2004

Question 10.
Which one of the following statements about the ileum is true?
A. the blood supply of the terminal ileum is from the superior mesenteric artery
B. the vasa recta of the terminal ileum are longer than those of the jejunum
C. the appendices epiploicae of the ileum are larger than those of the transverse colon
D. Peyer’s patches are less common in the distal ileum than in the jejunum
E. The plicae circulares of the lower ileum are larger than those of the duodenum

 

Question 11 Pancreatic epithelial cell secretion is regulated by:
A. acetylcholine
B. gastrin
C. cholecystokinin
D. alpha –1-antitrypsin
E. secretin
Question 12.
Which one of the following substances does not stimulate absorption of salts and water?
A. aldosterone
B. somatostatin
C. VIP
D. gluco-corticoids
E. prolactin

 

Question 14.
Which one of the following is not true for fluid processing in the intestine?
A. Daily ileocaecal flow is about 1.5-2 L
B. Colonic reabsorption is about 1.3-1.8L
C. Maximum colonic reabsorptive capacity is about 4-6L per day.
D. Cholera and similar toxigenic diarrhoeas affect colonic reabsorption
E. Infectious colitis such as Campylobacter infection affects colonic reabsorption

 

Question 15.
Which one of the following is not true for treatment of acute diarrhoea?
A. Opiate agonists have an antisecretory action
B. Glucose promotes colonic uptake of fluid
C. Oral rehydration solutions work best if they include glucose or a source of glucose
D. Oral rehydration solutions save lives and prevent dehydration
E. Opiate agonists should not be used when there is bloody diarrhoea
Question 16.
Which one of the following agents does not cause osmotic diarrhoea?
A. Epsom salts (magnesium sulphate)
B. Lactose in a person with lactose intolerance
C. Bile salts in a person with bile salt malabsorption
D. Sorbitol in chewing gum (large amounts)
E. Fructose in pears

 

Question 21.
With respect to malabsorption:
A. Coeliac disease may be associated with vitamin B12 deficiency
B. Terminal ileal resection can be associated with folate deficiency
C. Low serum vitamin folate is a characteristic feature of Coeliac disease
D. Bacterial overgrowth causes low serum folate and high serum vitamin Bl2 level
E. Pancreatic insufficiency is associated with iron deficiency

 

Question 29.
With respect to diarrhoea:
A. it can be defined as a daily stool weight >50gm
B. osmotic diarrhoea improves upon fasting
C. secretory diarrhoea improves if fasted
D. malabsorption is always associated with steatorrhoea
E. steatorrhoea is due to protein malabsorption

2005

Question 25
Intraluminal starch digestion is not performed by:
a. isomaltase
b. cellulose hydrolase
c. amylase
d. endo glycosidase
e. maltase

2006

Question 8.
Functions of the large bowel does not include:
A. Absorption of up to 4 litres of water daily
B. Detoxification of ingested substances
C. Fermentation by anaerobic bacteria
D. Controlled evacuation
E. Absorption of vitamin B12

Question 14.
Regarding intestinal absorption of water and salts:
A. About 100 ml of water is normally lost in faeces daily
B. Medium chain fatty acids are the principle colonic cations
C. The large intestine can absorb a maximum of 1000ml daily
D. Pancreatic secretions are about 300 ml daily
E. Daily saliva production is usually no more than 450ml
Question 17.
The role of micelles in the process of fat digestion is to:
A. Deliver chylonmicrons to epithelial cells from the lumen of the intestine
B. Collide with microvilli and deliver triglycerides to epithelial cells of the intestine
C. Collide with microvilli and deliver monoacylglycerides to epithelial cells of the intestine
D. Collide with microvilli and deliver pancreatic lipase to epithelial cells of the intestine
E. Are formed from triglyceride, cholesterol and phospholipids in the stomach

Question 20.
Pancreatic cells secrete:
A. Glucagon
B. Galactosidase
C. Fructase
D. Alpha –1-antitrypsin
E. Urease
Question 21.
With respect to malabsorption
A. Coeliac disease may be associated with vitamin A deficiency
B. Terminal ileal resection can be associated with folate deficiency
C. Low serum vitamin Bl2 is a characteristic feature of Coeliac disease
D. Bacterial overgrowth causes low serum folate and high serum vitamin Bl2 level
E. Pancreatic insuficiency is associated with iron deficiencyQuestion 25.
Bile acids are:
A. Secreted by the pancreas
B. Resorbed in the terminal ileum
C. Important for iron absorption
D. Synthesised in the bile duct
E. Enzymes which catalyse the hydrolysis of triglycerides

2007

Question 13.
Which of the following is least likely to be deficient as a result of Coeliac Disease?
A. Vitamin D
B. B12
C. Folate
D. Ferritin
E. Vitamin C

