BECOM 2 Exam 4 – 2020

Session 110 – Anterior Pituitary

1. Growth Hormone is mediated by what signalling cascade?

  1. RTK

  2. GPCR

  3. JAK2/STAT

  4. Wnt

  5. Adrenergic Receptor Pathway

 

2. Excess ACTH is very common in Addison’s disease and can present as…?

  1. HyperCalcemia

  2. Amenorrhea

  3. Hyperglycemia

  4. Hyperpigmentation

  5. Loss of pubic and axillary hair

 

3. Prolonged administration of Glucocorticoids can lead to a suppression of…?

  1. ACTH release

  2. TSH release

  3. GH release

  4. Dopamine release

  5. Cortisol release

4. A patient presenting with hyperprolactinemia is at a high risk of developing …?

  1. Dopamine resistance

  2. Breast Cancer

  3. Bone density loss

  4. Congenital Adrenal Hyperplasia

  5. TRH resistance

 

5. A 30 year old male patient has been experiencing excessive growth hormone release for many years. What condition will he have developed?

  1. Gigantism

  2. Galactorrhea

  3. Pituitary Dwarfism

  4. Acromegaly

  5. Amenorrhea

 

6. What hormone does somatostatin inhibit?

  1. ACTH

  2. TSH

  3. GH

  4. PRL

  5. LH

 

7. Which releasing hormone increases secretion of both TSH and Prolactin from the Adenohypophysis? 

  1. CRH

  2. TRH

  3. GHRH

  4. GNRH

  5. PRH

 

8. Which releasing hormone increases secretion of both LH and FSH from the Adenohypophysis? 

  1. CRH

  2. TRH

  3. GHRH

  4. GnRH

  5. PRH

 

9. Which releasing hormone increases secretion of ACTH from the Adenohypophysis? 

  1. CRH

  2. TRH

  3. GHRH

  4. GNRH

  5. PRH

10. Which hormone stimulates the development of ovarian follicles and regulates spermatogenesis in the testes?

  1. ACTH

  2. TSH

  3. GH

  4. FSH

  5. LH

 

11. Which hormone stimulates the production of estrogen, progesterone, and testosterone while also being responsible for ovulation and formation of the corpus luteum?

  1. ACTH

  2. TSH

  3. GH

  4. FSH

  5. LH

12. Which hormone is responsible for stimulating postnatal body growth and triglyceride lipolysis while inhibiting insulin action on carbohydrates and lipid metabolism?

  1. ACTH

  2. TSH

  3. GH

  4. FSH

  5. LH

 

13. Which of the following pairs of amino acids can induce the secretion of Growth Hormone?

  1. Arginine and Cysteine

  2. Leucine and Isoleucine

  3. Threonine and Cysteine

  4. Leucine and Cysteine

  5. Arginine and Leucine

 

Session 111 – Posterior Pituitary

14. Which of the following forms the posterior pituitary during development?

  1. Roof of the oral cavity

  2. Neuroendocrine System

  3. 3rd Pharyngeal Arch

  4. 4th Pharyngeal Arch

  5. Intermediate Mesoderm

 

15. Where is oxytocin produced?

  1. Infundibulum

  2. Anterior Pituitary

  3. Supraoptic Nucleus

  4. Anteromedial Nucleus

  5. Paraventricular nucleus

 

16. Why does more oxytocin get produced during pregnancy?

  1. High levels of progesterone from the corpus luteum suppress estrogen causing oxytocin to be released.

  2. Low levels of progesterone cause metabolic acidosis causing oxytocin to be released

  3. High levels of estrogen during pregnancy causes oxytocin to be released

  4. Low levels of estrogen cause oxytocin release to cause contractions of the myometrium of the uterus

  5. Equal levels of progesterone and estrogen help keep a stable environment in the uterus, so oxytocin is released to monitor any changes.

 

17. Where is ADH produced in the brain?

  1. Anterior Pituitary

  2. The Lungs

  3. Paraventricular nucleus

  4. Supraoptic Nucleus

  5. Edinger Westphal Nucleus

 

18. SIADH is characterized by hyponatremia, concentrated urine, and elevated urinary Na+. What effect would an overproduction of ectopic ADH by a paraneoplastic syndrome have on the secretion of ADH by the posterior pituitary?

  1. Decreased secretion of ADH by the supraoptic nucleus

  2. Increased secretion of ADH by the supraoptic nucleus

  3. Decreased secretion of ADH by the paraventricular nucleus

  4. Increased secretion of ADH by the paraventricular nucleus

  5. There would be no change in the secretion of ADH by the posterior pituitary

Session 112 – Adrenal Cortex and Medulla

19. A deficiency in 17⍺-hydroxylase (CYP17A1) results in reduced production of which of the following steroid pathways?

  1. Androgens

  2. Glucocorticoids (cortisol)

  3. Mineralocorticoids (aldosterone)

  4. A and B

  5. B and C

 

20. A deficiency in 21-hydroxylase (CYP21A2) results in reduced production of which of the following steroid pathways?

  1. Androgens

  2. Glucocorticoids (cortisol)

  3. Mineralocorticoids (aldosterone)

  4. A and B

  5. B and C

 

21. Which of the following would result in an increase in aldosterone production via the Renin-Angiotensin-Aldosterone pathway?

  1. Dehydration

  2. Hypernatremia 

  3. Increase in blood pressure

  4. Increase in blood volume

  5. Use of ACE-inhibitor

 

22. Which of the following effects of aldosterone remains constant despite the effects of aldosterone escape?

  1. Hypertension

  2. Hypotension

  3. Sodium retention

  4. Sodium secretion

  5. Water retention

    Following excess aldosterone levels for extended time, the patient’s natriuresis and diuresis will return to normal levels (no longer inhibited by aldosterone), but the patient will remain hypertensive.

 

23. Which of the following disorders of aldosterone function is correctly described below?

  1. Hyperaldosteronism results in hypertrophy of the zona reticularis

  2. Primary hyperaldosteronism causes hypertension and hypernatremia

  3. Primary hyperaldosteronism results from a hyposecreting adrenal tumor

  4. Secondary hyperaldosteronism is also known as Conn’s syndrome

  5. Secondary hyperaldosteronism results from overactivation in the renin-angiotensin system

 

Session 113 – Thyroid

24. In which of the following ways are the thyroid hormones (T3 &T4) stored?

  1. In vesicles inside the cell

  2. Extracellularly

  3. They are not stored, they created on demand

  4. In fat droplets inside the cell

  5. In neurosecretory bodies

 

25. Which of the following forms of the thyroid hormones is produced the most?

  1. T2

  2. T3

  3. T4

  4. rT3

  5. T5

 

26. Which of the following transporters is directly responsible for the uptake of iodine into the follicular cell from the blood?

