Basic Sciences in Gastroenterology

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Question 1 of 20

1. Question

Which transport protein is directly responsible for the final step of hydrogen ion secretion into the gastric lumen by the parietal cell?

Apical H⁺/K⁺-ATPase
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Apical cystic fibrosis transmembrane conductance regulator (CFTR)
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Apical Na⁺/H⁺ exchanger (NHE3)
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Basolateral Cl⁻/HCO₃⁻ exchanger (AE2)
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Basolateral Na⁺/K⁺-ATPase
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Question 2 of 20

2. Question

Secretin-stimulated pancreatic ductal fluid is alkaline and bicarbonate-rich. Which mechanism is principally responsible for bicarbonate secretion by the pancreatic duct cell?

Cyclic AMP-mediated activation of apical CFTR with CFTR-dependent Cl⁻/HCO₃⁻ exchange
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Apical Na⁺-dependent bile acid co-transport
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Basolateral H⁺/K⁺-ATPase activity
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Intracellular calcium-mediated activation of apical aquaporin channels
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Paracellular bicarbonate flux driven by luminal hypertonicity
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Question 3 of 20

3. Question

What is the principal luminal stimulus for cholecystokinin release from duodenal and jejunal I cells?

Long-chain fatty acids and aromatic amino acids
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Gastric distension
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Luminal hydrogen ions
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Luminal hyperosmolarity
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Unabsorbed short-chain fatty acids
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Question 4 of 20

4. Question

Which plasma protein has the shortest half-life and therefore falls earliest in acute hepatocellular failure?

Factor VII
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Albumin
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Antithrombin
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Fibrinogen
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Protein S
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Question 5 of 20

5. Question

Which hepatic enzyme is responsible for converting unconjugated bilirubin to a water-soluble form for biliary excretion?

Uridine diphosphate glucuronosyltransferase 1A1
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Biliverdin reductase
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Haem oxygenase-1
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Multidrug resistance-associated protein 2
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Organic anion transporting polypeptide 1B1
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Question 6 of 20

6. Question

Why is bilirubinuria absent in patients with unconjugated hyperbilirubinaemia?

Unconjugated bilirubin is tightly bound to albumin and is not filtered by the glomerulus
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Renal tubular cells metabolise unconjugated bilirubin to urobilinogen
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Unconjugated bilirubin is degraded by urinary nitrites
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Unconjugated bilirubin is rapidly reabsorbed in the proximal tubule
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Urine dipsticks detect only urobilinogen and not bilirubin
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Question 7 of 20

7. Question

Which factor best explains why ethanol is eliminated with zero-order kinetics at usual social drinking concentrations?

Limited regeneration of NAD⁺ and saturation of alcohol dehydrogenase
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Induction of hepatic CYP2E1 by chronic ethanol exposure
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Inhibition of aldehyde dehydrogenase by acetaldehyde
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Saturable gastric first-pass metabolism by gastric alcohol dehydrogenase
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Saturation of the microsomal ethanol-oxidising system
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Question 8 of 20

8. Question

By which mechanism does chronic heavy alcohol use increase susceptibility to paracetamol-induced hepatotoxicity?

Induction of CYP2E1 with increased NAPQI formation and depleted hepatic glutathione
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Competitive inhibition of paracetamol glucuronidation by ethanol
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Inhibition of renal paracetamol clearance
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Reduced first-pass sulfation with increased systemic bioavailability
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Reduced plasma protein binding of paracetamol
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Question 9 of 20

9. Question

Hepcidin reduces intestinal iron absorption by which mechanism?

Internalisation and degradation of basolateral ferroportin
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Competitive inhibition of apical divalent metal transporter 1
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Increased hepatic synthesis of transferrin
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Inhibition of duodenal cytochrome b ferric reductase
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Sequestration of iron within enterocyte ferritin by direct binding
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Question 10 of 20

10. Question

Absorption of the intrinsic factor–vitamin B12 complex occurs at which site and via which receptor?

