BIOD 151
Anatomy & Physiology
Module 3
Final Exam
2024
1. Q1 (MCQ): A 38-year-old with chronic pancreatitis has greasy stools, weight loss, and fatigue. Which mechanism best
explains his decreased energy harvest?
- A. Failure to acidify the stomach impairs pepsin activity
- B. Inadequate hydrolysis of triglycerides limits micelle formation and chylomicron assembly
- C. Reduced colonic goblet cells decrease mucin production
- D. Hypersecretion of gastrin accelerates gastric emptying
- ANSWER: B
- Rationale: Pancreatic lipase and colipase hydrolyze triglycerides into free fatty acids and 2-monoacylglycerol, enablin
bile salt–mediated micelle formation and subsequent chylomicron assembly. Without this, long-chain fat absorption falls,
markedly reducing caloric intake because lipids are the most energy-dense macronutrient.
2. Q2 (MCQ): A child with glucose-galactose malabsorption (SGLT1 mutation) presents with dehydration and failure to
thrive. Which diet best supports energy needs?
- A. High lactose diet
- B. Fructose-based carbohydrate sources
- C. High starch diet absorbed via SGLT1
- D. High protein diet with glucose polymers
- ANSWER: B
- Rationale: SGLT1 specifically cotransports glucose and galactose with Na+. Fructose uses the apical GLUT5 and
basolateral GLUT2 transporters, allowing carbohydrate-derived energy intake despite SGLT1 dysfunction.
3. Q3 (MCQ): A long-term proton pump inhibitor user develops microcytic anemia and exercise intolerance. Which
mechanism connects digestive function to reduced aerobic ATP production?
- A. Loss of intrinsic factor impairs iron absorption
- B. Reduced gastric acidity limits Fe2+ formation and iron absorption
, - C. Delayed gastric emptying decreases carbohydrate absorption
- D. Increased duodenal bicarbonate secretion chelates iron
- ANSWER: B
- Rationale: Gastric acid promotes reduction of ferric to ferrous iron and solubilization, facilitating DMT1-mediated upta
in the duodenum. Iron deficiency lowers hemoglobin and oxygen delivery capacity, constraining oxidative phosphorylation.
4. Q4 (MCQ): A patient with Zollinger–Ellison syndrome has intractable duodenal ulcers and steatorrhea. How does exce
acid impair energy extraction?
- A. Acid denatures pepsinogen, reducing protein digestion in the stomach
- B. Acid precipitates bile salts and inactivates pancreatic enzymes in the duodenum
- C. Acid stimulates CCK, slowing gastric emptying
- D. Acid accelerates colonic transit, limiting SCFA production
- ANSWER: B
- Rationale: Duodenal hyperacidity impairs pancreatic enzyme function and precipitates bile salts, diminishing fat
emulsification and enzyme activity, leading to fat malabsorption and reduced caloric absorption.
5. Q5 (MCQ): After a high-fat meal, which pathway predominantly delivers dietary triglycerides to systemic tissues for
energy?
- A. Portal vein as VLDL particles
- B. Lymphatic system as chylomicrons via lacteals
- C. Portal vein as free glycerol and fatty acids bound to albumin
- D. Hepatic artery as LDL particles
- ANSWER: B
- Rationale: Enterocytes re-esterify long-chain fatty acids to triglycerides, assemble chylomicrons (ApoB-48 dependent
and secrete them into lacteals. Lymphatics drain into the venous system, delivering lipid energy substrates systemically.
6. Q6 (MCQ): A patient on broad-spectrum antibiotics develops watery diarrhea and fatigue. Colonoscopy is normal. Whi
loss most directly reduces colonocyte ATP supply?
- A. Decreased lactate from enterocytes
- B. Decreased butyrate from microbial fermentation
- C. Decreased propionate from pancreatic enzymes
- D. Decreased acetate from gastric parietal cells
- ANSWER: B
- Rationale: Colonic microbiota ferment fiber into short-chain fatty acids; butyrate is the primary fuel for colonocytes,
supporting mitochondrial ATP production and mucosal integrity.
