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1. A 45 year old woman presents with dysphagia (difficulty in swallowing) for solid foods and liquids.

A barium swallow reveals dilation of the proximal esophagus, and a beak-like tapering of the distal esophagus. You correctly diagnosis achalasia and fully expect to see all of the following characteristics EXCEPT: a. increased tone in the lower esophageal sphincter (LES) b. absence of a coordinated peristaltic effort down the esophagus c. nonfunctional or absence of the esophageal intramural plexuses (i.e. ENS) *. decreased amounts of skeletal muscle along the upper third of esophagus e. simultaneous low pressure increases along the entire length of the esophagus during a swallow 2. Which of the following secretagogues or conditions is most likely to stimulate the secretion of cholecystokinin (CCK) from the duodenal mucosa? a. amino acids *. free fatty acids c. glucose d. high pH e. hypotonicity 3. What is the most common type of motility associated with the descending colon? *. haustrations b. antipropulsive movements c. mass movement d. perisatalsis e. segmentation 4.You have sat down to a scrumptious meal consisting of a spinach salad, a juicy piece of very lean filet mignion (16 oz.), a baked potato with generous gobs of butter and sour cream, and a fine glass of a robust wine. Which of the following represents the BEST order in which the above items are sequentially emptied from the stomach? a. fillet mignion, potato, wine, butter b. wine, filet mignion, potato, butter c. potato, filet mignion, butter, wine *. wine, potato, filet mignion, butter e. potato, wine, butter, filet mignion 5. Myenteric oscillation potentials are characterized as__________ slow waves which are ____________ likely to generate spontaneous action potentials. a. High amplitude & low frequency - Less b. High amplitude & low frequency - More c. Low amplitude & high frequency - Less *. Low amplitude & high frequency - More Below is a list of events that occur during the act of vomiting. 1. the LES and UES are open 2. forced inspiration against a closed glottis 3. reverse peristalsis from the mid small intestine 4. the LES is open and the UES is closed 5. relaxation of the pyloric sphincter 6. forceful contractions of the stomach 6. Indicate the correct sequence of events involved in the act of vomiting a. 5, 3, 2, 6, 4, 1 b. 3, 5, 6, 2, 1, 4 c. 3, 5, 2, 6, 1, 4 d. 5, 3, 6, 2, 1, 4 *. 3, 5, 2, 6, 4, 1

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7. Which gastrointestinal function IS NOT caused by cholecystokinin? a. contraction of the bladder *. increased rate of gastric emptying c. increased secretion of pancreatic juice rich in digestive enzymes d. potentiation of secretin-induced pancreatic secretion rich in bicarbaonate e. potentiation of secretin-induced bile production 8. Which of the following IS NOT a function of hepatocytes? a. active uptake of plasma bile acids b. synthesis of primary bile acids from cholesterol c. conjugation secondary bile acids *. conversion of bilirubin to urobilinogen e. secretion of bile acids into bile canaliculi 9. Which cells type is PROPERLY matched with its secretion? a. Enteroendocrine cell - Trypsinogen b. Chief cell - Intrinsic factor c. Parietal cell Gastrin

d. G-cell - Pepsinogen *. Enterochromaffin-like cell - Histamine

10. Which gland/organ is best represented from the above graph? a. parotid gland b. pancreatic *. gastric d. hepatic 11. By which mechanism of action does Cimetidine inhibit gastric acid secretion? *. competing for the H2 receptor b. competing for the M3 receptor c. competing for the CCK-B/Gastrin receptor d. blocking Ca4 channels e. inhibiting the proton-pump

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12. How does the autonomic nervous system affect salivary secretory rate? *. Salivary secretory rate is increased in response to parasympathetic and sympathetic stimulation. b. Salivary secretory rate is decreased in response to parasympathetic and sympathetic stimulation. c. Salivary secretory rate is increased in response to parasympathetic stimulation and decreased in response to sympathetic stimulation. d. Salivary secretory rate is decreased in response to parasympathetic stimulation and increased in response to sympathetic stimulation. 13. The transport of which substance IS NOT Na+-dependant? a. glucose *. fructose c. galactose d. proline e. tryptophan 14. One of your patients just got back from a wonderful weekend getaway to the Yucatan Peninsula (Central America). Only now, he does not feel so wonderful. He is complaining of stomach cramps and has experienced several bouts of explosive diarrhea. You immediately suspect enteritis (AKA Montazuma*s Revenge). In light of his condition, which treatment option would you suggest? a. cholinergic agonists b. Tums with Ca++ plus *. an elixir containing codeine (an opioid) d. caffeinated beverages (increases availability of cAMP) e. indomethecin (a prostaglandin E2 synthesis inhibitor) 15. Which bond is cleaved by the action of isomaltase? a. "-1, 4 glycosidic bonds of maltose *. "-1, 6 glycosidic bonds of "-limiting dextrins c. "-1, 6 glycosidic bonds of maltriose d. $-1,,4 glycosidic bond of trehalose e. $-1, 6 glycosidic bond of lactase 16. Excessive absorption of which substance is responsible for hemochromatosis? *. iron b. copper c. magnesium d. calcium e. zinc 17. A 38 year old male walks into your office complaining of abdominal pain. An upper GI series revealed the presence of a gastric ulcer. Gastrin levels are 74 pg/ml (normal range is 50 to 150 pg/ml). Hydrochloric acid levels are 2mmoles/hr (normal range is 1 to 5 mmoles/hr). Blood analysis reveals elevated levels of macrophages and other immunocytes. From the given information, this individual is most likely suffering from ___________ which is best treated with__________. *. Chronic Superficial Gastritis - antibiotics b. Crohns*s Disease - somatostatin c. Celiac Disease - opiates d. H. Pylori infection - omeprazole e. Gluten enteropathy - ipecac

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