Review, and challenge, are an important part of learning. This quiz is part of a set that will span the abdominal physiology and anatomy to challenge your synoptic linking ability. Good luck! 

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Gastrointestinal Physiology Review MCQ - Part 3

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Question 1

Stem 1 of 4

A patient is persistently 'bringing up food' during meals, is drooling more than expected and coughing without cessation.
Which cranial nerve is not at risk of lesion in this patient presentation?
A
V
B
IX
C
VIII
D
X
Question 1 Explanation: 
Cranial nerves V, IX and X are actively involved in successful swallowing. CN VIII is involved in hearing and balance.
Question 2

Stem 2 of 4

The patient has suffered a lesion to the nucleus of the solitary tract (NST). Where is the majority of the NST?
A
Cortex parietal lobe
B
Pons
C
Medulla oblongata
D
Midbrain
Question 2 Explanation: 
This is a bilateral structure dealing with heart/respiratory rate, sensation and thermoreception amongst other varied physiologic functions.
Question 3

Stem 3 of 4

Which of the following nerves innervate the soft palate during the swallowing reflex?
A
V1
B
V2
C
V3
D
VII
Question 3 Explanation: 
TVP is innervated by CNV3, with LVP innervated by CNX
Question 4

Stem 4 of 4

What occurs to the larynx during the pharyngeal phase of swallowing?
A
Elevation
B
Depression
C
Inversion
D
Eversion
Question 4 Explanation: 
The elevation occurs concurrent with the closure of the rima glottidis and epiglottic aperture. This is a measure to protect the laryngeal inlet from bolus inhalation - if this is faulty, aspiration can occur risking examples including choking or pneumonia.
Question 5
When is breathing reactivated during swallowing?
A
Oral phase
B
Pharyngeal phase
C
Laryngeal phase
D
Oesophageal phase
Question 5 Explanation: 
When the bolus is sensed by mechanoceptors to have stretched the walls of the oesophagus, then respiration is safe to be resumed as aspiration risk is reduced significantly.
Question 6
As a bolus passes from oesophagus to stomach, what is the first structure encountered within the gastric interior?
A
Cardia
B
Fundus
C
Corpus
D
Pylorus
Question 6 Explanation: 
The gastro-oesophageal junction is formed of the distal oesophagus communicating with the gastric cardiac region.
Question 7
The gastric chief cells contain an abundance of lysosomes filled with a zymogen. What is the function of these enzymes, when activated?
A
Proteolysis
B
Lipolysis
C
MMP
D
MALT
Question 7 Explanation: 
A zymogen is an inactive enzyme. It is usually a normal, active enzyme with a subunit added to prevent its functioning before reaching the site of interest. For instance, we do not want powerful enzymes of the pancreas to digest said pancreas. So they are inactive in transit until they reach the "unstirred" brush-border of the small intestine where enzymes of the family enterokinase convert them from zymogens to active units for digestion.
Question 8
The lower oesophageal sphincter (LOS/LES) is formed of...
A
Detrusor muscle
B
The right crus of the diaphragm
C
The cricopharygeus muscle
D
The hypertrophied muscularis propria of the distal oesophagus
Question 8 Explanation: 
The right crus of the diaphragm descends to form parts of two major structures: the LOS and the ligament of Treitz, the latter of which is the anatomic side of upper/lower GI bleeds.
Question 9
What is the consequence of a non-pharmacologically compensated gastrectomy?
A
Folate acid deficiency
B
Vitamin B6 deficiency
C
Vitamin B9 deficiency
D
Cobalamin deficiency
Question 9 Explanation: 
The only indispensable function of the stomach is the absorption of B12 through the released of intrinsic factor. Cobalamin is a the name of a class of cobalt-containing group also termed vitamin B12.
Question 10
Which of the following will cause an increase in the activation of the zymogen secreted by chief cells?
A
Histamine
B
Prostaglandin
C
Intestinal polypeptides
D
Somatostatin
Question 10 Explanation: 
The enzyme in question is pepsinogen. This is activated to pepsin in the presence of a low pH solution. This is therefore the remit of activation of the parietal cell's proton pump. Histamine, acetylcholine and gastrin activate the proton pump, thus histamine is the answer to this question.
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