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Beyond the Brain: Year 2 MCQ Q25-38 Explanations

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Year 2 MCQ - GI 2437808c@student.gla.ac.uk26. What type of epithelium lines the stomach? A. Simple columnar B. Stratified squamous keratinized C. Stratified squamous non-keratinized D. Simple squamous E. Transitional27. Ligamentum teres is a physiological remnant of which embryological feature? A.Urachus B.Ductus arteriosus C.Umbilical vein D.Foramen ovale E. Ductus venosus• Ligamentum teres (round ligament) o Fibrous cord in the free edge of falciform ligament o Runs from the porta hepatis and attaches to the area of the umbilicus o Remnant of the umbilical vein Urachus – remnant of channel Ductus arteriosus – connection of the between bladder and umbilicus pulmonary artery to the aorta Ductus venosus – shunt which allows oxygenated blood from the umbilical left and right atriumbetween the vein to bypass the liver which is important for normal foetal circulation28. Somatostatin is a peptide hormone that acts to inhibit insulin and glucagon secretion as well as reduce the rate of gastric emptying and reduce smooth muscle contractions within the gastrointestinal system. Where in the body is this hormone secreted from? A. Beta cells in pancreas B. D cells in pancreas and stomach C. G cells in stomach and duodenum D. Parietal cells in stomach E. S cells in duodenum Somatostatin is released from D cells, in the 
ancreas and stomach. 
 Beta cell islets in the pancreas secrete insulin. Insulin predominantly acts to move glucose from the bloodstream into cells 
 G cells in the stomach and duodenum produce and release the hormone
 gastrin (acts to stimulate the secretion of gastric acid by the parietal cells) 
 Parietal cells in the stomach are responsible for gastric acid secretion. Parietal cells also produce intrinsic factors which play a major role in vitamin 
12 absorption. 
 S cells in the duodenum release secretin. Secretin primarily functions to neutralise the pH in the duodenum, allowing digestive enzymes from the pancreas to function optimally.
 Taken from Passmedicine29. A 25-year-old female presents with diarrhoea, fatigue and bloating. She mentions her mother has a history of coeliac disease and undergoes a blood test to check this. What antibody test has high specificity and sensitivity to test for coeliac disease? A.Anti-EMA B.Anti-gliadin C.Anti-tTG D.Anti-GAD E. Anti-TPO•Autoantibodies seen in coeliac disease: • Anti-gliadin • Anti-tTG • IgA tTG (tissue transglutaminase Ab) • Most commonly used in clinical practice • Usually done in primary care • Sensitivity 93%; specificity >98% • These antibodies are involved in the destruction of the villous ECM and target the destruction of intestinal villous epithelial cells by killer cells • Anti-EMA • IgA EMA (antiendomysial Ab) • Previously used now much less common • Sensitivity 70-100%; specificity >99%30. A patient presents to the GP with a 6-month history of epigastric pain. He then gets an with a spiral outline. What is the most likely micro-organism causing the patients symptoms? A. Campylobacter jejuni B. Shigella C. Salmonella typhi D. Staphylococcus aureus E. Helicobacter pyloriH.Pylori infection General Characteristics SSx - Gram –ve, spiral shaped, Camylobacter like organism -Dyspepsia - Urease*- (key feature), catalase , mucinase ( highly motile -Symptoms of GORD organisms, gastric strains) -Upper abdo pain - Can cause inflammation in lining of stomach and result in peptic -N+V ulcers by producing an alkali environment to survive Treatment Pathophysiology Initiate eradication therapy (TRIPLE Mainly associated with role of CYTOKINES. 1) Alters secretion of mucus in the stomach. THERAPY) 2) Releases cytokines i.e. TNF-a, IL-8. 3) Increases Gastrin release. 4) Releases parietal cells- Increases acid secretion?31. Hepcidin is an important regulator of iron homeostasis. What is the likely consequence of loss of hepcidin? A. Decreased ferroportin channels – normal function – normal function B. Decreased iron absorption C. Decreased iron release from macrophages – normal function – not affected by hepcidin D.Decreased activity of haem oxygenase E. Increased transferrin saturationLoss of hepcidin: IRON OVERLOAD - Increased GI absorption - Increased release by RES system - Increased TF saturation32. A 46-year-old woman attends a routine liver clinic. She has been struggling for many years with alcohol dependence, often consuming 80 units in a week. On examination, she appears jaundiced and looks unwell. You see multiple spider- like blood vessels on her chest. Given the likely diagnosis, what blood test would be most useful? A. ALP B. AST C. ALT D. Prothrombin time E. Bilirubin Liver enzymes are a poor way to look at liver function - they are usually low in end-stage cirrhosis whereas coagulation and albumin are better measures Prothrombin time is the correct answer. The history of long-term alcohol dependence combined with clinical findings is suggestive of cirrhosis. Liver enzymes are a poor way to measure liver function in this case- if the liver is very damaged it may be falsely normal. Prothrombin time and albumin are better measures as they show the liver's ability to make 
lotting factors and proteins. 
