A 60-year-old man is seen in the emergency room. He is disoriented and complains of fatigue and weakness.
A physical examination reveals signs of alcohol abuse and a hardened liver. Blood tests reveal hypoglycemia. Loss of the function of which hepatic cell type most likely accounts for his inability to maintain normal levels of plasma glucose?
A. endothelial cells
B. Kupffer's cells
C. stellate cells
D. hepatocytes
E. cholangiocytes
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Question 2) In an experiment, a researcher infuses a solution of conjugated bile acids into the portal vein of a rat such that their normal concentration is approximately doubled.
He collects samples of hepatic bile from the rat before and after the infusion. Before the infusion, the concentrations of bile acids (BA), phosphatidylcholine (PC), and cholesterol (chol) are 30, 9, and 3 units per mL. What would be the predicted concentrations of PC and chol in the bile following the BA infusion?
A. PC: 9; chol: 3
B. PC: 18; chol: 3
C. PC: 9; chol: 6
D. PC: 18; chol: 6
E. PC: 3; chol: 9
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Question 3) A newborn infant is observed to be mildly jaundiced. Bilirubin is not found in the urine. A relative absence of which of the following liver proteins likely accounts for the symptoms?
A. BSEP
B. OATP
C. UGT
D. MRP2
E. ABC5/ABC8
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Question 4) A 45-year-old woman comes to her physician complaining of a 2-month history of recurrent, severe abdominal pain that occurs mainly after eating large, fatty meals.
However, she is well-nourished and an aspirate of her duodenal contents shows normal micellar concentrations of bile acids. A diagnostic procedure reveals a biliary obstruction; where is the gallstone most likely to be lodged?
A. right hepatic duct
B. cystic duct
C. common hepatic duct
D. common bile duct
E. sphincter of Oddi
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Question 5) A college student decides to enter the Peace Corps following graduation and is assigned to teach English in sub-Saharan Africa where the ambient temperature averages 100 F.
During the first few weeks of his stay, he notes copious sweating and mild constipation. His gastrointestinal symptoms are most likely due in part to upregulated expression of which of the following transport proteins?
A. CFTR
B. NBC1
C. ABST
D. NKCC1
E. ENaC
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Question 6) In an experiment, a researcher raises mice under completely germfree conditions such that colonization of their intestine with commensal bacteria cannot occur.
Compared to a conventionally-raised animal, the concentration of which of the following would be expected to be increased in the colonic contents of such mice?
A. butyrate
B. taurochenodeoxycholic acid
C. unconjugated bilirubin
D. IgA
E. lithocholic acid
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Question 7) A 45-year-old woman receiving chemotherapy for breast cancer complains of nausea, abdominal pain, bloody diarrhea, and malnutrition.
Her symptoms most likely reflect toxicity of the chemotherapy toward which of the following gastrointestinal cell types?
A. smooth muscle
B. parietal cells
C. pancreatic acinar cells
D. hepatocytes
E. epithelial cells
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Question 8) A college student notes that when sitting down to dinner, he is frequently struck by an intense impulse to use the restroom.
The proximal signal that triggers the reflex arc promoting this response most likely originates in which part of the system involved in the integrated response to a meal?
A. brain
B. pharynx
C. esophagus
D. stomach
E. duodenum
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Question 9) A child is brought to a gastroenterologist because of persistent diarrhea, particularly after ingesting fatty meals. An extensive workup eventually reveals that the child lacks the ability to synthesize peptide YY.
The increased stool volume seen in the child is most likely primarily ascribable to abnormally high active secretion of which of the following?
A. short chain fatty acids
B. Na+
C. K+
D. Cl-
E. triglycerides
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Question 10) Routine neonatal testing suggests that a baby lacks a transport protein responsible for the uptake of cysteine in the intestine and kidneys.
However, while cysteine accumulates in the urine, its concentration in the plasma is normal when the child receives a diet containing protein. Which intestinal transporter most likely provides for uptake of cysteine in this child?
A. CFTR
B. NKCC1
C. ENaC
D. PepT1
E. SLC6A19
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