Hall: Guyton and Hall Textbook of Medical Physiology, 12th Edition
Chapter 64: Secretory Functions of the Alimentary Tract and Chapter 66: Physiology
of Gastrointestinal Disorders
Test Bank
1. How does secretin stimulate the secretion of bicarbonate from the pancreas?
A. Closes potassium channels
B. Closes sodium channels
C. Decreases norepinephrine levels
D. Increases acetylcholine levels
E. Opens chloride channels
2. A 67-year-old man has heartburn and stomach pain. Endoscopy shows several small
gastric ulcers in the corpus. Biopsies were positive for H. pylori, which promotes gastric
ulcer formation by damaging which of the following?
A. Circular muscle layer
B. Gastric mucosal barrier
C. G cells
D. Myenteric plexus
E. Parietal cells
3. Which of the following decreases when salivary flow increases?
A. Bicarbonate concentration
B. Chloride concentration
C. Osmolarity
D. Potassium concentration
E. Sodium concentration
4. Which of the following leads to a decrease in salivary flow?
A. Chewing
B. Fear
C. Nausea
D. Smooth objects in the mouth
5. The pH of the gastric contents is lowest under which condition?
A. After a fatty meal
B. After a high protein meal
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64 and 66-2
C. After a starchy meal
D. Between meals
6. Which of the following substances secreted by the stomach is absolutely critical for life?
A. Gastrin
B. HCl
C. Intrinsic factor
D. Pepsin
E. Rennin
7. A 44-year-old man underwent a cholecystectomy nine years ago. At that time, the liver
was normal, but an enlarged pancreatic head was identified. Three years ago, he was
admitted for upper gastrointestinal bleeding. Endoscopy revealed multiple ulcers in the
duodenum. The serum gastrin level was 1,100 pg/mL (normal, 0 to 100 pg/mL).
Abdominal computed tomography revealed two masses in the pancreas and multiple liver
metastases. The liver biopsy confirmed the presence of non-beta islet cell tumor tissue.
This patient is most likely to be suffering from which of the following diseases?
A. Achalasia
B. Alcoholic cirrhosis
C. Cystic fibrosis
D. Diverticulosis
E. Type II diabetes
F. Zollinger-Ellison syndrome
8. A 72-year-old man underwent a cholecystectomy seven years ago. At that time, the liver
was normal, but an enlarged pancreatic head was identified. Three years ago, he was
admitted for upper gastrointestinal bleeding. Endoscopy revealed multiple ulcers in the
duodenum. The serum gastrin level was 1,000 pg/mL (normal, 0 to 100 pg/mL).
Abdominal computed tomography revealed two masses in the pancreas and multiple liver
metastases. The liver biopsy confirmed the presence of non-beta islet cell tumor tissue.
Administration of which substance is useful in confirming the diagnosis in this man?
A. Cholecystokinin (CCK)
B. Gastric inhibitory peptide (GIP)
C. Pentagastrin
D. Secretin
E. Vasoactive intestinal peptide (VIP)
9. Which one of the following sets of changes occurs in patients with pernicious anemia
compared with the normal population?
Gastric Acid Output Serum Gastrin Levels
A.
B.
C.
D.
E.
10. Vagal stimulation tends to cause which of the following changes in the release of gastric-
releasing peptide (GRP) and somatostatin?
GRP Somatostatin
A.
B.
C.
D.
E.
11. Intravenous administration of atropine causes which of the following changes in the
ability of gastrin, acetylcholine, and histamine to stimulate acid secretion?
Gastrin Acetylcholine Histamine
A.
B.
C.
D.
E.
12. A 27-year-old woman eats a healthy dinner. The answer choices indicate the rate of acid
secretion before and various times after the meal. At which time is the pH of the stomach
contents the lowest?
Time Rate of Acid Secretion
A. Before meal 2 mEq H+/hr
B. 30 mins after meal 35 mEq H+/hr
C. 60 mins after meal 29 mEq H+/hr
D. 90 mins after meal 20 mEq H+/hr
E. 120 mins after meal 10 mEq H+/hr
13. Which of the following can totally eliminate the cephalic phase of gastric secretion?
A. Antiacids (e.g., Rolaids)
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64 and 66-4
B. Anti-gastrin antibody
C. Atropine
D. Histamine H2 blocker
E. Vagotomy
14. A 65-year-old man with hematemesis and melena has a crescentic ulcer in the duodenum.
Lavage dislodged the clot, revealing an underlying raised blood vessel, which was
successfully eradicated by cautery with a bipolar gold probe. Which of the following
factors are diagnostic for duodenal ulcer?
