Case 11 Questions 1-10

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Question 1

What event does not occur between week 5-8 of GI development in a foetus?

  1. The arterial supply of the GIT begins to develop
  2. Midgut rotates 180 degrees anticlockwise
  3. The yolk sac is obliterated
  4. The foregut rotates 90 degrees clockwise
  5. The foregut, midgut and hindgut differentiate

The correct answer is option b Midgut rotates 180 degrees anticlockwise

The midgut rotates 180 degrees after week 10
a. This occurs between week 5-8
c. This occurs between week 5-8
d. This occurs between week 5-8
e. This occurs between week 5-8

Question 2

Which gland is the most important for the production of serous saliva in the oral cavity?

  1. Parotid gland
  2. Thyroid gland
  3. Sublingual gland
  4. Submandibular gland
  5. Hypothalamus

The correct answer is option d Submandibular gland

Creates 70% of all saliva, both of serous and mucous kind
a. Incorrect as it only produces 25% of total saliva, all is serouis but is less than the submandibular
b. This produces T3 and T4 but no saliva
c. This gland only produces mucous saliva
This is a stimulating hormone releasing gland, and does not make saliva

Question 3

What pattern of motility is propulsive

  1. Churning
  2. Mixing
  3. Peristalisis
  4. Segmentation
  5. Slow wave

The correct answer is option c Peristalisis

This causes the food bolus to move in one direction
a. This is in the stomach and breaksdown food into smaller chunks
b. This is also in the stomach to increase the surface area of food exposed to gastric juice
d. This is in the large intenstine and is not propulsive
e. Not specifically propulsive

Question 4

Select the physiological inhibitor of gastric secretions in the stomach

  1. Somatostatin
  2. Gastrin
  3. Acetylcholine
  4. Omeprazole
  5. Histamines

The correct answer is option a Somatostatin

This inhibits D cells which cascades to G cells and parietal cells, secreating gastrin and gastric acid
b. This stimulates gastric motility and HCl secretion
c. This secreates HCl and increases the K+ pump for HCl secreations
d. This is a PPI, so is a pharmacological inhibitor, not physiological
e. Histamine binds to H2 receptors, increasing HCl secretion

Question 5

Julian is an 85yo male who presents to A&E with a 5 day history of severe abdominal pain 4hrs after eating dinner. Upon questioning he tells you the pain sometimes wakes him from sleep, and he also reports having very dark foul smelling stools. He has been taking aspirin once a day for a month. What is the most likely diagnosis?

  1. Acute gastritis
  2. Chronic gastritis
  3. Duodenal ulcer
  4. Gastric ulcer
  5. Oesophagitis

The correct answer is option c Duodenal ulcer

Correct as this is a typical presentation for a duodenal ulcer, due to the late night pain as well as darkened stools and PPI use
a. This has stomach pain, N+V which isnt here, and sudden onset
b. This is typical epigastric pain, long term as well as loss of weight
d. This has no vomiting blood or anorexia so is not likely
e. This is typically due to reflux and is worse right after eating

Question 6

Select the answer that is NOT a major cause of GORD

  1. Radiotherapy
  2. Hiatus hernia
  3. Decrease in LOS tone
  4. Decrease in salivatory flow
  5. Reduced gastric emptying

The correct answer is option a Radiotherapy

This is not a cause of GORD – Think RETCH – Resistance, emptying, tone, Clearance, Hiatus hernia
b. This is a cause of gastric emptying
c. This is a cause of gastric emptying
d. This is a cause of gastric emptying
e. This is a cause of gastric emptying

Question 7

How does Pylori increase risk of gastric ulcer formation?

  1. Secreates NH3 to neutralise stomach acid
  2. Adheres to cells by LPS
  3. Causes epithelium breakdown by secreting exotoxins
  4. Directly stimmulate parietal cells to increase stomach acid
  5. Has flagella

The correct answer is option c Causes epithelium breakdown by secreting exotoxins

This is correct as this allows HCl to move into the tissue, causing ulcification
a. Whilst H. pylori does carry out this, it does not directly cause gastric ulcers
b. Whilst H. pylori does carry out this, it does not directly cause gastric ulcers
d. This is not a function of H. pylori
e. Whilst this may be true, is not relevant to the question

Question 8

Select the Mechanism of Action of antacids

  1. Inhibits COX1
  2. Kills H. pylori
  3. Irreversibly blocks H+/K+ channels
  4. Acts as a barrier over the gastric mucosa
  5. Neutralises gastric acid

The correct answer is option e Neutralises gastric acid

Correct, Antacids work to neutralise the gastric acid directly
a. This is the MOA of NSAIDs
b. This is not a pharmacological treatment
c. This is the MOA of PPIs
d. This is the MOA of sucralfate

Question 9

Select the correct example of a cohort study

  1. Follow 2 groups of people one exposed to radiation, one group not exposed, take histories and compare results over time
  2. Take 2 groups, one with lung cancer and one without lung cancer and compare histories of exposure
  3. Give one group a PPI and one group a placebo and compare results for treatment of gastric ulcer
  4. Looking at the demographic of people in 1990 to see prevalence of cancer compared to 2015
  5. Look at a number of studies taken over the last 10 years and review

The correct answer is option a Follow 2 groups of people one exposed to radiation, one group not exposed, take histories and compare results over time

This is the correct example of a cohort study
b. This is a case controlled study
c. This is a randomised control trial
d. This is a cross sectional study
e. This is a literature review

Question 10

In the larynx, which structure might be incised during an emergency intubation procedure

  1. Cricothyroid ligament
  2. Thyrohyoid membrane
  3. Cricohyoid membrane
  4. Cricoid cartilage
  5. Rima Glottidis

The correct answer is option a Cricothyroid ligament

This is where the incision is made in a cricothyroidotomy for intubation
b. This is superior to the thyroid cartilage and between the thyroid cartilage and the hyoid bone
c. There is a muscle, but no membrane
d. This is a ring that makes up the inferior border of the larynx
e. This is the space between the vocal folds