Instructions

Answer the following questions and then press 'Submit' to get your score.

Question 1
Which single statement below, about the stomach, is actually correct?

a) Acid secretion occurs in response to secretion of the hormone, carbonic anhydrase

b) Glands called Peyer's patches are responsible for acid secretion
c) The vagus nerve inhibits acid secretion after a meal has been consumed

d) Pepsinogen and gastric lipase are two enzymes secreted into the lumen of the
stomach
Question 2

The function of the gastrointestinal tract can be classified in several ways. Which of the
following functions is most important for survival immediately after a meal?

a) Absorption and retention of water and electrolytes

b) Elimination of toxins
c) Maintenance of barrier function

d) Extraction of maximum value from nutrients

Question 3

Water transport can occur from the lumen of the intestine to the blood stream, or from the
blood stream to the intestinal lumen. Which single statement about this phenomenon, below,
is actually correct?

a) A "flip-flop" mechanism efficiently transports water directly across the enterocyte

membrane
b) Water flows into the gut from the mucosa, during digestion of starch and protein,
in order to reduce luminal osmolality
c) Water is mostly absorbed by movement between the cells lining the gut (enterocytes)
via tight junctions

d) Dietary intake of water is always greater than water movement in the small intestine
Question 4

Which statement about intestinal "brakes" and "accelerators" is FALSE?

a) Dietary starch is a potent stimulator of small intestinal motility because it causes

insulin release from the pancreas
 b) Food in the stomach causes gastrin release, which stimulates acid secretion
c) Short-chain fatty acids which move from colon to caecum (reflux) promote ileo-caecal
motility

d) The arrival of lipid in the duodenum causes an immediate reduction in motility and a
switch from the "fasting" to the "feeding" pattern.
Question 5

Which single statement about fat digestion and absorption is correct?

a) Absorption of fatty acids in the intestine occurs mainly through FABP and FAT/CD36
transport proteins in the enterocytes of the distal duodenum
b) After absorption, medium chain triglycerides (MCT) enter the lymphatic system,
whereas long chain triglycerides enter the portal blood system.
c) The products of partial digestion of triglycerides (triacylglycerols) can form mixed
micelles with pancreatic cholesterol and phospholipids and this increases absorption

d) Triglycerides (triacylglycerols) must be emulsified and digested before the fatty

acids can be transported
Question 6

Which statement about protein digestion and absorption is most correct?

a) The products of protein digestion may be absorbed as free amino acids or as di-
or tripeptides
b) Gastric digestion of all proteins is equally efficient because of the grinding action of
the antrum
c) Gastric zymogenic (chief) cells produce and secrete chymotrypsin, elastase and
carboxypeptidase A and this initiates the process of protein digestion

d) The products of digestion of dietary protein by luminal and brush-border enzymes are
only absorbed by one of the 14 different amino acid transporters
Question 7

Which statement about dietary fibre is most correct?

a) The end products of it fermentation is mainly malic, succinic and propionic acids
b) Fermentation studies in vitro, with human faeces, have shown that soluble and
insoluble forms are fermented completely within 24 hours
c) Fibre sources, such as hemicelluloses, pectins and inulin are rapidly fermented to
short chain fatty acids, which have trophic effects on the colon

d) Stool bulking occurs mainly through the action of insoluble fibres such as cellulose
Question 8

Which statement about absorption from the gastro-intestinal (GI) tract is most correct?
a) The absorption of glucose is associated with sodium uptake.
b) Fructose is absorbed more rapidly than glucose.
c) Galactose and fructose are absorbed by the same transporter at the brush border
membrane.

d) Most water absorption along the GI tract occurs in the colon.