,7. Q7 (MCQ): A 46-year-old undergoes cholecystectomy. Postoperatively, fat intake causes bloating but no pain. Which
change most affects energy harvest from fat?
- A. Loss of bile salt synthesis
- B. Continuous, less concentrated bile delivery to the duodenum
- C. Loss of pancreatic lipase secretion
- D. Blockade of enterohepatic circulation
- ANSWER: B
- Rationale: Bile is still produced and bile salt recycling persists, but gallbladder removal eliminates pulsatile, concentra
bile release with meals. Early adaptation can transiently reduce emulsification efficiency and fat energy extraction.
8. Q8 (MCQ): A marathon runner takes orlistat for weight loss. She reports fatigue during training. Which mechanism
explains decreased available energy?
- A. Inhibition of SGLT1 reduces glucose absorption
- B. Inhibition of gastric lipase only
- C. Inhibition of pancreatic and gastric lipases reduces fat absorption
- D. Inhibition of GLUT5 blocks fructose transport
- ANSWER: C
- Rationale: Orlistat inhibits luminal lipases, decreasing triglyceride hydrolysis and micelle formation, thus lowering
absorption of energy-dense lipids and fat-soluble vitamins.
9. Q9 (MCQ): A patient with celiac disease has villous atrophy predominantly in the proximal small intestine. Which energ
related consequence is most expected early?
- A. Reduced intrinsic factor secretion
- B. Reduced iron and carbohydrate absorption
- C. Reduced colonic water absorption
- D. Reduced bile acid synthesis
- ANSWER: B
- Rationale: Duodenal and proximal jejunal mucosal injury impairs iron and monosaccharide absorption, reducing energ
intake and leading to fatigue and anemia.
10. Q10 (MCQ): After truncal vagotomy with pyloroplasty, a patient experiences dizziness and palpitations 30 minutes af
meals. Which best explains the energy-related symptoms?
- A. Protein maldigestion causing hypoglycemia
- B. Rapid gastric emptying causing exaggerated insulin response
, - C. Reduced gastric acid causing early satiety
- D. Enhanced bile flow causing hyperglycemia
- ANSWER: B
- Rationale: Dumping syndrome from rapid delivery of hyperosmolar chyme increases incretins and insulin, producing
reactive hypoglycemia and compromised postprandial energy availability.
11. Q11 (MCQ): A patient has severe protein maldigestion after pancreatic surgery. Which brush-border enzyme is
essential to trigger intraluminal proteolysis?
- A. Aminopeptidase N
- B. Lactase
- C. Enteropeptidase (enterokinase)
- D. Sucrase–isomaltase
- ANSWER: C
- Rationale: Enteropeptidase activates trypsinogen to trypsin; trypsin then activates other pancreatic zymogens, enablin
peptide breakdown and amino acid availability for energy and biosynthesis.
12. Q12 (MCQ): A 55-year-old with chronic pancreatitis has postprandial pain relieved by pancreatic enzyme therapy.
Secretin stimulation testing is low. Which physiologic action of secretin most directly supports energy absorption?
- A. Stimulates pepsinogen secretion
- B. Inhibits bile salt synthesis
- C. Stimulates pancreatic ductal bicarbonate to neutralize chyme
- D. Stimulates gastric acid secretion
- ANSWER: C
- Rationale: Neutralization of acidic chyme optimizes pH for pancreatic enzyme activity in the duodenum, enabling
efficient macronutrient digestion and caloric extraction.
---
Multiple response (select all that apply)
13. Q13 (Multiple response): A 27-year-old with Crohn’s disease undergoes terminal ileum resection and later develops
weight loss and steatorrhea. Which consequences contribute to reduced energy harvest? (Select all that apply.)