  1. NIS

  2. Pendrin

  3. TPO

  4. Na/K ATPase

  5. It is brought in through endocytosis

 

27. Which of the following enzymes is required to turn Iodide (I-) into Iodine (I2) by using H2O2?

  1. Thyroid Reductase (TR)

  2. Thyroid Oxidase (TO)

  3. Thyroid Peroxidase (TPO)

  4. Thyroglobulin synthase (TS)

  5. Thyroid deiodinase (TDI)

 

28. In which ways are thyroid hormones primarily transported in the blood?

  1. Freely

  2. Bound to albumin

  3. Bound to androgen binding globulin (ABG)

  4. Bound to thyroid binding globulin (TBG)

  5. It is not transported in the blood but by neurons

 

29. Which is the primarily bioactive (the one that binds to the receptors and causes cellular effects) form of the thyroid hormones?

  1. T2

  2. T3

  3. rT3

  4. T4

  5. T5

 

30. In which of the following locations would you expect to find the deiodinase D1?

  1. Skeletal muscle

  2. Brain

  3. Brown fat

  4. Placenta

  5. Liver

 

31. Grave’s disease is an autoimmune disorder characterized by antibodies that stimulate the TSH receptor on the thyroid gland. How would you expect this disease to affect the levels of TSH and T3/T4 respectively?

  1. Elevate both

  2. Decrease both

  3. Elevate TSH, decrease T3/T4

  4. Decrease TSH, elevate T3/T4

  5. Since it is an antibody, not a hormone, it wont affect these levels

 

32. Which of the following would increase the levels of circulating thyroid hormones?

  1. Stress

  2. Cold

  3. Increased iodide in the blood

  4. Sleep 

  5. Fasting

 

33. Which of the following is the primary mechanism of action for thyroid hormones?

  1. It binds to a plasma membrane receptor and activates a Gs GPCR

  2. It binds to a plasma membrane receptor and activates a Gq GPCR

  3. It binds to an intracellular receptor and increases the displacement of transporters to the plasma membrane

  4. It binds to an intracellular receptor and translocates ot the mitochondria to increase BMR

  5. It binds to an intracellular receptor and acts as a transcription factor to induce transcription

 

34. Which of the following is a action of thyroid hormones?

  1. Decrease cardiac output 

  2. Increase lipogenesis 

  3. Decrease oxygen consumption

  4. Increase gluconeogenesis 

  5. Decrease Na/K ATPase activity

 

35. Why did the big bad government put iodine in our salt?

  1. To try and increase the BMR of americans cause we’re getting too fat

  2. That’s predominantly done in the north where its cold to keep people warm

  3. To make sure pregnant women and newborns have enough thyroid hormone for brain maturation of the child

  4. To give everyone anxiety over their own lives so they’ll stop looking into government corruption 

  5. Cause salt is yummy in my tummy

 

36. Which class of medications can be given to help reduce symptoms of hyperthyroidism?

  1. Synthetic thyroid hormone to induce negative feedback mechanisms

  2. Cholesterol lowering medication to reduce the production of the steroid based thyroid hormones

  3. Epinephrine to increase heart rate and block inflammation 

  4. Beta Blockers to help reduce the permissive effects of catecholamines

  5. Dopamine or antipsychotics to inhibit TSH release

 

37. Which of the following is a symptom of hypothyroidism but NOT hyperthyroidism?

  1. Heat intolerance

  2. Goiter

  3. Infertility 

  4. Weight gain

  5. Rapid heart beat

 

Session 114 – Parathyroid

38. Which of the following is NOT a function of vitamin D?

  1. Increase Calcium absorption in intestines

  2. Decrease diabetes syndrome

  3. Decrease Cancer Cell proliferation

  4. Increase PTH secretion

  5. Increase Muscle strength

 

39. RANKL and M-CSF bind to which of the following?

  1. Pre-osteoclast

  2. Osteoclast

  3. Pre-Osteopblast

  4. Osteoblast

  5. Parathyroid Cells

 

40. Which of the following aspects is NOT related to high Ca++ regulation of PTH?

  1. Stimulation of CaSR

  2. IP3

  3. DAG

  4. CaMP

  5. Decreased PTH secretion

 

41. A patient presents with hypercalcemia, hyperphosphaturia, renal stone and osteitis fibrosa cystica. The patient likely has a characteristic diagnosis of which of the following?

  1. Hypothyroidism

  2. HyperThyroidism

  3. Hyperparathyroidism 

  4. Rickets

  5. Hypoparathyroidism

 

42. Which of the Following is NOT a cause of osteoporosis?

  1. Malnutrition 

  2. Excessive Vit C

  3. Lack of Vit D

  4. Decreased estrogen

  5. Cushing Syndrome

Session 115 – Endocrine Pancreas

43. Dysfunctional delta cells in the islets of Langerhans could lead to which problem?

  1. Increased fatty acids 

  2. Hypoglycemia 

  3. Increased amino acids 

  4. Hyperglycemia 

  5. Increased concentration of GI hormones

 

44. Insulin binds to what kind of receptors on the cell surface of adipose tissue?

  1. GLUT1 

  2. GLUT2 

  3. GLUT3 

  4. GLUT4 

  5. GLUT5

 

45. Normal levels of C-peptide and blood glucose levels of 130mg/dl is indicative of what disease?

  1. Type 1 Diabetes 

  2. Type 2 Diabetes 

  3. Dysfunctional alpha cells

  4. Hypoglycemia 

  5. SLE

 

46. Which of the following is NOT associated with increased alpha cell secretion?

  1. Increased Glycogenolysis 

  2. Decreased Glycogen synthesis 

  3. Increased Gluconeogenesis 

  4. Increased protein synthesis 

  5. Increased lipolysis

 

47. Which of the following is an inhibitory agent of insulin secretion?

  1. Hyperglycemia 

  2. Ach 

  3. Epinephrine/Norepinephrine 

  4. Gastrin/Secretin/GLP-1 

  5. Increased amino acids

 

Session 119 – Histology – Male Reproductive System I

 

48. In the following histological cross-section, which of the testicular interstitium resident cells are both endocrine in function and responsible for the production of testosterone?

 

 

  1. A

  2. B

  3. C

  4. D

  5. E

 

49. Which of the following hormones is the direct regulator of the cells depicted by the blue arrows to produce testosterone?

  1. LH

  2. DHEA

  3. FSH

  4. GnRH

  5. TSH

 

50. Which of the following cells in the histological cross-section provide structural support within the seminiferous epithelium while also providing nourishment to sperm precursors throughout spermatogenesis?

 

 

  1. A

  2. B

  3. C

  4. D

  5. E

 

51. In response to ______ secretion by the Anterior pituitary, Sertoli cells secrete ______ in order to maintain high testosterone concentrations within the Seminiferous tubule.

