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Physiology and Pharmacology of the Large Intestine MCQs

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Question 1
Which of the following is not a function of the large bowel?
A
Absorption of B12
B
Extraction of cations from lumen
C
Storage of faeces
D
Mass movement of faeces to the rectum
Question 2
Decrease in the activity of luminal large intestine goblet cells makes which of the following more likely?
A
Helicobater multiplication
B
Lubrication
C
A more alkali environment
D
Reduced integrity of faecal mass
Question 3
Which ion is primarily responsible for faeces concentration?
A
Sodium
B
Potassium
C
Calcium
D
Magnesium
Question 4
A patient with recurrent gallstones has developed a fistula between the gallbladder fundus and jejunum. On radiography, a clear large bowel is noted with largely distended small intestine.
Peristalsis has halted, causing dilation of the small intestine lumen. Which of the below sites is the most likely point of occlusion?
A
Terminal ileum
B
Meckel’s diverticulum
C
Vermiform appendix
D
Ileocaecal valve
Question 5
A patient on longstanding loperamide presents with new onset constipation.  Which of the following best explains this?
A
Myenteric plexus antagonism
B
Submucosal plexus antagonism
C
Mu-receptor agonism
D
Kappa-receptor antagonism
Question 6
Which of the following is a colonic movement increased by a gastrinoma?
A
Haustral contractions
B
Teniae contractions
C
Pyloric sphincter dilation
D
Antagonistic wave
Question 6 Explanation: 
"A gastrinoma is a tumor in the pancreas or duodenum that secretes excess of gastrin leading to ulceration in the duodenum, stomach and the small intestine. There is hypersecretion of HCl acid into the duodenum, which causes the ulcers." - Wikipedia Definition
Question 7
T/F - a patient having four mass movements a day is more than expected?
A
True
B
False
Question 7 Explanation: 
True - one to three mass movements daily are expected. But, with all things, deviation from the mean does not necessarily warrant a pathological correlate.
Question 8
What is the consequence of duodenal longitudinal smooth muscle immediately distal to the bolus as an increase in gastrin occurs?
A
Relaxation
B
Reflexive relaxation
C
Contraction
D
Cycling of contraction and relaxation
Question 9
Which of the following is not a step of the defaecation reflex?
A
rectal relaxation
B
Relaxation of the ANS innervated sphincter
C
Initial contraction of the somatically innervated sphincter
D
Increased peristaltic activity in the sigmoid colon
Question 9 Explanation: 
The rectal mural surface must contract proximal to the faeces to assist in expulsion.
Question 10
Which of the following would negatively affect the Valsalva manoeuvre?
A
Hypertrophied rectus abdominis musculature
B
Increased intra-abdominal pressure at rest (eg gravid uterus)
C
Superior laryngeal nerve lesion
D
Aortopulmonary window malignancy
Question 10 Explanation: 
The answer is given. This is as the L recurrent laryngeal nerve recurs through the aorticopulmonary window most inferiorly. What does this mean? Well, if we have lesion to the vagal nerve portion supplying most of the motoric supply to the larynx, then we cannot adequately occlude the rima glottidis. The consequence is stark: we cannot undertake the valsalva manoeuvre sufficiently.
Question 11
Which of the following is responsible for the brown colour of faeces?
A
Urobilin
B
Stercobilin
C
Skatole
D
Indole
Question 12
The type of microbiota present in the human large intestine readily utilises
A
Beta oxidation
B
Cori cycle
C
Glluconeogenesis
D
MRSA phenotypes
Question 12 Explanation: 
The microbiota are most all anaerobes. This means they utilise the oxygen poor cori cycle prominently.
Question 13
T/F - a patient with bowel movements of 2 per week is deemed clinically “constipated”?
A
True
B
False
Question 13 Explanation: 
Of course it is true!!! ≤3 per week is considered clinical constipation, from the latin “constipatio”, meaning “crowd together”.
Question 14
A patient with congenital volvulus has silent bowel sounds in the RLQ. But loud sounds heard in the LUQ. Where is the most likely site of the obstruction?
A
Terminal ileum
B
Ligament of Trietz
C
Ileocaecal valve
D
Midjejunum
Question 15
A cylindrical, smooth and soft textured faces sample is where on the Bristol Stool Chart (BSC)?
A
Type 3
B
Type 4
C
Type 5
D
Type 6
Question 16
Which of the following general examination signs indicate late stage constipation?
A
Flat abdomen
B
Localised tenderness
C
Rectal bleeding
D
Enhanced bowel sounds
Question 17
The mechanism of docusate can be summarised as
A
Increase GI motility
B
Increase stool water content
C
Increase volume of non-absorbable residue
D
Alter faecal consistency
Question 18
The mechanism of senna can be best summarised as
A
Increase volume of non-absorbable residue
B
Increase stool water content
C
Alter faecal consistency
D
Increase GI motility
Question 19
A patient with flatus, abdominal pain that is diffuse and umbilical with fatigue and constipation is diagnosed with IBS after a negative colonoscopy and endoscopy.  Which is the best first line treatment?
A
Ispaghula husk
B
Senna
C
Docusate
D
Arachis oil
Question 20
Magnesium sulphate and magnesium hydroxide are given to this patient to relieve his non-responsive constipation. What type of receptor does this rely upon?
A
Baroreceptor
B
Stretch receptor
C
Chemoreceptor
D
Thermoreceptor
Question 20 Explanation: 
The answer is stretch receptor. These receptors are responsive to transmural GIT distention whereupon they trigger powerful peristalsis to launch defecation reflex.
Question 21
A paediatric patient  faecal impaction is given an osmotic laxative that is an inert polymer of ethylene glycol. What is this medication termed?
A
Lactulose
B
Senna
C
Macrogol
D
Saline purgative
Question 22
A patient with liver flap on general examination, generalised confusion and day-night somnolence inversion is given a medication to treat their constipation.   As this medication is fermented, it is converted into ...
A
Acetic acid
B
Lactate
C
Lactulose
D
Ascorbic acid
Question 22 Explanation: 
The stem is describing the drug lactulose which is converted by microbiota of the patient gut to lactic and acetic acid. It is readily used in chronic constipation patients with hepatic encephalopathy.
Question 23
Which medication would be given to a patient recovering from an overdose where they had resultant bradycardia, decreased respiratory effort and fixed miosis before naloxone reversal?
A
Macrogol
B
Lactulose
C
Senna
D
Bisacodyl
Question 23 Explanation: 
Lactulose is given to negate the constipating effects of opiates, which is the OD described classically in the stem above.
Question 24
A patient has had piles for some days now. They are placed on a class of medication to relieve this. Which is best indicated?
A
Bulk laxatives
B
Osmotic laxatives
C
Faecal softeners
D
Stimulant purgatives
Question 25
Which of the following is not a widely recognised type of diarrhoea?
A
Motility
B
Secretory
C
Osmotic
D
Infective
E
Inflammatory
Question 26
What is the first line treatment of diarrhoea?
A
ORT
B
Anti-bacteria
C
Loperamide
D
Senna
Question 26 Explanation: 
ORT - oral rehydration therapy - dehydration is a key risk for the patient with diarrhoea.
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