BIOD 151
Module 3 – Skeletal System
Final Assessment Review
(With Solutions)
2025
1
,1. A 48-year-old patient undergoes an ileal resection for Crohn’s disease.
Postoperatively, he develops steatorrhea and fat-soluble vitamin
deficiencies. Which physiologic mechanism is primarily disrupted?
a. Passive diffusion of short-chain fatty acids
b. Micelle formation by bile salts in the terminal ileum
c. Enzymatic cleavage of triglycerides by gastric lipase
d. Pepsinogen activation in the duodenum
ANS: b. Micelle formation by bile salts in the terminal ileum
Rationale: Bile salts recycled in the terminal ileum are essential for
emulsification and micelle formation. Ileal loss leads to fat malabsorption
and steatorrhea.
2. A 55-year-old woman presents with refractory gastroesophageal
reflux. Endoscopy shows an ulcer near the pylorus and elevated gastrin
levels. Which disorder best fits this presentation?
a. Stress-related mucosal disease
b. Zollinger–Ellison syndrome
c. Menetrier’s disease
d. Gastric adenocarcinoma
ANS: b. Zollinger–Ellison syndrome
Rationale: A gastrin-secreting tumor causes hypergastrinemia,
excessive acid production, peptic ulcers, and refractory GERD.
3. A patient with cholestatic liver disease has decreased bile salt
secretion. Which change in bile composition predisposes to cholesterol
gallstone formation?
a. Increased lecithin: cholesterol ratio
b. Reduced cholesterol concentration
c. Elevated cholesterol: bile salt ratio
d. Excess biliary bilirubin conjugates
2
, ANS: c. Elevated cholesterol: bile salt ratio
Rationale: When cholesterol exceeds the solubilizing capacity of bile
salts, cholesterol precipitates and forms gallstones.
4. A 60-year-old on chronic proton pump inhibitors develops
hypomagnesemia and increased risk of osteoporosis. Which absorption
process is inhibited by sustained gastric acid suppression?
a. Passive chloride absorption in the jejunum
b. Vitamin B₁₂ release from intrinsic factor
c. Ionization of calcium and magnesium at low pH
d. Alcohol dehydrogenase activity in the stomach
ANS: c. Ionization of calcium and magnesium at low pH
Rationale: Gastric acid maintains divalent cation solubility. Acid
suppression impairs Ca²⁺/Mg²⁺ ionization and absorption, leading to
deficiencies.
5. A 45-year-old man with chronic pancreatitis exhibits steatorrhea and
weight loss. Which enzyme replacement most effectively improves fat
digestion?
a. Pepsin
b. Pancreatic lipase
c. Gastric amylase
d. Trypsin inhibitor
ANS: b. Pancreatic lipase
Rationale: Pancreatic lipase is the primary enzyme for triglyceride
hydrolysis; supplementation corrects fat maldigestion.
6. A marathon runner with IBS reports alternating diarrhea and
constipation. Which motility pattern predominantly regulates fasting
interdigestive cleaning waves?
a. Peristalsis in the esophagus
b. Migrating motor complex (MMC) phase III
c. Segmental contractions in the colon
3
Module 3 – Skeletal System
Final Assessment Review
(With Solutions)
2025
1
,1. A 48-year-old patient undergoes an ileal resection for Crohn’s disease.
Postoperatively, he develops steatorrhea and fat-soluble vitamin
deficiencies. Which physiologic mechanism is primarily disrupted?
a. Passive diffusion of short-chain fatty acids
b. Micelle formation by bile salts in the terminal ileum
c. Enzymatic cleavage of triglycerides by gastric lipase
d. Pepsinogen activation in the duodenum
ANS: b. Micelle formation by bile salts in the terminal ileum
Rationale: Bile salts recycled in the terminal ileum are essential for
emulsification and micelle formation. Ileal loss leads to fat malabsorption
and steatorrhea.
2. A 55-year-old woman presents with refractory gastroesophageal
reflux. Endoscopy shows an ulcer near the pylorus and elevated gastrin
levels. Which disorder best fits this presentation?
a. Stress-related mucosal disease
b. Zollinger–Ellison syndrome
c. Menetrier’s disease
d. Gastric adenocarcinoma
ANS: b. Zollinger–Ellison syndrome
Rationale: A gastrin-secreting tumor causes hypergastrinemia,
excessive acid production, peptic ulcers, and refractory GERD.
3. A patient with cholestatic liver disease has decreased bile salt
secretion. Which change in bile composition predisposes to cholesterol
gallstone formation?
a. Increased lecithin: cholesterol ratio
b. Reduced cholesterol concentration
c. Elevated cholesterol: bile salt ratio
d. Excess biliary bilirubin conjugates
2
, ANS: c. Elevated cholesterol: bile salt ratio
Rationale: When cholesterol exceeds the solubilizing capacity of bile
salts, cholesterol precipitates and forms gallstones.
4. A 60-year-old on chronic proton pump inhibitors develops
hypomagnesemia and increased risk of osteoporosis. Which absorption
process is inhibited by sustained gastric acid suppression?
a. Passive chloride absorption in the jejunum
b. Vitamin B₁₂ release from intrinsic factor
c. Ionization of calcium and magnesium at low pH
d. Alcohol dehydrogenase activity in the stomach
ANS: c. Ionization of calcium and magnesium at low pH
Rationale: Gastric acid maintains divalent cation solubility. Acid
suppression impairs Ca²⁺/Mg²⁺ ionization and absorption, leading to
deficiencies.
5. A 45-year-old man with chronic pancreatitis exhibits steatorrhea and
weight loss. Which enzyme replacement most effectively improves fat
digestion?
a. Pepsin
b. Pancreatic lipase
c. Gastric amylase
d. Trypsin inhibitor
ANS: b. Pancreatic lipase
Rationale: Pancreatic lipase is the primary enzyme for triglyceride
hydrolysis; supplementation corrects fat maldigestion.
6. A marathon runner with IBS reports alternating diarrhea and
constipation. Which motility pattern predominantly regulates fasting
interdigestive cleaning waves?
a. Peristalsis in the esophagus
b. Migrating motor complex (MMC) phase III
c. Segmental contractions in the colon
3