 

  1. FSH, Fructose

  2. LH, Androgen-binding protein

  3. GnRH, FSH

  4. FSH, Androgen-binding protein

  5. LH, Pregnenolone

 

52. Which of the following sperm precursors is the first to enter Meiosis during the process of Spermatogenesis?

 

  1. Type A pale spermatogonia

  2. Type A dark spermatogonia

  3. Type B spermatogonia

  4. Primary Spermatocyte

  5. Secondary Spermatocyte

 

53. Which section of a mature sperm contains the highest concentration of Mitochondria?

 

  1. Acrosome

  2. Neck

  3. Principle piece of the tail

  4. Middle piece of the tail

  5. End piece of the tail

 

Session 120 – Histology – Male Reproductive System II

54. While rotating through a fertility clinic, a patient with a pituitary tumor comes in. It is determined that he has low sperm counts due to a decrease in the amount of FSH being secreted. Which of the following cells depicted in the histology slide above would be affected by this and thus not be able to help with spermatogenesis?

  1. B

  2. C

  3. D

  4. E

 

55. Which of the following is true regarding the above image?

  1. It is made up of ciliated stratified columnar epithelium

  2. It has principal cells for absorption and secretion

  3. It connects the rete testis to the ductus epididymidis

  4. It contains stereocilia

  5. It is where sperm becomes motile

 

56. A developmental defect in the above structure would result in what?

  1. Inability to mature sperm

  2. Inability of sperm to form flagella 

  3. Inability of sperm to get from seminiferous tubules to the vas deferens

  4. Decreased sperm count

  5. Decreased volume of ejaculate

 

57. Which of the following would likely result in micturition problems as one of the first clinical symptoms?

  1. Prostate cancer because it occurs in the transitional zone

  2. Prostate cancer because it occurs in the peripheral zone

  3. Benign prostatic hyperplasia because it occurs in the transitional zone

  4. Benign prostatic hyperplasia because it occurs in the peripheral zone

 

58. Which of the following occurs during an erection?

  1. Acetylcholine is inhibited allowing for blood to flow in

  2. The vascular spaces of the corpus cavernosa fill with blood

  3. Helicine arteries become spirally coiled 

  4. The deep arteries in the corpus spongiosum become engorged

  5. The usually loose subcutis becomes rigid

 

Session 121 – Histology – Female Reproductive System I 

59. What hormone will initiate follicular growth in primordial follicles following the beginning of puberty?

  1. Luteinizing Hormone

  2. Follicular Stimulating Hormone

  3. Follicular Growth Hormone

  4. Growth Hormone

  5. Gonadotropin Hormone

 

60. Follicular development progresses correctly in which of the following answer choices?

  1. Primordial → Multilaminar Primary → Unilaminar Primary → Graafian → Secondary

  2. Unilaminar Primary → Multilaminar Primary → Primordial → Secondary → Graafian

  3. Primordial → Unilaminar Primary → Multilaminar Primary → Graafian → Secondary

  4. Primordial → Unilaminar Primary → Multilaminar Primary → Secondary → Graafian

  5. Graafian → Primordial → Unilaminar Primary → Multilaminar Primary → Secondary

 

61. During the course of Follicular development, when will the Theca interna first appear?

  1. Unilaminar Primary Follicle

  2. Multilaminar Primary Follicle

  3. Secondary Follicle

  4. Graafian Follicle

  5. Primordial Follicle

 

62. A patient presents to your clinic with Type 2 DM and questions about her trouble conceiving a child. She brought with her an ultrasound of her ovaries that shows what looks like a “string of pearls”. You recognize this as a symptom of Polycystic Ovary Syndrome, however this is the only symptom that is pertinent. Why is a diagnosis of PCOS not appropriate?

  1. A diagnosis of PCOS requires two of three specific conditions to be met

  2. An increased level of blood androgens is the primary indicator of PCOS

  3. The patient must be experiencing irregular menstrual cycles in order to be diagnosed with PCOS

  4. The patient must have three specific conditions in order to be diagnosed with PCOS

  5. You must have excess insulin production in order to be diagnosed with PCOS

 

63. What hormone is in direct control of ovulation?

  1. Follicle Stimulating Hormone

  2. Luteinizing Hormone

  3. Growth Hormone

  4. Human Chorionic Gonadotropin

  5. Oocyte Maturation Inhibitor

 

64. Atresia of follicles occurs because….?

  1. An ovum is not released during ovulation

  2. Granulosa cells become detached from the Granulosa layer and float freely in the Antrum

  3. The follicles that undergo atresia have more than one defect

  4. The secondary oocyte of the ovulated follicle releases Inhibin shutting down FSH production

  5. There is a loss of cells in the Corona Radiata

65. What is the function of the cell labeled “A”?

 

  1. Assist sperm motility by beating its cilia towards the uterus

  2. Secrete Progesterone for blood clotting of the endometrium

  3. Secrete LH for ovulation to occur

  4. Provide nourishment for the sperm

  5. Catch the egg with its cilia for implantation

 

Session 122 – Histology – Female Reproductive System II

66. Which of the following does the myometrium secrete to trigger contractions?

  1. Oxytocin

  2. Estrogen

  3. ADH

  4. Vasopressin

  5. Prostaglandins

 

67. What is the purpose of the basal layer of the endometrium?

  1. To secrete ADH

  2. It undergoes hypertrophy and hyperplasia during pregnancy

  3. It regenerates the functional later during the menstrual cycle

  4. It is where the eggs are stored until ovulation

  5. To be sloughed off during menstruation

 

68. A female patient comes to the clinic complaining of abdominal cramps along with severe pelvic cramps during menstruation. Blood tests show no signs of STI’s. Of your differential diagnoses, which of the following would you expect to be the most likely culprit?

  1. Pancreatitis

  2. Sexually Transmitted Infection

  3. Ectopic Pregnancy

  4. Endometriosis

  5. Ruptured Ovary

 

69. Which of the following is the reason that the vagina has such an acidic envrionment?

  1. Increased release of H+ ions by type A intercalated cells

  2. Glycogen being metabolized by comensal lactobacilli to lactic acid

  3. Exfoliation of the vaginal mucosa during the menstrual cycle

  4. Increased amount of estrogen being secreted from vaginal cells

  5. Increased amount of blood vessels that are contained by the lamina propria

 

70. Which type of vaginitis is characteristic of strawberry mucosa and/or a frothy gray-white discharge and numerous neutrophils in an inflammatory vaginal smear?

  1. Gardnerella vaginalis

  2. Trichomonas vaginalis

  3. Candida albicans

  4. Gonorrhea

  5. Human papillomavirus

 

71. Which quadrant of the breast tissue has the highest occurence of breast cancer?

  1. Superior Medial

  2. Inferior Medial

  3. Superior Lateral

  4. Inferior Lateral

  5. Centrally spanning all quadrants equally

 

72. Which of the following includes the structures found in the breast of a female going through puberty?

  1. Nipple and ducts

  2. Nipple, ducts, and adipose tissue

  3. Nipple, ducts, lobules, and adipose tissue

  4. Nipple, ducts, lobules, adipose tissue, and secretory mammary glands

 

73. The Papanicolaou smear has greatly reduced which of the following conditions?

  1. Cervical cancer

  2. Endometriosis

  3. Androgen Insensitivity

  4. Pregnancy

  5. Breast Cancer

 

74. Which of the following hormones initiates milk secretion?

  1. Oxytocin

  2. ADH

  3. Prolactin

  4. Estrogen

  5. Relaxin

 

Session 123 – Reproductive System Development

75. The female genitalia (excluding the ovary) primarily develop from which of the following embryonic structures present during the indifferent state (weeks 5-6)?