Endoscopy Plasma Gastrin Levels Rate of Acid Secretion
A. No No No
B. Yes No No
C. Yes No Yes
D. Yes Yes No
E. Yes Yes Yes
15. Which of the following factors stimulate the release of hormones or stimulate nervous
reflexes, which can inhibit gastric acid secretion?
Acid Fatty Acids Hyperosmotic Solutions Isotonic Solutions
A. No No Yes No
B. No No Yes Yes
C. Yes Yes No Yes
D. Yes Yes Yes Yes
E. Yes Yes Yes No
16. Most of the acid response to a meal occurs during which phase?
A. Cephalic phase
B. Esophageal phase
C. Gastric phase
D. Intestinal phase
17. Which of the following weakens the gastric mucosal barrier?
A. Bile salts
B. Epidermal growth factor
C. Gastrin
D. Mucus
18. The most common cause of chronic pancreatitis in adults is which of the following?
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64 and 66-5
A. Alcoholism
B. Celiac sprue
C. Cystic fibrosis
D. Gallstones
E. Malignancy
19. Which of the following is critical for stimulating bicarbonate excretion from the
pancreas?
A. Acetylcholine
B. CCK
C. GIP
D. Gastrin
E. Secretin
20. Which of the following sets of changes occur as the rate of salivation increases?
Osmolarity Sodium Conc. Potassium Conc. Bicarbonate Conc.
A.
B.
C.
D.
E.
F.
21. Which of the following can damage the gastric mucosal barrier and stimulate gastric acid
secretion?
A. Bile salts
B. Epidermal growth factor
C. Gastrin
D. Helicobacter pylori
E. Mucus
22. A 70-year-old woman undergoes a gastrectomy for Zollinger-Ellison syndrome. Her
physician informs her that she will need to take intramuscular vitamin B12 shots for the
rest of her life. Absence of which of the following cell types are responsible for this
vitamin replacement requirement?
A. Chief cells
B. G cells
C. Goblet cells
D. Mucous neck cells
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64 and 66-6
E. Parietal cells
23. The stimulatory effects of gastrin on acid secretion are mediated in part by gastrin-
induced secretion of which substance?
A. Acetylcholine
B. Amino acids
C. Gastrin-releasing peptide
D. Histamine
E. Somatostatin
24. A 55-year-old woman with upper abdominal pain and blood in the stool had been taking
NSAIDs for the pain. Endoscopy revealed global gastritis in the gastric fundus and body.
A serious, potentially life-threatening, long-term problem is decreased secretion of which
substance?
A. Gastrin
B. HCl
C. Intrinsic factor
D. Pepsinogen
E. Rennin
25. Which of the following is higher in saliva compared with blood plasma?
A. Chloride concentration
B. Osmolarity
C. Potassium concentration
D. Protein concentration
E. Sodium concentration
26. Acidification of the antrum diminishes amino acid–induced stimulation of gastrin
secretion by increasing local levels of which substance?
A. Acetylcholine
B. GRP
C. Histamine
D. Secretin
E. Somatostatin
27. When does the pH of the gastric contents reach its lowest level?
A. 1.0 hour after a meal is taken
B. 1.5 hours after a meal is taken
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C. 2.0 hours after a meal is taken
D. 2.5 hours after a meal is taken
E. 3.0 hours after a meal is taken
F. 4.0 hours after a meal is taken
28. Which of the following factors inhibit gastric acid secretion?
Somatostatin Secretin GIP Enterogastrones Nervous
Reflexes
A. No Yes Yes Yes No
B. No Yes Yes Yes Yes
C. Yes Yes No Yes Yes
D. Yes Yes Yes No No
E. Yes Yes Yes Yes Yes
29. A 48-year-old man with a recurrent history of ulcer disease associated with diarrhea and
a strong family history of duodenal ulcer disease is suspected of having Zollinger-Ellison
syndrome (i.e., gastrinoma). Secretin (1 unit/kg) was given as a rapid intravenous
injection to test for gastrinoma. Which of the following results supports the existence of a
gastrinoma after secretin administration?
A. Decreased serum gastrin
B. Increased serum gastrin
C. Inhibition of gastric acid secretion
D. Inhibition of gastric emptying
E. Stimulation of pancreatic HCO3− secretion
30. A 44-year-old woman with hematemesis has heartburn and stomach pain. Endoscopy
shows inflammation involving the gastric body and antrum, as well as a small gastric
ulcer. Biopsies were positive for H. pylori, which damages the gastric mucosa primarily
by increasing mucosal levels of which substance?
A. Ammonium
B. Bile salts
C. Gastrin
D. Nonsteroidal anti-inflammatory drugs (NSAIDs)
E. Pepsin
31. A 61-year-old man is admitted as an emergency for upper gastrointestinal bleeding.
Endoscopy reveals multiple ulcers in the duodenum. Serum gastrin levels are eightfold
higher compared with normal. Zollinger-Ellison syndrome (i.e., gastrinoma) is suspected.