Terminal ileum via the cubilin–cubam receptor
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Terminal ileum via transcobalamin II receptors
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Duodenum via divalent metal transporter 1
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Jejunum via the proton-coupled folate transporter
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Stomach via gastric intrinsic factor receptors
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Question 11 of 20

11. Question

Which test is the most appropriate initial non-invasive investigation for suspected exocrine pancreatic insufficiency?

Faecal elastase-1
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72-hour quantitative faecal fat estimation
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Faecal calprotectin
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Secretin-stimulated magnetic resonance cholangiopancreatography
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Serum amylase and lipase
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Question 12 of 20

12. Question

A serum–ascites albumin gradient of 11 g/L or greater indicates which of the following?

Portal hypertension
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Bacterial peritonitis
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Chylous ascites
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Peritoneal malignancy
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Tuberculous peritonitis
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Question 13 of 20

13. Question

Which is the most appropriate initial serological test for coeliac disease in an adult consuming a gluten-containing diet?

IgA anti-tissue transglutaminase antibody with total serum IgA
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HLA-DQ2 and DQ8 genotyping
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IgA anti-deamidated gliadin peptide antibody
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IgG anti-gliadin antibody
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IgG anti-tissue transglutaminase antibody
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Question 14 of 20

14. Question

What best explains the characteristic aspartate aminotransferase to alanine aminotransferase ratio greater than 2 in alcohol-related liver disease?

Relative hepatic pyridoxal-5′-phosphate deficiency with release of mitochondrial AST
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Cholestasis-induced enzyme induction
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Concomitant rhabdomyolysis contributing skeletal muscle AST
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Preferential hepatocyte necrosis in zone 1 of the hepatic lobule
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Reduced renal clearance of aspartate aminotransferase
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Question 15 of 20

15. Question

Which mediator released from ileal enterocytes provides negative feedback on hepatic bile acid synthesis?

Fibroblast growth factor 19
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Cholecystokinin
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Glucagon-like peptide-2
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Motilin
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Secretin
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Question 16 of 20

16. Question

Why does the antisecretory effect of proton pump inhibitors greatly outlast their plasma half-life?

Irreversible covalent inhibition of the H⁺/K⁺-ATPase requiring new pump synthesis
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Accumulation of active drug in plasma with repeated dosing
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Enterohepatic recirculation of the active metabolite
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High plasma protein binding prolonging the effective half-life
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Slow dissociation from the histamine H₂ receptor
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Question 17 of 20

17. Question

Which biochemical abnormality most characterises refeeding syndrome, and what is its mechanism?

Hypophosphataemia from insulin-driven intracellular phosphate uptake
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Hypercalcaemia from increased intestinal calcium absorption
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Hypernatraemia from osmotic diuresis
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Hypoglycaemia from suppressed hepatic gluconeogenesis
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Metabolic alkalosis from increased renal bicarbonate reabsorption
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Question 18 of 20

18. Question

Ammonia-induced astrocyte swelling in hepatic encephalopathy results from intracellular accumulation of which metabolite?

Glutamine
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Gamma-aminobutyric acid
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Lactate dehydrogenase
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Manganese
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Myo-inositol
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Question 19 of 20

19. Question

Which protein is essential for the assembly and secretion of chylomicrons by the enterocyte?

Microsomal triglyceride transfer protein
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Apolipoprotein C-II
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Cholesteryl ester transfer protein
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Lipoprotein lipase
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Niemann-Pick C1-like 1 protein
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Question 20 of 20

20. Question

The effectiveness of oral rehydration solution in secretory diarrhoea depends principally on which transport mechanism?

Sodium-glucose co-transport by SGLT1 in the small intestinal brush border
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Aquaporin-mediated transcellular water flux in the colon
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Cyclic AMP-dependent chloride secretion through CFTR
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Electroneutral sodium chloride absorption via NHE3 and DRA
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Paracellular sodium absorption driven by glucose-induced hypertonicity
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Basic Sciences in Gastroenterology

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