  1. Allantois

  2. Mesonephric ducts

  3. Mesonephros

  4. Paramesonephric ducts

  5. Wolffian ducts

 

76. Which portion of the male genital organs is formed from the paramesonephric duct?

  1. Appendix of the testis

  2. Bulbourethral gland

  3. Ductus deferens

  4. Prostate

  5. Seminal gland

 

77. Which of the following correctly list the order of primordial structures in the development of the vagina?

  1. Sinus tubercle -> sinovaginal bulbs -> uterovaginal primordium and urogenital sinus -> vaginal plate

  2. Sinus tubercle -> sinovaginal bulbs -> vaginal plate -> uterovaginal primordium and urogenital sinus 

  3. Uterovaginal primordium and urogenital sinus -> sinovaginal bulbs -> sinus tubercle -> vaginal plate

  4. Uterovaginal primordium and urogenital sinus -> sinus tubercle -> sinovaginal bulbs -> vaginal plate

  5. Uterovaginal primordium and urogenital sinus -> vaginal plate ->  sinovaginal bulbs -> sinus tubercle -> vaginal plate

 

78. Which of the following pairs of male and female structure derive from the same structure in the indifferent stage?

  1. Glans penis; glans clitoris

  2. Glans penis; labia minora

  3. Penis shaft; labia majora

  4. Scrotum; glans clitoris

  5. Scrotum; labia minora

    A, both are derived from the primordial phallus. Penis shaft and labia minora are derived from the urethral folds. Scrotum and labia majora are derived from the labioscrotal swellings.

 

79. Which of the following listed abnormalities is correctly described?

  1. Bicornuate uterus: complete failure of the of paramesonephric ducts to fuse

  2. Cryptorchidism: testes fail to ascend through the inguinal canal, leading to sterility

  3. Divided uterus: one paramesonephric duct fails to develop

  4. Hydrocele: process vaginalis persists small enough to allow peritoneal fluid to accumulate in the scrotum but not tissues/organs

  5. Hypospadias: the male external urethral orifice develops on the dorsal side of the penis shaft instead of the tip of the glans penis

 

Session 124 – Male Reproductive System I

80. In which of the following locations will the sperm undergo functional maturation and develop the ability to become motile?

  1. Seminiferous Tubules

  2. Rete Testes

  3. Epididymis

  4. Vas Deferens

  5. Urethra

 

81. Where does the fibrinogen in semen come from in order to clot the ejaculate within the vagina?

  1. Sertoli Cells

  2. Seminal Glands

  3. Prostate Gland

  4. Bulbourethral Glands

  5. Greater Vestibular Glands

 

82. Which of the following is responsible for lubricating the glans of the penis to reduce friction as it enters the vagina?

  1. Seminal Glands

  2. Prostate Gland

  3. Bulbourethral Glands

  4. Greater Vestibular Glands

  5. Vaginal Wall Glands

 

83. GnRH synthesizing cell bodies are found within which nucleus of the hypothalamus?

  1. Supraoptic

  2. Ventromedial

  3. Paraventricular

  4. Arcuate

  5. Lateral

 

84. A young patient after a stroke is suffering from infertility/sterility due to damage in the hypothalamus resulting in a deficiency in intrinsic GnRH production. Which of the following methods would be the best mode of treatment for this patient?

  1. Administer GnRH is a pulsatile fashion every 90-120 minutes

  2. Administer GnRH in a diurnal fashion 

  3. Administer GnRH in a slow, continuous fashion 

  4. Administer GnRH orally after each meal

  5. Allow the patient sufficient recovery time and allow these neurons to regenerate naturally

 

85. Which of the following is a true neuronal control mechanism for the release of GnRH?

  1. Kisspeptin inhibits the release of GnRH

  2. Neurokinin B inhibits the release of GnRH

  3. Exogenous Opioids increase the release of GnRH

  4. Stress increase the release of GnRH indirectly

  5. Gonadotropin Inhibitory Hormone increase the release of GnRH

 

86. Which of the following is NOT released from Sertoli cells?

  1. Activin

  2. Inhibin

  3. Follistatin

  4. Anti Mullerian Hormone (AMH)

  5. Testosterone

 

87. Stress causes the release of CRH, ACTH, Cortisol, and for whatever reason ADH. Which of the following medications can be given to block the CRH caused LH suppression?

  1. Beta Blockers

  2. Insulin

  3. Naloxone

  4. Prednisone

  5. Statins

 

88. Why does cryptorchidism (undescended testes) have to be repaired in order to be able to reproduce?

  1. If the testes do not descend a loop of intestines could herniate into the scrotum and begin to function as the site of spermatogenesis

  2. Spermatogenesis must be conducted at a lower temperature than the temperature inside the body

  3. Cryptorchidism does not need to be repaired but is often done for the aesthetic purpose for the patient

  4. The testes need to be in a warmer environment so having them outside of the body wall allows them to behave like a miniature oven for spermatogenesis 

  5. Undescended tests are still functional but not visually pleasing so the chance of reproduction decreases

 

89. Which enzyme is necessary for the translocation of cholesterol to the mitochondria within leydig cells in order to being the testosterone synthesis?

  1. CYP11A1

  2. 5α-reductase

  3. CPY19A1

  4. STARD1

  5. CYP17A1

 

90. A patient has just recently been diagnosed with BPH (benign prostatic hyperplasia). You decide to prescribe the patient Finasteride (Propecia) to help treat the BPH because this medication inhibits which of the following enzymes?

  1. CYP11A1

  2. 5α-reductase

  3. CPY19A1

  4. StarD1

  5. CYP17A1

 

Session 125 – Genetic Disorders of Reproductive Systems

91. This condition involves being defective in GnRH synthesis. Which of the following is the most common x-linked recessive mutation to cause said condition?

  1. ANOS1

  2. CHD7

  3. FGF8

  4. PROK2

  5. FGRF1

 

92. A patient presents to the clinic as infertile with small testes, decreased muscle tone, loss of libido, decreased bone density and breast enlargement. Which of the following is NOT an aspect of his inheritance pattern or statistic resulting from the condition?

  1. XXXY

  2. XXY

  3. Possible Mosaic

  4. Accounts for 40% of male infertility

  5. Accounts for 10% of males with oligospermia

 

93. A patient presents with a mutation in the MKRN3 gene. Which of the following diseases shares the same inheritance pattern?