Question 9

Select the single most accurate statement about the absorptive area of the human intestine?

a) The absorptive area is equivalent to that of a tennis court

b) All of the options given are correct
c) Changes in motility increase the contact time between nutrients and absorptive surface

d) The presence of folds, villi and microvilli on the surface of enterocytes magnifies the
absorptive area
Question 10

Which statement about the oral phase of digestion is INCORRECT?

a) About 2% of the energy content of food is expended during the action of chewing and
swallowing it.
b) Swallowing involves contraction and relaxation of at least 14 groups of muscles in
about 10 seconds in healthy subjects
c) The biofilm covering tooth enamel contains several salivary and bacterial enzymes

d) Salivary amylase digests the dextran film on tooth enamel formed from dietary
sucrose
Question 11

The stomach lining contains several types of cells. Which statement about them is correct?
a) Mucous cells secrete the glycoprotein mucin
b) Chief cells the hormone gastrin (which stimulates acid secretion).
c) Parietal cells secrete pepsinogen, the inactive precursor of pepsin

d) G Cells secrete hydrochloric acid

Question 12
 The pancreas secretes a large amount of digestive enzymes after a meal. Which statement
about this process is correct?
a) Pepsinogen is the chief enzyme which digests protein and requires removal of a
peptide sequence from the active cleft before it can work
b) Pancreatic á-amylase will hydrolyse starch to free glucose
c) Enteropeptidase converts trypsinogen to trypsin by cleavage of a peptide
sequence that blocks the active site of trypsin.

d) Pancreatic secretion of hydrochloric acid is required to provide the correct pH for

maximal pancreatic enzyme in the duodenum
Question 13

Intestinal motility is a complex process, orchestrated by nerves, hormones and the presence
of food in the stomach. Which statement about this process is correct?

a) The migrating motor complex is chiefly responsible for peristaltic movement of food
after a meal has been consumed
b) The release of insulin after eating a meal will slow the emptying of the stomach
c) At the start of a meal, the stomach increases its "tone" in order to develop pressure
which will lead to expulsion of its contents, via the pylorus

d) The presence of partially digested fat and starch in the duodenum, slows
intestinal motility
Question 14

The colonic microflora can be considered as "an organ within an organ". Which of the
following statements best describes the functions of the microbiota?
a) Measurement of daily dietary fibre intake underestimates the amount of fermentable
material entering the colon each day
b) All of the options given are correct
c) Acetate, propionate and butyrate are the chief organic acids produced by anaerobic
colic fermentation

d) The establishment of an "acetate buffer" in the colonic lumen suppresses the growth of
some pathogenic bacteria.
Question 15

Which of the following is the most plausible explanation for the protective effect of dietary
fibre against cancer of the colon?
a) Propionic acid, formed during colonic fibre fermentation inhibits liver fatty acid
synthesis
 b) Butyric acid, formed during colonic fibre fermentation stimulates "silencing" of the
SLC5A8 tumour suppressor gene
c) None of these options are correct

d) Butyric acid, formed during colonic fibre fermentation stimulates anti-oxidant

defences in the colon
Question 16

Which statement best describes the process of absorption of vitamins from the intestine?
a) All of the options given are correct
b) Vitamin E is absorbed by a protein which normally binds peroxidised fatty acids to
scavenge them
c) It is necessary to dephosphorylate thiamine pyrophosphate or pyridoxal phosphate
before they can be absorbed

d) Oxidised vitamin C (dehydroascorbic acid) is absorbed by a glucose transporter

Question 17

Which of the following statements about the role of the intestine in development of obesity
best describes the situation?
a) Obesity occurs because gut hormone secretion becomes deranged and PYY secretion
fails to give a satiety signal.
b) The gut/brain signalling pathway controls energy intake to within 2% of
requirements, even in people who are morbidly obese
c) The problem is one of greed and gluttony, whereby people override strong satiety
signals on a regular basis

d) Flavour signals from tasty, processed food will override satiety signals even after a
large meal

Question 18

Which one of the following is a definition of glycaemic index?