Question 15.
Which statement about intestinal fluid movement is incorrect?
A. The colon generally absorbs 0.2 litres per day.
B. Small intestine generally absorbs 5 to 7 litres per day
C. Maximum absorptive capacity of the colon is 4 to 6 litres per day
D. Total fluid load presented to stomach and entire small intestine is up to 7 litres per day.
E. Bile flow is between 250 - 1200 ml per day
Question 16.
Which of the following substances do not stimulate absorption of salts and water?
A. Aldosterone
B. Somatostatin
C. VIP
D. Gluco-corticoids
E. Prolactin
Question 21.
The role of micelles in the process of fat digestion is to:
A. Deliver chylomicrons to epithelial cells from the lumen of the intestine
B. Collide with microvilli and deliver triglycerides to epithelial cells of the
intestine
C. Collide with microvilli and deliver monoacylglycerides to epithelial cells of the intestine
D. Collide with microvilli and deliver pancreatic lipase to epithelial cells of the intestine
E. Are formed from triglyceride, cholesterol and phospholipids in the stomach
Question 22.
Concerning coeliac disease:
A. Iron deficiency is common
B. Vitamin B12 deficiency is common
C. Vitamin D deficiency is not associated
D. Vitamin A deficiency is not associated
E. Vitamin C deficiency is common
Question 24.
Intraluminal starch digestion is not performed by:
A. Isomaltase
B. Cellulose hydrolase
C. Amylase
D. Endo glycosidase
E. Maltase
Question 26.
Which of the following is unlikely to cause B12 deficiency?
A. Gastrectomy
B. Crohn’s Disease
C. Ulcerative Colitis
D. Pernicious Anaemia
E. Coeliac Disease
Question 9.
The following substances stimulates active absorption of salts and water in the small intestine or colon. Indicate whether each is True or False:
a) Glucose
b) Cellulose
c) VIP
d) The short chain fatty acid butyrate
e) Fructose
(2.5 marks)
Question 10.
Regarding intestinal fluid shifts and luminal conditions in a normal person, please indicate whether the following statements are True or False:
a) Daily faecal water loss is about 50-200 ml daily.
b) Medium chain fatty acids are the principle colonic cations.
c) The large intestine can absorb a maximum of 1000ml daily.
d) Ileo-caecal flow is usually greater than 2L per day.
e) Daily small intestinal absorption normally exceeds 6L per day.
Question 19.
A Gluten-free diet (GFD) is the key to the management of Coeliac Disease. Please read each of the statements below and mark them as either True or False:
a) Beer should be avoided.
b) Oats should not be included in the diet because they are frequently contaminated with wheat.
c) IgA Gliadin and IgA Endomysial Antibodies remain detectable for many years in people compliant with a strict GFD.
d) Bone density rarely improves with a GFD.
e) The most common cause of non-responsiveness to a GFD is small intestinal lymphoma.
(2.5 marks)
Question 22.
Regarding the Ileum, please indicate whether the following statements are True or False:
a) Ileal diverticulum (Meckel’s Diverticulum) represents the remnant of the proximal portion of the embryonic yolk sac.
b) Plicae Circulares are larger in the ileum than in the jejunum.
c) The ileum is the major site of iron absorption.
d) The ileum is supplied by the superior mesenteric artery.
e) Peyer’s Patches are more common in the ileum then jejunum.
(2.5 marks)

 