 ALT, ALP and AST are liver enzymes. Usually, raised ALT and AST suggest damage to the liver itself. A raised ALP often suggests post- hepatic damage. However, in a patient with cirrhosis, the liver may struggle to produce the enzymes in the first place. 
 
 While you would expect bilirubin to be raised in a jaundiced patient with liver disease, it is not the best measure of liver function. Taken from Passmedicine33. A 43-year-old was referred to your clinic with a 3 year history of tiredness. She also mentions a lot more stress at work which has led her to drink from 8 units a week to 14 units of alcohol a week. Blood investigations show: Based on the results, what is the most likely diagnosis? A.Biliary obstruction B.Autoimmune hepatitis C.Primary biliary cirrhosis D.Hypothyroidism E. Alcoholic liver diseaseBiliary obstruction – unlikely as bilirubin is normal Autoimmune hepatitis is unlikely as this would feature elevated ALT and IgG as well as be associated with positive antinuclear and anti-smooth Ab Alcohol liver disease is unlikely as this would be associated to an AST/ALT ratio >2 PBC is characterised by: Cholestatic LFTs Positive anti-mitochondrial Ab. Typical histological features on liver biopsy34. What artery supplies the abdominal part of the oesophagus A. Left gastric artery B. Coeliac artery C. Splenic artery D. Right gastric artery E. Gastroduodenal artery35. What organ is this histology slide from? Mucosa A.Stomach B.Oesphagus Submucosa C.Small intestine D.Large intestine E.Liver Muscularis externa36. What is B pointing to? A.Inferior vena cava B.Aorta C.Renal veins D.Superior mesenteric vessels E. Inferior mesenteric vessels37. A 59-year-old man is undergoing an extended left hemicolectomy for a carcinoma of the splenic flexure of the colon. The surgeons divide the middle colic vein close to its origin. Into which of the following structures does this vessel primarily drain? A.Superior mesenteric vein B.Portal vein C.Inferior mesenteric vein D.Inferior vena cava E. Ileocolic vein The middle colonic vein drains into the SMV, if avulsed during mobilisation then dramatic haemorrhage can occur and be difficult to control. Blood supply of gut: SMA ▯ ileocolic, right colic, middle colic and marginal artery (ascending colon + 2/3 of transverse colon) IMA ▯ left colic, sigmoid and superior rectal artery (last 1/3 of transverse and descending colon) Venous drainage follows arterial supply (except inferior mesenteric vein; drains into splenic vein then portal vein) Therefore, answer is SMA and IMA for this question Taken from Passmedicine38. A 43-year-old female with persistent gastro-oesophageal reflux disease comes to the GP complaining of a burning pain in her chest. She is referred to a gastroenterologist who performs an endoscopy with biopsy. This leads to a diagnosis of Barrett's oesophagus. The patient is warned this increases her cancer risk and better management of the reflux is necessary. Describe the metaplasia that occurs in Barrett's oesophagus. A. Simple columnar to stratified squamous B. Simple squamous to simple columnar C. Simple cuboidal to stratified squamous D. Stratified squamous to simple cuboidal E. Stratified squamous to simple columnar Barretts oesophagus is the metaplasia of epithelial cells of the lower oesophagus from stratified squamous to simple columnar epithelium Barrett's oesophagus increases the risk of oesophageal cancer 30-fold and can be caused by gastro-oesophageal reflux disease. • If the metaplastic stimulus is removed, the cells will return to their original pattern of differentiation. However, if the stimulus is not removed then progression to dysplasia may occur. • Not considered directly carcinogenic, however the factors which predispose to metaplasia, if persistent may induce malignant transformation.  Taken from Passmedicine