a) The decrease in blood glucagon concentration after consuming a food compared with
that after consuming an equivalent amount of white bread.
b) The increase in blood glucose concentration after consuming the food.
c) The increase in blood glucose concentration after consuming the food compared
with that after consuming an equivalent amount of white bread.
d) The increase in blood insulin concentration after consuming the food.

e) The increase in blood insulin concentration after consuming the food compared with
that after consuming an equivalent amount of white bread.
Question 19

A blood sample is taken from a 45 year old man after he has broken his overnight fast by
eating three slices of toast and a boiled egg. Which one of the following will be at a higher
concentration than if the blood sample had been taken before breakfast?
a) Alanine
b) Glucose
c) Glucagon
d) Ketone bodies

e) Non-esterified (free) fatty acids

Question 20

A 20 year old student who has recently arrived in Britain from Sudan visits the university
health centre to complain of abdominal cramps and diarrhoea after drinking milk. Which of
the following is the most likely cause of his problem?
a) Bacterial and yeast overgrowth in the small intestine
b) Infection with the intestinal parasite Giardia lamblia
c) Lack of pancreatic amylase
d) Lack of small intestinal lactase

e) Lack of small intestinal sucrase-isomaltase

Question 21

Which of the following statements about glucose metabolism is correct?

a) All of the reactions of glycolysis are freely reversible for gluconeogenesis.
b) Fructose cannot be used for gluconeogenesis in the liver.
c) Glycolysis can proceed in the absence of oxygen only if pyruvate is formed from
lactate in muscle.
d) Red blood cells can catalyse aerobic glycolysis because they contain oxygen bound to
haemoglobin.

e) Red blood cells can only metabolise glucose by anaerobic glycolysis and the
pentose phosphate pathway.
Question 22

Which of the following statements about glycogen metabolism is correct?

a) A key step in the synthesis of glycogen is the formation of UDP-glucose
b) In muscle in the fasting state, glycogen is broken down to glucose 6-phosphate, then
free glucose.
 c) Glycogen is stored mainly in the liver and brain.
d) Insulin inhibits the synthesis of glycogen.

e) Glucagon increases the synthesis of glycogen

Question 23

Which of the following will provide the main fuel for muscle contraction during short-term
intense activity such as sprinting?
a) Muscle triacylglycerol
b) Plasma free fatty acids
c) Plasma triacylglycerol in VLDL
d) Muscle glycogen

e) Plasma glucose
Question 24

Which of the following cannot be a substrate for gluconeogenesis?

a) Glutamic acid
b) Aspartic acid
c) Palmitic acid
d) Glycerol

e) Galactose
Question 25

Which of the following statements about glucose metabolism is correct?

a) Glucagon increases the rate of glycolysis
b) Glycolysis requires NADP+
c) In glycolysis, glucose is cleaved into two three-carbon products
d) The end-product of glycolysis in red blood cells is pyruvate

e) Glycogen is synthesised in the liver in response to insulin and exported to other tissues
for use as a metabolic fuel
Question 26

Which of the following is the yield of ATP from complete oxidation of glucose to carbon
dioxide and water?

a) 10
 b) 20
c) 25
d) 30

e) 32
Question 27

Which of the following will have the lowest glycaemic index?

a) A baked apple
b) A baked potato
c) A raw apple
d) A raw potato

e) Apple juice

Question 28

What are the functions of dietary fat?

a) Provide energy to the body
b) Form part of cellular membranes
c) Cell signalling

d) All options given are correct

Question 29

Which membrane fatty acids are precursors for eicosanoids?

a) C20 and C22 saturated fatty acids
b) C18 and C22 polyunsaturated fatty acids
c) C20 and C22 monounsaturated fatty acids

d) C20 and C22 polyunsaturated fatty acids

Question 30

Which of the following statements about plasma lipoproteins is correct?

a) They have a hydrophobic core of triacylglycerol and cholesterol esters
b) They have a hydrophobic core of phospholipids and free cholesterol
c) They have a hydrophilic core of triacylglycerol and cholesterol esters
 d) They have a hydrophobic core of phospholipid and apolipoproteins
Question 31