  1. Cystic Fibrosis

  2. Birt hogg dube

  3. Hemophilia A

  4. Muscular Dystrophy

  5. Congenital Hypertrichosis

 

94. Which of the following is NOT characteristic of turner syndrome?

  1. Webbed Toes

  2. Short Stature

  3. Edema of the feet

  4. Gonadal dysgenesis

  5. infertility

 

95. A person presents to the clinic with a deletion of the SRY segment on the y chromosome. Which statement correlates to that condition?

  1. Causes a 17a-hydroxylase deficiency 

  2. Condition can also be caused by x-linked inheritance 

  3. Male external genitalia 

  4. Most cases are inherited

  5. Patient presents with amenorrhea

 

Session 126 – Male Reproductive System II

96. Following the successful division of meiosis 1 the immature male germ cells would be labeled as what?

  1. Spermatogonium 

  2. Spermatids 

  3. Primary Spermatocytes 

  4. Secondary Spermatocytes 

  5. Spermatozoa

 

97. Which part of the spermatozoa is responsible for the penetration of the zona pellucida in the female ovum?

  1. Head  

  2. Acrosome 

  3. Midpiece 

  4. Tail 

  5. Nucleus

 

98. During which time period would plasma testosterone levels be close to zero?

  1. Fetal 

  2. Neonatal 

  3. Pre-Pubertal 

  4. Adult

  5. Old Age

 

99. Administration of Tadalafil works by what mechanism in the male reproductive system?

  1. Increased cGMP breakdown 

  2. Increased cAMP breakdown 

  3. Decreased cGMP breakdown

  4. Increased cGMP breakdown 

  5. Decreased nitric oxide creation

 

100. Administration of a ‘beta-adrenergic blocker’ would have difficulty with which process?

  1. Emission 

  2. Ejaculation 

  3. Spermiogenesis 

  4. Spermatogenesis 

  5. Capacitation

 

Session 127 – Female Reproductive System I

101. Prior to ovulation, a dramatic increase in ________ precedes the LH surge which results in expulsion of the ovum from the follicle. 

 

  1. FSH

  2. Progesterone

  3. Estradiol

  4. hCG

  5. Estriol

 

102. After ovulation, the presence of which hormone is essential to keep the corpus luteum alive?

 

  1. Follistatin

  2. Progesterone

  3. hCG

  4. Estradiol

  5. FSH

 

103. During tertiary follicular development, high levels of Estradiol will result in which of the following?

 

  1. Inhibition of Kiss-peptide secreting hormones

  2. Increased prostaglandin and histamine in the dominant follicle

  3. Meiotic arrest of the egg

  4. Decrease in plasminogen activator

  5. Smooth muscle relaxation

 

104. During the secondary follicular stage, which cells respond to FSH by producing an increasing amount of Estrogen?

 

  1. Granulosa cells

  2. Theca interna cells

  3. Theca externa cells

  4. Zona pellucida

  5. Antrum

 

105. During the menstrual cycle, Estradiol concentrations are at their highest:

 

  1. During the middle of the Luteal phase when the endometrium is proliferating

  2. At the beginning of Menses

  3. At the beginning of the Follicular phase when follicle development is critical

  4. Just prior to the LH surge

  5. At the end of Menses

 

Session 128 – Female Reproductive System II

106. Use the above image for the next 5 questions. Which of the following is represented by the blue line?

  1. Body Temp

  2. Estradiol

  3. Follicle stimulating hormone

  4. Luteinizing hormone

  5. Progesterone

 

107. Which of the following is represented by the yellow line?

  1. Body Temp

  2. Estradiol

  3. Follicle stimulating hormone

  4. Luteinizing hormone

  5. Progesterone

 

108. Which of the following is represented by the red line?

  1. Body Temp

  2. Estradiol

  3. Follicle stimulating hormone

  4. Luteinizing hormone

  5. Progesterone

 

109. Which of the following is represented by the green line?

  1. Body Temp

  2. Estradiol

  3. Follicle stimulating hormone

  4. Luteinizing hormone

  5. Progesterone

 

110. Which of the following is represented by the purple line?

  1. Body Temp

  2. Estradiol

  3. Follicle stimulating hormone

  4. Luteinizing hormone

  5. Progesterone

 

111. Which of the following correctly sequences the phases of the uterine cycle?

  1. Ovulation phase, Menstrual phase, Proliferative phase, Secretory phase

  2. Menstrual phase, Ovulation Phase, Proliferative phase, Secretory phase

  3. Secretory phase, Proliferative phase, Ovulation phase, Menstrual phase

  4. Menstrual phase, Proliferative phase, Ovulation phase, Secretory phase

  5. Proliferative phase, Secretory phase, Ovulation phase, Menstrual phase

 

112. Why is there more blood but less blood clotting on the first day of the menstrual phase of the uterine cycle?

  1. FSH is high and LH is low

  2. Release of prostaglandin

  3. LH surge

  4. Endometrial cells secreting glycogen

  5. Presence of fibrinolysin

 

113. What causes the increase in body temperature and during what phase does this occur?

  1. LH; ovulation

  2. FSH; luteal phase

  3. Progesterone; ovulation

  4. E2; menstrual phase

  5. E2; follicular phage

 

114. While on rotations, one of your patients mentions in her history that she is on Boniva for bone density. This drug is commonly given to women with osteoporosis. She asks you why it is so common for post-menopausal women to experience osteoporosis? You tell her it is because at menopause: 

  1. E1 levels decrease

  2. E2 levels decrease

  3. E3 levels decrease

  4. Progesterone levels decrease 

  5. FSH/LH levels decrease

 

115. While talking to a pro-life friend they tell you that they would never take a “morning after pill” because it kills the embryo and that is the same thing as abortion. Without trying to start an ethical debate, you explain to her that the “morning after pill” otherwise known as PlanB works by:

  1. Killing sperm before it reaches the egg

  2. Preventing the LH surge

  3. Preventing the acrosome reaction

  4. Preventing implantation

  5. Phagocytosing the zygote

 

116. Which of the following is only a primary cause of female infertility?

  1. Anorexia 

  2. Hyperprolactinemia

  3. Hypogonadotropism

  4. Polycystic ovaries

  5. Turner syndrome

 

Session 129 – Female Reproductive System III

117. What hormone will sustain the corpus luteum during the first 7 weeks of pregnancy?

  1. LH

  2. FSH

  3. Progesterone

  4. Estrogen

  5. hCG

 

118. What hormone plays a major role in the development of gestational diabetes?

  1. LH

  2. Progesterone

  3. Human Chorionic Somatomammotropin

  4. hCG

  5. Estrogen

 

119. Estriol is formed at the placenta and from what source predominantly? 

  1. Maternal DHEA

  2. Cholesterol

  3. 17α-hydroxy-pregnenolone

  4. Fetal DHEA

  5. Cortisol

 

120. Near the start of parturition, what hormone will suddenly drop in production, by the placenta, making the uterine smooth muscle more excitable?

  1. Estrone

  2. Estriol

  3. Estradiol

  4. Progesterone

  5. Relaxin

 

121. During parturition, a patient’s cervix will continue to dilate until the delivery is complete. What hormone participates in a positive-feedback cycle to ensure this will occur?