2009

Miss Simone Milligan is a 23 year-old studying commerce at university. She is currently preparing for her mid-year examinations.
Miss Milligan lives at home with her parents and two younger brothers.
She has experienced good health in the past and is on no medications. She is a smoker. Miss Milligan now presents to her General Practitioner with a three-month history of loose bowel actions. She is opening her bowels about 4 times a day and her stools are loose in consistency. Mucus is noted within her bowel actions, but there has been no overt bleeding. She often needs to rush to get to the toilet, and at times, wakes in the night to open her bowels. Miss Milligan believes she has lost about 4kg over the last 3 months.
Question 1.
Do you think this could be a functional (non-organic) disorder?
Please briefly explain the reasoning for your answer.
(2 marks)
Question 2.
What other history would you like to obtain from Miss Milligan?
(5 marks)
Question 3.
What would you look for on physical examination?
(5 marks)
Question 4.
You are considering referring Miss Milligan to a gastroenterologist, but would like a little more information before doing so.
In view of her presentation with chronic diarrhea, what investigations should be performed before she is referred to a gastroenterologist?
Please be specific. For instance ‘Complete Blood Picture’ is not sufficient.
Briefly explain why each investigation is important.
(8 marks)
Miss Milligan returns three days later for the results of the investigations performed. Her symptoms are unchanged.
You look through the results you have received thus far and note the following:
BLOODS NORMAL RANGE
Hb 95 115 – 155 g/L
MCV 102 80 – 99 fL
WCC 4.6 4.0 – 11.0
Platelets 472 150 – 450
Albumin 32 35 – 50 g/L
LFT’s Normal
Ferritin 7 20 – 250 ug/L
Iron 6 8 – 35 umol/L
Transferrin 25 25 – 50 umol/L
Transferrin Sat. 4% 10 – 55 %
TSH 1.6 0.5 – 3.7 mIU/L
Vitamin B12 67 100 – 700 pmol/L
Serum Folate 34 5 – 45 nmol/L
Vitamin D 45 60 – 160 nmol/L
FAECES No organisms on microscopy or culture
No ova/parasites detected
Question 5.
What do the above investigations demonstrate?
Please present your answer from a pathophysiological perspective and not a specific diagnosis.
(8 marks)
Question 6.
Please list the TWO most likely diagnoses.
(2 marks)
On the basis of the investigations performed, you write a referral for Miss Milligan to see a gastroenterologist. An appointment is made for her to see the gastroenterologist in three weeks, after her final university exam.
However, within a week, she develops severe abdominal pain and presents to the Accident and Emergency Department. A CT Scan is performed and she is taken to theatre, where an ileo-caecal resection is carried out. The resected specimen (45cm terminal ileum and 8cm colon) is sent for Histopathology, and a diagnosis of CROHN’S DISEASE is made.
Question 7.
What are the histological features distinguishing Crohn’s Disease from Ulcerative Colitis?
(6 marks)
Question 8.
What are the local complications of Crohn’s disease and how may they present clinically?
(6 marks)
Question 9.
What TWO specific complications are associated with terminal ileal resection, and how could EACH of these be managed?
(4 marks)
Question 10.
With the resected margins free of Crohn’s Disease, is Miss Milligan now cured of her disease?
If not, what can be done to reduce the chance of post-operative recurrence?
(4 marks)
Question 11.
Please indicate which of the following statements is TRUE regarding Coeliac Disease:
a) IgA deficiency is uncommon in patients with Coeliac Disease.
b) The prevalence of Coeliac Disease in first-degree relatives of patients with Coeliac Disease is approximately 50%.
c) IgG Endomysial Antibody is more specific than IgA Gliadin Antibody for Coeliac Disease.
d) A minority of patients with Coeliac Disease carry HLA-DQ2 or HLA-DQ8.
e) False positive results of IgA Tissue Transglutaminase Antibody do not occur.

 

Question 19.
Please indicate which of the following statements is INCORRECT regarding Vitamin B12:
a) Deficiency may result in macrocytosis, with or without anaemia.
b) Malabsorption in Pernicious Anaemia is due to Intrinsic-Factor deficiency.
c) Vitamin B12 is absorbed from the distal jejunum.
d) Vitamin B12 deficiency may be encountered in patients with Coeliac Disease.
e) Crohn’s Disease is a recognized cause of Vitamin B12 deficiency.
Question 20.
Concerning pathologically disturbed fluid processing in the intestine, indicate which of the following statements is
CORRECT:
a) Cholera toxin impairs small intestinal absorptive mechanisms.
b) Colonic reabsorption in cholera is limited to <2L per day.
c) Passive glucose reabsorption in small intestine can be utilised in cholera to improve rehydration.
d) Bile salt malabsorption is a cause of secretory diarrhoea.
e) Diarrhoea in conditions that inflame the colon is due to the products of inflammation (blood, mucus, pus etc).
Question 27.
Regarding intestinal fluid shifts and luminal conditions in a normal person, which ONE of the following statements is CORRECT:
a) Medium chain fatty acids are the principle colonic cations.
b) The large intestine can absorb a maximum of 1000mls daily.
c) Ileo-caecal flow is usually greater than 2L per day.
d) The short chain fatty acid Butyrate stimulates active absorption of salts and water.
e) Daily faecal water loss is about 500mls.
Question 28.
In terms of response to a meal, please indicate which ONE of the following statements is CORRECT:
a) Acid and pepsin gastric output is not dependent on how enjoyable a person perceives a meal.
b) The stomach empties food into the duodenum regardless of particle size.
c) Hypertonic drinks slow gastric emptying.
d) Gastric Intrinsic Factor binds all vitamin B12 in the stomach.
e) Pepsin is only activated by acid.
Question 29.
Regarding the mucosal histopathological findings in Coeliac Disease, please identify which one of the following statements is INCORRECT:
a) Crypt atrophy is a feature.
b) Coeliac Disease generally affects the mucosa of the proximal small bowel, with damage gradually reducing in severity distally.
c) The intraepithelial lymphocyte count is usually raised.
d) Giardiasis can produce a similar histological lesion.
e) Biopsy specimens should be obtained from the second part of the duodenum.