Which are the FIVE main series of apoproteins that have been identified?
a) apoA, apoB, apoC, apoD, and apoE
b) apoA, apo(a), apoB, apoC and apoE
c) apoA, apoB, apoC, apo E, and apoL

d) apoB, apoC, apoD, apoE and apoM

Question 32

Which of the following lipoproteins is produced via the exogenous lipoprotein pathway?
a) High density lipoproteins
b) Very low density lipoproteins
c) Chylomicrons

d) Low density lipoproteins

Question 33

The Atherogenic Lipoprotein Phenotype (ALP) is a collection of which lipoprotein

abnormalities?
a) Reduced levels of HDL, a high proportion of small dense LDL and raised
triglycerides
b) Reduced levels of HDL, a high proportion of small dense LDL and normal
triglycerides
c) Raised levels of HDL, a high proportion of small dense LDL and raised triglycerides

d) Reduced levels of HDL, a low proportion of small dense LDL and raised triglycerides
Question 34

The amount and composition of dietary fat are important factors for influencing blood lipid
metabolism. Which of the following statements is correct?
a) Replacement of saturated fatty acids with n-6 polyunsaturated fatty acids is associated
with a reduction in plasma triglyceride concentrations
b) Replacement of saturated fatty acids with monounsaturated fatty acids is associated
with an increase in LDL cholesterol
c) Consumption of soluble dietary fibre and plant stanols/sterols is associated with a
significant increases in LDL cholesterol
 d) Replacement of saturated fatty acids with large amounts of carbohydrate is
associated with decreased LDL and increased plasma triglyceride concentrations
Question 35

Which of the following statements is correct regarding intracellular fat metabolism?

a) The mechanism by which non-esterified fatty acids are taken up by cells is by
diffusion only.
b) The mechanism by which non-esterified fatty acids are taken up by cells is by a
combination of diffusion and carrier-mediated transport involving fatty acid binding,
translocase and transport proteins.
c) The mechanism by which non-esterified fatty acids are taken up by cells is by a
combination of diffusion and carrier-mediated transport involving fatty acid
esterification, synthesis and transport proteins.

d) The mechanism by which non-esterified fatty acids are taken up by cells is by carrier-
mediated transport only involving fatty acid binding, translocase and transport proteins.
Question 36

De novo fatty acid synthesis usually signifies which of the following?

a) An excess of fat intake
b) A depletion of energy yielding substrates
c) Only occurs with prolonged fasting

d) An excess of energy yielding substrates

Question 37

Which of the following statements is incorrect regarding fatty acid ß-oxidation?

a) The major site of fatty acid ß-oxidation is the peroxisomes, the mitochondria also
contain enzymes for this pathway
b) Within the liver peroxisomes serve to oxidise very long chain fatty acids to medium
chain products
c) The rate of b-oxidation is regulated by the availability of fatty acids and the rate of
utilisation of b-oxidation products

d) Peroxisomes are the site for the degradation of xenobiotics and eicosanoids
Question 38

Which of the following rules regarding the interconversion of fuels are central to the
integration of metabolic pathways?
a) Fatty acids can be made from and converted to carbohydrates and amino acids
 b) Carbohydrates can be made from and converted to amino acids and fatty acids
c) Fatty acids can be made from but not converted to carbohydrates and amino
acids

d) Amino acids can be made from and converted to fatty acids

Question 39

After consumption of a mixed meal, a complex cascade of events takes place that integrates
fat metabolism at the whole body level. Which of the following is correct?
a) Consumption of a meal leads to suppression of lipase activity within adipose tissue
leading to a decrease in plasma NEFA concentrations
b) Adipose tissue lipoprotein lipase is activated by insulin and therefore is most active
following meal consumption
c) During the postprandial period the VLDL synthesis pathway is suppressed in favour of
hydrolysis of chylomicrons

d) All options given are correct