Gastric secretion regulation — MCQs

A 38-year-old man comes to the clinic complaining of recurrent abdominal pain for the past 2 months. He reports a gnawing, dull pain at the epigastric region that improves with oral ingestion. He has been taking calcium carbonate for the past few weeks; he claims that “it used to help a lot but it’s losing its effects now.” Laboratory testing demonstrated increased gastrin levels after the administration of secretin. A push endoscopy visualized several ulcers at the duodenum and proximal jejunum. What characteristics distinguish the jejunum from the duodenum?

A scientist is studying the mechanism by which the gastrointestinal system coordinates the process of food digestion. Specifically, she is interested in how distension of the lower esophagus by a bolus of food changes responses in the downstream segments of the digestive system. She observes that there is a resulting relaxation and opening of the lower esophageal (cardiac) sphincter after the introduction of a food bolus. She also observes a simultaneous relaxation of the orad stomach during this time. Which of the following substances is most likely involved in the process being observed here?

A 38-year-old man comes to the physician because of an 8-month history of upper abdominal pain. During this period, he has also had nausea, heartburn, and multiple episodes of diarrhea with no blood or mucus. He has smoked one pack of cigarettes daily for the past 18 years. He does not use alcohol or illicit drugs. Current medications include an antacid. The abdomen is soft and there is tenderness to palpation in the epigastric and umbilical areas. Upper endoscopy shows several ulcers in the duodenum and the upper jejunum as well as thick gastric folds. Gastric pH is < 2. Biopsies from the ulcers show no organisms. Which of the following tests is most likely to confirm the diagnosis?

A 53-year-old patient presents to his primary care provider with a 1-week history of abdominal pain at night and between meals. He has attempted taking antacids, which help briefly, but then the pain returns. The patient has not noticed any changes to the color of his stool but states that he has been having some loose bowel movements. The patient reports that he has had duodenal ulcers in the past and is concerned that this is a recurrence. On exam, his temperature is 98.4°F (36.9°C), blood pressure is 130/84 mmHg, pulse is 64/min, and respirations are 12/min. The abdomen is soft, nontender, and nondistended in clinic today. A fecal occult blood test is positive for blood in the stool. During outpatient workup, H. pylori stool antigen is negative, endoscopy demonstrates duodenal ulcers, and gastrin levels are elevated after a secretin stimulation test. Which of the following should also be examined in this patient?

During digestion of a high-fat meal, which of the following gastrointestinal hormones primarily stimulates gallbladder contraction?

A 33-year-old man comes to the physician because of a 2-month history of burning epigastric pain, dry cough, and occasional regurgitation. The pain is aggravated by eating and lying down. Physical examination shows a soft, non-tender abdomen. Upper endoscopy shows hyperemia in the distal third of the esophagus. Which of the following drugs is most likely to directly inhibit the common pathway of gastric acid secretion?

A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

A 59-year-old woman comes to the clinic complaining of an intermittent, gnawing epigastric pain for the past 2 months. The pain is exacerbated with food and has been getting progressively worse. The patient denies any weight changes, nausea, vomiting, cough, or dyspepsia. Medical history is significant for chronic back pain for which she takes ibuprofen. Her father passed at the age of 55 due to pancreatic cancer. Labs were unremarkable except for a mild decrease in hemoglobin. What medication is most appropriate to be switched to from the current medication at this time?

During a study on gastrointestinal hormones, a volunteer is administered the hormone secreted by S cells. Which of the following changes most likely represent the effect of this hormone on gastric and duodenal secretions? $$$ Gastric H+ %%% Duodenal HCO3- %%% Duodenal Cl- $$$

A 28-year-old female comes to the emergency department complaining of heart palpitations. She has had multiple episodes of these in the past few months. She has found that if she wears tight clothing then sometimes these episodes will stop spontaneously. On presentation to the ED, she feels like her heart is pounding and reports feeling nauseous. She appears mildly diaphoretic. Her blood pressure is 125/75 mmHg, pulse is 180/min, and respirations are 22/min with an O2 saturation of 99% on room air. A neck maneuver is performed and her pulse returns to 90/min with improvement of her symptoms. Stimulation of afferent fibers from which nerve are most responsible for the resolution of her symptoms?