SBPM Multiple Choice #5
April 1, 2003
1. Which of the following is correct?
a.
b.
c.
d.
Bile stored in the gallbladder is hypertonic to plasma, but isotonic to canalicular bile.
The liver secretes bile only intermittently, in response to food ingestion.
Secretin-dependent excretion of water and bicarbonate in the distal bile ductules does not increase the rate of flow of
canalicular bile.
Electrolyte concentrations in bile are identical to those in plasma.
2. Pernicious Anemia results from a deficiency (lack of availability to cells) of:
a.
b.
a.
b.
Iron
Cobalamin
Folic acid
Calcium
3. Which of the following events increases upon reduction of body weight?
a. parasympathetic nervous system tone
b. 24 hour energy expenditure
c. resting energy expenditure
d. residual calories
4. Events associated with lipid metabolism are listed below. What is the correct order of
these events?
I. Association with chylomicrons
II. Emulsification using bile
III. Esterification of fatty acids to form triglycerides
IV. Hydrolysis of ester bonds in triglycerides producing glycerol and free fatty acids
a.
b.
c.
d.
IIIIIIVI
IVIIIIII
IIIVIIII
IVIIIIII
5. Rank in order of most hydrophilic to least hydrophilic.
Primary Bile Salts
Secondary Bile Salts
Cholesterol
Conjugated primary Bile salt
6. Which of the following statements regarding drug detoxification is true:
a)
b)
c)
d)
e)
detoxification pathways are not used in hepatocytes of patients who are not taking any drugs
the Golgi apparatus contains the majority of the enzymes necessary for detoxification pathways
mutations in p450 enzymes hamper the liver’s ability to covalently attach water soluble carrier molecules to oxidized
drugs
While hepatocytes are metabolizing drugs, the drugs are mostly compartmentalized, and do not freely float in the
cytosol
Phase I reactions have more of an effect on water solubility than Phase II reactions
7. The mechanism of excretion of K+ ingested from a person’s diet primarily involves
a)
b)
c)
d)
decreased reabsorption of K+ by the proximal tubule and loop of Henle and increased secretion of K+ by the distal
segments
increased aldosterone secretion, increased secretion of K+ by the distal segments and increased urinary flow rate
increased ADH secretion, increased secretion of K+ by the proximal segments and increased urinary flow rate
increased aldosterone secretion and decreased reabsorption of K+ by the proximal tubule and loop of Henle
8. A patient presents in the ER with a BP of 90/60, dry mucous membranes and ABG values of pH 7.56, [HCO 3-] 50 mEq/L and
pCO2 58 mm Hg, what type of acid-base abnormality is this and which of the following responses would you also expect to see in
this patient?
a)
b)
c)
d)
metabolic alkalosis, hyperventilation
respiratory alkalosis, decreased K+ secretion by the distal tubules
metabolic alkalosis, exchange of intracellular H+ for extracellular K+
respiratory alkalosis, increased ratio of H2PO4- to HPO4-2 in the urine
9. Which of the following associations is INCORRECT?
a)
b)
c)
d)
cardiac arrhythmia --- hyperkalemia
flaccid paralysis --- hypokalemia
type 1 diabetes mellitus --- hyperkalemia
β-blockers --- hypokalemia
10. Match the ENS transmitters with their functions
a. 5HT3
b. 5HT1p
c. 5HT4
______activate myenteric IPAN with transmission to extrinsic sensory neurons
______activate submucosal IPAN
______enhance pre-synaptic release of submucosal IPAN vescicles
11. Match these drugs with their functions
a. Ondansetron
b. Tegaserod
c. SSRI
______5-HT3 antagonist
______5-HT4 agonist
______ SERT inhibitor
12. What happens to patients with IBS patients who have SERT mutations that fail to recycle serotonin?
a.
b.
c.
d.
diarrhea
constipation
alternative diarrhea and constipation
bloody stool
13. Which of the following correctly describes the some of the body’s afferent and efferent responses to high sodium intake and
volume expansion?
A.
High salt intake stimulates firing of the sympathetic nerves, which increases the amount of epinephrine and norepinephrine
circulating. This allows vasodilatation, which increases the capacity of the circulatory system to accommodate the large
ECV.
B. Increased salt intake is sensed by osmoreceptors in the hypothalamus, which responds by increasing its synthesis and
release of aldosterone, which tells the kidney to retain water.
C. Increased ECV is sensed by volume receptors in the heart and carotid arteries, which causes inhibition of the sympathetic
nervous system. In the absence of sympathetic stimulation, the kidney produces less renin, and consequently there is less
Angiotensin II circulating and sodium reabsorption decreases.
D. Volume receptors sense an increase in ECV and provoke the release of antidiuretic hormone (ADH) from the adrenal
cortex, causing the collecting duct to become more permeable to NaCl, thus allowing more to be excreted.
E. Volume receptors in the left atrium cause release of atrial natriuretic peptide (ANP) from myocytes, which decreases GFR
by constricting the afferent arteriole.
14.When compared to normal steady state, what effect would severe dehydration have on the relationship between plasma
osmolality and plasma [ADH]?
A.
B.
C.
D.
E.
Lower set point, shallower curve
Lower set point, steeper curve
Higher set point, shallower curve
Higher set point steeper curve
No change
15. Which one of the following is NOT part of the glomerular filtration barrier?
a. Capillary endothelial cells
b. Type IV collagen
c. Podocytes
d. Mesangial cells
16. The concentration of creatinine in a patient's plasma is 0.6 mg/ml. You collect the urine produced by the patient over 24
hours (1.2L) and find that the concentration of creatinine in the urine is 70 mg/ml. What is the patient's GFR?
a. 68 ml/min
b. .007 ml/min
c. 97 ml/min
d. 140 ml/min
17. Which of the following is not true?
a) secretin is the main stimulus for bicarb secretion in the pancreas
b) hyperosmolarity is a stimulus to secretion
c) digestive enzymes are released in a fixed ratio upon stimulation
d) acetylcholine directly causes the release of secretin
18. Which of the following is not part of GIP's action?
a) inhibition of gastrin stimulated secretion
b) inhibition of gastric motility
c) stimulation of insulin release
d) acceleration of gastric emptying time