- A. Bile acid loss causing impaired micelle formation
- B. Loss of intrinsic factor secretion
- C. Vitamin B12 malabsorption
Anatomy & Physiology
Module 3
Final Exam
2024
1. Q1 (MCQ): A 38-year-old with chronic pancreatitis has greasy stools, weight loss, and fatigue. Which mechanism best
explains his decreased energy harvest?
- A. Failure to acidify the stomach impairs pepsin activity
- B. Inadequate hydrolysis of triglycerides limits micelle formation and chylomicron assembly
- C. Reduced colonic goblet cells decrease mucin production
- D. Hypersecretion of gastrin accelerates gastric emptying
- ANSWER: B
- Rationale: Pancreatic lipase and colipase hydrolyze triglycerides into free fatty acids and 2-monoacylglycerol, enablin
bile salt–mediated micelle formation and subsequent chylomicron assembly. Without this, long-chain fat absorption falls,
markedly reducing caloric intake because lipids are the most energy-dense macronutrient.
2. Q2 (MCQ): A child with glucose-galactose malabsorption (SGLT1 mutation) presents with dehydration and failure to
thrive. Which diet best supports energy needs?
- A. High lactose diet
- B. Fructose-based carbohydrate sources
- C. High starch diet absorbed via SGLT1
- D. High protein diet with glucose polymers
- ANSWER: B
- Rationale: SGLT1 specifically cotransports glucose and galactose with Na+. Fructose uses the apical GLUT5 and
basolateral GLUT2 transporters, allowing carbohydrate-derived energy intake despite SGLT1 dysfunction.
3. Q3 (MCQ): A long-term proton pump inhibitor user develops microcytic anemia and exercise intolerance. Which
mechanism connects digestive function to reduced aerobic ATP production?
- A. Loss of intrinsic factor impairs iron absorption
- B. Reduced gastric acidity limits Fe2+ formation and iron absorption
, - C. Delayed gastric emptying decreases carbohydrate absorption
- D. Increased duodenal bicarbonate secretion chelates iron
- ANSWER: B
- Rationale: Gastric acid promotes reduction of ferric to ferrous iron and solubilization, facilitating DMT1-mediated upta
in the duodenum. Iron deficiency lowers hemoglobin and oxygen delivery capacity, constraining oxidative phosphorylation.
4. Q4 (MCQ): A patient with Zollinger–Ellison syndrome has intractable duodenal ulcers and steatorrhea. How does exce
acid impair energy extraction?
- A. Acid denatures pepsinogen, reducing protein digestion in the stomach
- B. Acid precipitates bile salts and inactivates pancreatic enzymes in the duodenum
- C. Acid stimulates CCK, slowing gastric emptying
- D. Acid accelerates colonic transit, limiting SCFA production
- ANSWER: B
- Rationale: Duodenal hyperacidity impairs pancreatic enzyme function and precipitates bile salts, diminishing fat
emulsification and enzyme activity, leading to fat malabsorption and reduced caloric absorption.
5. Q5 (MCQ): After a high-fat meal, which pathway predominantly delivers dietary triglycerides to systemic tissues for
energy?
- A. Portal vein as VLDL particles
- B. Lymphatic system as chylomicrons via lacteals
- C. Portal vein as free glycerol and fatty acids bound to albumin
- D. Hepatic artery as LDL particles
- ANSWER: B
- Rationale: Enterocytes re-esterify long-chain fatty acids to triglycerides, assemble chylomicrons (ApoB-48 dependent
and secrete them into lacteals. Lymphatics drain into the venous system, delivering lipid energy substrates systemically.
6. Q6 (MCQ): A patient on broad-spectrum antibiotics develops watery diarrhea and fatigue. Colonoscopy is normal. Whi
loss most directly reduces colonocyte ATP supply?
- A. Decreased lactate from enterocytes
- B. Decreased butyrate from microbial fermentation
- C. Decreased propionate from pancreatic enzymes
- D. Decreased acetate from gastric parietal cells
- ANSWER: B
- Rationale: Colonic microbiota ferment fiber into short-chain fatty acids; butyrate is the primary fuel for colonocytes,
supporting mitochondrial ATP production and mucosal integrity.