  1. Prolactin

  2. Estrogen

  3. Progesterone

  4. Relaxin

  5. Oxytocin

 

Session 133 – Histology – Alimentary Canal I

122. Which of the following structures has adventitia in contrast to having serosa?

  1. Esophagus

  2. Stomach

  3. Small intestine

  4. Large Intestine

  5. Colon

 

123. Identify the structure labeled X.

  1. Orbicularis Oris

  2. Capillaries

  3. Vermilion zone

  4. Submucosa

  5. Enteric Nervous Plexus

 

124. A patient presents to the clinic with a painful blister above their upper lip. They admit to having fallen asleep outside in the sun last week, but their sunburn had cleared up a couple of days before. This is the fifth time that they have had this kind of blister within the past 2 years. You determine that it is viral in nature. Which nerve does the virus that causes them lay dormant?

  1. CN III

  2. CN IV

  3. CN V

  4. CN VI

  5. CN VII

 

125. Which muscle of the tongue is innervated by CN X?

  1. Hyoglossus

  2. Styloglossus

  3. Genioglossus

  4. Palatoglossus

  5. Mylohyoid

 

126. Which lingual papillae lack gustatory cells?

  1. Fungiform papilla

  2. Filiform papilla

  3. Vallate papilla

  4. Foliate papilla

 

127. Ameloblasts make which of the following parts of the tooth?

  1. Enamel

  2. Root

  3. Cementum

  4. Tooth Pulp

  5. Dentin

 

128. What is the function of the denoted by OL?

  1. To protect the periodontal ligament from bacteria

  2. To anchor the tooth to the alveolar bone

  3. To attach the gingiva to the enamel

  4. To carry blood and nutrients to the tooth

  5. To produce dentin which makes up the bulk of the tooth

 

129. How would you differentiate between a serous cell and a mucous cell?

  1. Serous cells contain numerous SER while mucous cells contain numerous RER

  2. Serous cells have a foamy appearance while mucous cells have a dense appearance

  3. Serous cells contain protein-rich granules while mucous cells contain an abundance of carbohydrates

  4. Serous cells are seven times bigger than mucous cells

  5. There is no easy way to differentiate between the two cells

 

130. The parotid gland contains ______ and stains _____while the submandibular gland contains mainly  ______.

  1. Serous and Mucous acini; Light; Mucous acini

  2. Serous and Mucous acini; Light; Serous acini

  3. Mucous acini; Light; Serous and Mucous acini

  4. Serous acini; Dark; Serous and Mucous acini

  5. Mucous acini; Dark; Serous and Mucous acini

 

131. A 45 year old male presents to the clinic complaining of pain while eating. He is on a myriad of prescriptions that include hypertension medication and antihistamines for severe pollen allergies. Upon physical examination on his oral cavity you notice a hard nodule under his tongue that is tender to palpation and has palpable borders. While waiting for an Xray to confirm your suspicion, what is your most likely differential diagnosis?

  1. Neuropathy of sublingual tissue

  2. Salivary calculus

  3. Dental Caries

  4. Necrosis of oral tissue

  5. A piece of food

 

Session 134 – Histology – Alimentary Canal II

132. The epithelia of the esophagus and stomach consist of which of the following, respectively?

  1. Non-keratinized stratified squamous; simple columnar

  2. Non-keratinized stratified squamous; simple cuboidal

  3. Simple cuboidal; stratified columnar

  4. Stratified cuboidal; simple columnar

  5. Simple squamous; simple cuboidal

 

133. Barret’s esophagus, a precursor of esophageal adenocarcinoma,  is described as which of the following?

  1. Denervation of the the smooth muscle portion of the esophageal muscularis externa

  2. Ischemia of the striated muscle muscle portion of the esophageal muscularis externa

  3. Hypertrophy of the longitudinally orientated smooth muscles bundles in the muscularis mucosa

  4. Loss of function of esophageal mucosal glands

  5. Metaplasia of esophageal epithelium to simple columnar

 

134. Parietal cells of the stomach are found in which type of gland and secrete which substance?

  1. Cardiac glands; gastrin

  2. Fundic glands; HCl and intrinsic factor

  3. Fundic glands; insoluble mucus

  4. Pyloric glands; pepsinogen

  5. Pyloric glands; soluble mucus

 

135. Enteroendocrine cells (G cells) at the base of the fundic glands secrete which of the following  GI hormones?

  1. Gastrin

  2. Ghrelin

  3. Secretin

  4. A and B

  5. A and C

     

 

136. Which of the following statements regarding tumors of the stomach is true?

  1. Adenocarcinomas arise from the surface epithelial cells

  2. Carcinomas arise from the glandular epithelial cells

  3. Penetration of the tumor into the muscularis externa begins to warrant a poor prognosis

  4. All of the above

  5. None of the above

     

 

Session 135 – Histology – Alimentary Canal III

137. Which of the following is NOT a function of the small intestine?

  1. Digestion

  2. Absorption

  3. Immune Defense

  4. Storage

  5. Regulation of GI function

 

138. Which of the following is the name for the permanent folds found in the jejunum that are composed of both mucosa and submucosa?

  1. Vili

  2. Microvilli

  3. Plicae

  4. Rugae

  5. Anal Columns

 

139. Which structure is most drastically affected in individuals with celiac disease?

  1. Esophageal Mucosa

  2. Gastric Rugae

  3. Duodenum Villi

  4. Colon Haustra

  5. Anal Sphincters

 

140. Which of the following cells is found in the crypts of Lieberkuhn?

  1. Goblet Cells

  2. M Cells

  3. Enteroendocrine Cells

  4. Parietal Cells

  5. Paneth Cells

 

141. Which of the following nutrients is NOT initially transported through the blood to get into the liver?

  1. Carbohydrates

  2. Proteins

  3. Lipids

  4. Nucleic Acids

  5. None of the above

 

142. Which type of cells overly the lymphoid follicles in the small intestine and aid in antigen transport to the lymphocytes?