Administration of which substance is useful in confirming the diagnosis in this man?
Test Bank
64 and 66-8
A. CCK
B. GIP
C. Motilin
D. Pentagastrin
E. Secretin
F. VIP
32. Which of the following factors strengthen or weaken the gastric mucosal barrier?
Bile Salts Mucus NSAIDs Gastrin Ethanol Aspirin
A. Strengthen Strengthen Weaken Weaken Strengthen Strengthen
B. Strengthen Strengthen Weaken Weaken Weaken Strengthen
C. Weaken Strengthen Strengthen Weaken Strengthen Weaken
D. Weaken Strengthen Weaken Weaken Strengthen Weaken
E. Weaken Weaken Weaken Strengthen Strengthen Weaken
33. A 54-year-old man with dyspepsia and a history of chronic gastric ulcer has abdominal
pain. Endoscopy shows a large ulcer in the proximal gastric body. Biopsies were positive
for H. pylori. Which of the following are used clinically for treatment of gastric ulcers of
various causes?
Antibiotics NSAIDs H2 Proton Pump Pentagastrin
Blockers Inhibitors
A. No No Yes Yes Yes
B. Yes No No Yes No
C. Yes No Yes Yes No
D. Yes Yes Yes Yes No
E. No Yes Yes Yes Yes
34. A 55-year-old man presents with abdominal pain and hematemesis. Findings of an
abdominal examination were relatively benign, but abdominal radiographs suggested a
perforated viscus. Endoscopy revealed a chronically perforated gastric ulcer, through
which the liver was visible. Which of the following is a forerunner to gastric ulcer
formation?
A. Back-leak of hydrogen ions
B. Mucus secretion
C. Proton pump inhibition
D. Tight junctions between cells
E. Vagotomy
35. Administration of a histamine H2 receptor blocker causes which of the following changes
in the ability of gastrin, acetylcholine, and histamine to stimulate acid secretion?
Test Bank
64 and 66-9
Gastrin Acetylcholine Histamine
A.
B.
C.
D.
E.
36. What is the direct physiological effect of the various hormones on gastric acid secretion?
Gastrin Secretin CCK GIP Motilin_
A. No effect Stimulate Stimulate No effect No effect
B. Stimulate Inhibit No effect Inhibit No effect
C. Stimulate Inhibit No effect No effect No effect
D. Stimulate Inhibit Inhibit Stimulate Stimulate
E. Stimulate Stimulate Inhibit Inhibit No effect
37. A 77-year-old woman with upper abdominal pain and blood in the stool has been taking
NSAIDs for arthritis. Endoscopy revealed patchy gastritis throughout the stomach.
Biopsies were negative for H. pylori. Pentagastrin administered intravenously led to a
less than expected (i.e., less than normal) increase in which of the following?
A. Duodenal mucosal growth
B. Gastric acid secretion
C. Gastrin secretion
D. Pancreatic enzyme secretion
E. Pancreatic growth
38. Which of the following correctly pairs the secreted substance with the cell-type that
secretes the substance?
Somatostatin/D-cell Cholecystokinin/I-cell Histamine/H-cell
A. Correct Correct Incorrect
B. Correct Correct Correct
C. Correct Incorrect Incorrect
D. Incorrect Correct Incorrect
E. Incorrect Incorrect Correct
F. Incorrect Incorrect Incorrect
39. The control of gastric acid secretion in response to a meal involves several events that
take place over a four or five hour period following the meal. These events include (1) a
decrease in the pH of the gastric contents, (2) an increase in the rate of acid secretion, (3)
a decrease in the rate of acid secretion, and (4) an increase in the pH of the gastric
Test Bank
contents. Which of the following best describes the correct temporal order of events over
a four or five hour period following a meal?
A. 4, 3, 2, 1
B. 3, 1, 4, 2
C. 3, 4, 1, 2
D. 2, 1, 4, 3
E. 4, 2, 1, 3
F. 1, 2, 3, 4
G. 2, 3, 1, 4
H. 1, 3, 2, 4
40. A 22-year-old male is fed intravenously for several weeks following a severe automobile
accident. The intravenous feeding leads to atrophy of the gastrointestinal mucosa most
likely because the blood level of which of the following hormones is reduced?
A. Cholecystokinin only
B. Gastrin only
C. Secretin only
D. Gastrin and cholecystokinin
E. Gastrin and secretin
F. Secretin and cholecystokinin
41. Which of the following conditions in the stomach would most likely lead to the greatest
amount of gastric acid secretion following a meal containing proteins?
Gastric pH Somatostatin
A. ↑ ↓
B. ↑ ↑
C. ↓ ↓
D. ↓ ↑