,7. Q7 (MCQ): A 46-year-old undergoes cholecystectomy. Postoperatively, fat intake causes bloating but no pain. Which
change most affects energy harvest from fat?
- A. Loss of bile salt synthesis
- B. Continuous, less concentrated bile delivery to the duodenum
- C. Loss of pancreatic lipase secretion
- D. Blockade of enterohepatic circulation
- ANSWER: B
- Rationale: Bile is still produced and bile salt recycling persists, but gallbladder removal eliminates pulsatile, concentra
bile release with meals. Early adaptation can transiently reduce emulsification efficiency and fat energy extraction.
8. Q8 (MCQ): A marathon runner takes orlistat for weight loss. She reports fatigue during training. Which mechanism
explains decreased available energy?
- A. Inhibition of SGLT1 reduces glucose absorption
- B. Inhibition of gastric lipase only
- C. Inhibition of pancreatic and gastric lipases reduces fat absorption
- D. Inhibition of GLUT5 blocks fructose transport
- ANSWER: C
- Rationale: Orlistat inhibits luminal lipases, decreasing triglyceride hydrolysis and micelle formation, thus lowering
absorption of energy-dense lipids and fat-soluble vitamins.
9. Q9 (MCQ): A patient with celiac disease has villous atrophy predominantly in the proximal small intestine. Which energ
related consequence is most expected early?
- A. Reduced intrinsic factor secretion
- B. Reduced iron and carbohydrate absorption
- C. Reduced colonic water absorption
- D. Reduced bile acid synthesis
- ANSWER: B
- Rationale: Duodenal and proximal jejunal mucosal injury impairs iron and monosaccharide absorption, reducing energ
intake and leading to fatigue and anemia.
10. Q10 (MCQ): After truncal vagotomy with pyloroplasty, a patient experiences dizziness and palpitations 30 minutes af
meals. Which best explains the energy-related symptoms?
- A. Protein maldigestion causing hypoglycemia
- B. Rapid gastric emptying causing exaggerated insulin response
, - C. Reduced gastric acid causing early satiety
- D. Enhanced bile flow causing hyperglycemia
- ANSWER: B
- Rationale: Dumping syndrome from rapid delivery of hyperosmolar chyme increases incretins and insulin, producing
reactive hypoglycemia and compromised postprandial energy availability.
11. Q11 (MCQ): A patient has severe protein maldigestion after pancreatic surgery. Which brush-border enzyme is
essential to trigger intraluminal proteolysis?
- A. Aminopeptidase N
- B. Lactase
- C. Enteropeptidase (enterokinase)
- D. Sucrase–isomaltase
- ANSWER: C
- Rationale: Enteropeptidase activates trypsinogen to trypsin; trypsin then activates other pancreatic zymogens, enablin
peptide breakdown and amino acid availability for energy and biosynthesis.
12. Q12 (MCQ): A 55-year-old with chronic pancreatitis has postprandial pain relieved by pancreatic enzyme therapy.
Secretin stimulation testing is low. Which physiologic action of secretin most directly supports energy absorption?
- A. Stimulates pepsinogen secretion
- B. Inhibits bile salt synthesis
- C. Stimulates pancreatic ductal bicarbonate to neutralize chyme
- D. Stimulates gastric acid secretion
- ANSWER: C
- Rationale: Neutralization of acidic chyme optimizes pH for pancreatic enzyme activity in the duodenum, enabling
efficient macronutrient digestion and caloric extraction.
---
Multiple response (select all that apply)
13. Q13 (Multiple response): A 27-year-old with Crohn’s disease undergoes terminal ileum resection and later develops
weight loss and steatorrhea. Which consequences contribute to reduced energy harvest? (Select all that apply.)
- A. Bile acid loss causing impaired micelle formation
- B. Loss of intrinsic factor secretion
- C. Vitamin B12 malabsorption