  1. G cell

  2. M cell

  3. Goblet cell

  4. I cell

  5. Paneth cell

 

143. The image above was taken from which section of the GI tract?

  1. Stomach

  2. Duodenum

  3. Jejunum

  4. Ileum

  5. Ascending Colon

 

144. The histology image shown above was taken from which section of the GI tract?

  1. Stomach

  2. Duodenum

  3. Jejunum

  4. Ileum

  5. Ascending Colon

 

145. Which section of the GI tract has both an adventitia and serosa?

  1. Stomach

  2. Duodenum

  3. Jejunum

  4. Ileum

  5. Transverse colon

 

146. Which of the following is NOT a primary function of the large intestine?

  1. Digestion

  2. Reabsorption of water

  3. Reabsorption of electrolytes

  4. Immune defense (compliments of the intestinal flora)

  5. Storage of feces

 

147. Which of the following is a major difference between the small and large intestines?

  1. The large intestine has longer vili than the small intestine in order to reabsorb water

  2. The large intestine has increased number of paneth cells in order to kill all bacteria

  3. The large intestine has lymphoid nodules dispursed throughout its entire length

  4. The large intestines’ outer longitudinal layer is arranged into teniae coli

  5. The large intestine is longer than the small intestine, hence the name

 

Session 136 – Histology – Alimentary Canal IV

148. Which of the following is NOT in the portal triad?

  1. Portal Venule

  2. Hepatic arteriole

  3. Bile ductule

  4. Hepatic sinusoids

  5. None of the above

 

149. Which of the following is the correct flow of bile?

  1. Towards the center

  2. From Canals of Hering to Bile canaliculi

  3. From Bile ductules to bile canaliculi

  4. From Bile Canaliculi to Left Hepatic Duct

  5. From Bile Ductule to canal of hering

 

150. Which of the following ways to view the liver’s organization emphasizes exocrine function?

  1. Classic Liver lobule

  2. Portal Lobule

  3. Hepatic acinus

  4. Zone gradient lobule

  5. Bile lobule

 

151. A patient presents with cirrhosis of the liver and starts listing off facts he learned from Google. Which statement is false?

  1. Cirrhosis is from scar tissue

  2. Cirrhosis is treatable

  3. Cirrhosis damage is generally reversible from regeneration of the liver

  4. Caused by chronic alcoholism

  5. Histologically characteristic of having hepatocyte nodules

 

152. Which of the following is NOT a cause of gallstones?

  1. Too much cholesterol

  2. Sickle Cell Anemia

  3. Blockage of the gallbladder

  4. Cholelithiasis 

  5. Lowered amounts of unconjugated bilirubin

 

153. A 45 yo male presents with no prior history of pancreatic conditions, which of the following in the history and physical would NOT indicate acute pancreatitis?

  1. Gallstones

  2. Progressive fibrosis 

  3. Alcoholism

  4. Drugs

  5. Infection

 

Session 137 – Introduction to GI Physiology

154. Evidence of pernicious anemia could be a byproduct of which problem?

  1. Increased HCl secretion

  2. Decreased Intrinsic Factor secretion

  3. Increased Vitamin B-12 absorption 

  4. Increased Ghrelin secretion 

  5. Increased insulin secretion

 

155. Which of the following influences the thin muscle layer of the mucosa through the enteric nervous system?

  1. Myenteric plexus 

  2. Meissner’s plexus 

  3. Auerbach’s plexus

  4. Brachial plexus 

  5. Lumbosacral plexus

 

156. Which of the following is NOT influenced by the vagus nerve?

  1. Stomach 

  2. Esophagus 

  3. Pancreas 

  4. Large Intestine 

  5. Rectum 

 

157. Which of the following is NOT altered by the enteric nervous system?

  1. Smooth muscle activity 

  2. Secretory cell secretion 

  3. Endocrine cell secretion 

  4. Skeletal muscle activity 

  5. Blood vessel dilation

 

158. Increased secretion of VIP will have what effect on the GI system?

  1. Relaxation of skeletal muscle 

  2. Constriction of smooth muscle 

  3. Relaxation of smooth muscle 

  4. Increased villi contractions

  5. Increased GI hormonal activity

 

Session 138 – Neural Control of GI Function

159. After experiencing a devastating mountain biking accident, a Fort Smith native is rushed to the  E/R for a fractured spine and possible paralysis. Radiographic imaging depicts a fractured and dislodged T4 vertebrae and MRI reveals severely damaged spinal cord at the level of T5. Regarding the patient’s GI system, which neurological relationship would still remain intact?

 

  1. Sympathetic inhibition of the foregut (esophagus to upper duodenum)

  2. Parasympathetic stimulation of the rectum

  3. Sympathetic inhibition of the hindgut (distal ⅓ transverse colon to rectum)

  4. Sympathetic inhibition of peristaltic contractions in the ileum 

  5. Parasympathetic stimulation of the stomach

 

160. After eating a meal high in polyunsaturated fats, which of the following is least likely to occur as the fatty-chyme enters the duodenum?

 

  1. Increased pancreatic secretion of digestive enzymes

  2. Inhibition of gastric emptying

  3. Contraction of the sphincter of Oddi 

  4. Contraction of the gallbladder

  5. Contraction of the of the pyloric sphincter of the stomach

 

161. A 55 year old male presents to the clinic with complaints of abdominal pain and diarrhea. Physical exam reveals a distended, bloated abdomen. Patient notes that the abdominal pain decreases shortly after food intake. A stool sample is collected and tests negative for campylobacter, h. pylori, and shigella; but reveals a high fat content in the stool (steatorrhea). GI scope shows inflamed duodenal ulcers. What is the primary GI hormone that is being secreted to cause these symptoms?

  1. Somatostatin

  2. Secretin

  3. GIP

  4. Gastrin

  5. CCK-33

 

162. Which of the following GI hormones would have the most antagonizing effect on GI acidity by neutralizing H+ ions and inhibiting gastric acid secretions?

 

  1. VIP

  2. Histamine

  3. Gastrin

  4. GRP

  5. A high protein meal

 

163. After shadowing a 2 hour surgery, your stomach begins to growl after you exit the OR. Your last meal was 5 hours ago and the hospital cafeteria food begins to sound more appetizing with every step you take towards the cafe. Which of the following satiety hormones is responsible for your increasing appetite?

 

  1. GLP-1

  2. Insulin

  3. Ghrelin

  4. Leptin

  5. POMC

 

Session 139 – Clinical Genetics Techniques

164. Which one is true regarding blunt ends and sticky ends?

  1. Sticky ends are cut by restriction enzymes whereas blunt ends are not

  2. Blunt ends are cut at specific sequences whereas sticky ends are cut at random sequences

  3. They cannot be used for the detection of restriction fragment length polymorphisms

  4. Sticky ends have an overhang of nucleotides that do not have complementary base pairs  

  5. Blunt ends are used to detect genetic variation whereas sticky ends are used to detect genetic similarity

 

165. Trisomy 21 is an aneuploidy resulting from a nondisjunction of the 21st chromosome. The 21st chromosome can be described as?

  1. Metacentric

  2. Submetacentric

  3. Acrocentric

  4. Suprametacentric

  5. Telocentric

 

166. What is the difference between fluorescence in situ hybridization (FISH) and comparative genomic hybridization (CGH)?

  1. CGH provides a much higher resolution and specificity than FISH

  2. CGH shows translocations and rearrangements whereas FISH only shows relative copy

  3. CGH works by mixing two samples and looking at the ratios whereas FISH looks at the arrangement of a chromosomal region. 

