamol overdose. You can see that he is jaundiced and are concerned about his liver function. What mechanism is responsible for paracetamol-induced liver injury?

• Inhibition of CYP3A leading to reduced clearance of paracetamol

• Saturation of the phase I oxidation pathway • Saturation of the phase I reduction pathway• Saturation of the phase II pathway• Saturation of the phase III pathway

21.

How does glucose enter beta cells?

• Along its concentration gradient• Co-transportation with calcium• GLUT-1 receptor• GLUT-2 receptor• GLUT-4 receptor

22.

A 64 year old man presents to the GP. He has been taking co-codamol for a week due to pain in his joints and has returned complaining of constipation. You decide to prescribe lactulose. What kind of drug is lactulose?

• Bulk laxative• Faecal softener• Alginate• Stimulant purgative• Osmotic laxative

23.

What is the origin of the blood supply to the pancreas?

• Coeliac trunk• Superior mesenteric artery• Inferior mesenteric artery• 1 & 2• 2 & 3

24.

A 19 year old man who suffers from depression is admitted to hospital following a suspected paracetamol overdose. You can see that he is jaundiced and are concerned about his liver function. What mechanism is responsible for paracetamol-induced liver injury?

• Inhibition of CYP3A leading to reduced clearance of paracetamol

• Saturation of the phase I oxidation pathway • Saturation of the phase I reduction pathway• Saturation of the phase II pathway• Saturation of the phase III pathway

21.

✔

How does glucose enter beta cells?

• Along its concentration gradient• It is co-transported with calcium• GLUT-1 receptor• GLUT-2 receptor• GLUT-4 receptor

22.

✔

A 64 year old man presents to the GP. He has been taking co-codamol for a week due to pain in his joints and has returned complaining of constipation. You decide to prescribe lactulose. What kind of drug is lactulose?

• Bulk laxative• Faecal softener• Alginate• Stimulant purgative• Osmotic laxative

23.

✔

What is the origin of the blood supply to the pancreas?

• Coeliac trunk• Superior mesenteric artery• Inferior mesenteric artery• 1 & 2• 2 & 3

24.

✔