  4. CHG is specific for a targeted region whereas FISH is able to analyze the entire genome 

  5. There is no difference between the two. They are different techniques for measuring the presence of a DNA sequence.

 

167. Which of the following is the most common cause of spontaneous abortions?

  1. Down Syndrome

  2. Edward Syndrome

  3. Klinefelter Syndrome

  4. Patau Syndrome

  5. Turner Syndrome

 

168. Which of the following would be an indication for a chorionic villi sampling as opposed to an amniocentesis?

  1. High amniotic fluid alpha-fetoprotein

  2. Low amniotic fluid alpha-fetoprotein

  3. Detection in week 10 of gestation

  4. Indication of a neural tube defect during a first or second trimester screening

  5. An abnormality shown during karyotyping

 

Session 140 – Digestive System Development I

169. Which of these organs are classified as intraperitoneal?

  1. Kidney

  2. Head of Pancreas

  3. Cranial Duodenum

  4. Caudal Duodenum

  5. Ascending Colon

 

170. What arteries supply the Foregut, Midgut, and Hindgut in that order?

  1. SMA, IMA, Celiac artery

  2. IMA, Celiac artery, SMA

  3. Celiac artery, SMA, IMA

  4. Celiac artery, IMA, SMA

  5. SMA, Celiac artery, IMA

 

171. The ventral and dorsal bud of the pancreas fuse following what action?

  1. Volvulus of the SMA

  2. Rotation of the Duodenum

  3. Rotation of the Stomach

  4. Left displacement of the Dorsal Mesogastrium

  5. Right displacement of the Liver

 

 

 

172. During our dissection last semester, the intestines were difficult to untangle. We learn this semester that this is normal due to the intestines rotating around the SMA by…

  1. 90o

  2. 150o

  3. 180o

  4. 270o

  5. 360o

 

173. Which of these are derivatives of the Foregut?

  1. Esophagus, stomach, cranial duodenum, and liver

  2. Jejunum, Ileum, Cecum, and Appendix

  3. Descending Colon, Sigmoid colon, Rectum, and Anal canal

  4. Esophagus, Jejunum, Descending colon, and Rectum

  5. Stomach, liver, Pancreas tail, and Ileum

 

174. Which of these are derivatives of the Midgut?

  1. Esophagus, stomach, cranial duodenum, and liver

  2. Jejunum, Ileum, Cecum, and Appendix

  3. Descending Colon, Sigmoid colon, Rectum, and Anal canal

  4. Esophagus, Jejunum, Descending colon, and Rectum

  5. Stomach, liver, Pancreas tail, and Ileum

 

175. Which of these are derivatives of the Hindgut?

  1. Esophagus, stomach, cranial duodenum, and liver

  2. Jejunum, Ileum, Cecum, and Appendix

  3. Descending Colon, Sigmoid colon, Rectum, and Anal canal

  4. Esophagus, Jejunum, Descending colon, and Rectum

  5. Stomach, liver, Pancreas tail, and Ileum

 

Session 141 – Digestive System Development II

176. A neonate patient presents with persistent vomiting containing bile. Which of the following should be included in your differential diagnosis?

  1. Accessory hepatic duct

  2. Accessory spleen

  3. Annular pancreas

  4. Biliary duct atresia

  5. Esophageal stenosis

    An annular pancreas results in a duodenal stenosis which can lead to vomitus containing bile provided it occurs distal to the bile duct and does not stenose the bile duct as well. 

 

177. A neonate patient presents with persistent vomiting containing undigested breast milk. Which of the following should be included in your differential diagnosis?

  1. Accessory hepatic duct

  2. Accessory spleen

  3. Annular pancreas

  4. Biliary duct atresia

  5. Esophageal stenosis

     

 

178. During your rounds in the NICU, you see a neonate with some of its organs protruding from the umbilicus. Your attending asks you to describe what you know about such an occurrence. Which of the following statements would be correct to state to him/her? (Which of the following statements are correct and won’t make him/her think you are a dunce?)

  1. An umbilical hernia, also known as a congenital omphalocele, occurs when the intestines grow outside the abdominal cavity.

  2. Correction of gastroschisis first requires surgically widening the umbilicus to accommodate pushing the organs back into the abdominal cavity.

  3. In development, the fetus’ intestines grow quicker than the abdominal cavity, forcing the intestines down the umbilical cord.

  4. The organ most commonly herniated through the umbilicus is the large intestine.

  5. This situation is usually fatal to the neonate due to difficulty and trauma associated with correction

    A, an umbilical hernia and congenital omphalocele are not the same. In an umbilical hernia, skin and subcutaneous tissue still cover the intestines, whereas a congenital omphalocele does not and has intestines exposed to the outside world. B, primary correction of the gastroschisis relies on gravity and time to ease the intestines back through the umbilicus before surgery is warranted. C, correct. D, it is the small intestines. E, it is not usually fatal unless left uncorrected, leading to ischemia and stenosis of the intestines as the umbilicus tries to close, or infection due to displacement outside the cavity.

 

179. Failure of the cecum to properly separate from the inferior surface of the liver is rare, but can lead to misdiagnosis or delayed diagnosis of which critical condition?

  1. Appendicitis

  2. Biliary Duct Atresia

  3. Crohn’s Disease

  4. Duodenal Stenosis

  5. Irritable Bowel Syndrome

    The patient will present with signs and symptoms of appendicitis but in the upper right quadrant instead of the right lower quadrant.

 

180. Midgut nonrotation will usually present with which of the following critical complications?

  1. Duodenal obstruction

  2. Intestinal ischemia

  3. Stenosis of the superior mesenteric artery

  4. B and C

  5. None of the above

    Midgut nonrotation usually presents as asymptomatic.

 

181. Which of the following is a condition characterized by neural crest cells improperly migrating during weeks 5-7 to form the myenteric plexus, leading to lack of peristalsis?

  1. Hirschsprung disease (megacolon)

  2. Imperforate anus

  3. Meckel (illeal) diverticulum

  4. Midgut volvulus

  5. Omphaloenteric duct remnants

 

182. When reviewing abdominal vascular contrast radiographs with the interventional radiologist, she notices an omphaloenteric duct remnant in the patient. When she asks you which blood vessel persisted from the intestines to the anterior abdominal wall, what should you say?

  1. Alantois

  2. Cardinal vein

  3. Umbilical artery

  4. Umbilical vein

  5. Vitelline artery

 

Session 142 – GI Motility

183. Slow waves are produced by which of the following in the small intestine?

  1. Mucosal cells

  2. Interstitial cells of Cajal

  3. G cells

  4. D cells

  5. K cells

 

184. Peristaltic contractions around a food bolus are characterized by:

  1. Distal segment contracting and proximal segment dilating to mix chyme

  2. Distal segment dilating and proximal segment dilating to ease the passage of the bolus through the alimentary canal

  3. Proximal segment contracting and distal segment dilating to mix chyme

  4. Proximal segment dilating and distal segment contracting to ease the passage of the bolus through the alimentary canal

  5. Proximal segment contracting and distal segment dilating to ease the passage of the bolus through the alimentary canal

 

185. As deglutition takes place, which of the following occurs to prevent food from entering the nasal passage?

  1. Elevation of the larynx

  2. Epiglotti