Physiology - Ch 21, Digestive System, Chapter 23- physio

Human Physiology: An Integrated Approach, 6e (Silverthorn)
Chapter 21 The Digestive System

1) Mechanical digestion refers to
A) the progressive dehydration of indigestible residue.
B) the input of food into the digestive tract.
C) the enzymatic breakdown of food.
D) the absorption of nutrients in the gut.
E) the effects of chewing, churning, and segmentation.
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Human Physiology: An Integrated Approach, 6e (Silverthorn)
Chapter 21 The Digestive System

1) Mechanical digestion refers to
A) the progressive dehydration of indigestible residue.
B) the input of food into the digestive tract.
C) the enzymatic breakdown of food.
D) the absorption of nutrients in the gut.
E) the effects of chewing, churning, and segmentation.
: E
Section Title: Digestion and Absorption
Learning Outcome: 21.4
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)

2) Chemical digestion refers to
A) the progressive dehydration of indigestible residue.
B) the input of food into the digestive tract.
C) the enzymatic breakdown of food.
D) the absorption of nutrients in the gut.
E) the effects of chewing, churning, and segmentation.
: C
Section Title: Digestion and Absorption
Learning Outcome: 21.11
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)

3) Which function(s) is/are NOT continuously regulated by the GI tract?
A) absorption only
B) motility only
C) secretion only
D) All 3 functions are regulated.
E) None of the 3 functions are regulated.
: A
Section Title: Regulation of GI Function
Learning Outcome: 21.6
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)
4) Which of the following is an accessory organ of digestion?
A) stomach
B) pancreas
C) spleen
D) colon
E) esophagus
: B
Section Title: Secretion
Learning Outcome: 21.1
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge)


5) The ________ is a significant site of absorption of water and electrolytes, but NOT of nutrients.
A) mouth
B) stomach
C) small intestine
D) large intestine
E) None of the answers are correct.
: D
Section Title: Digestion and Absorption
Learning Outcome: 21.10
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)

6) Which of the following is the sequence of layers from the lumen to the outer wall of the digestive tract?
A) serosa, submucosa, mucosa, muscularis externa
B) submucosa, mucosa, serosa, muscularis externa
C) mucosa, submucosa, serosa, muscularis externa
D) submucosa, muscularis externa, serosa, mucosa
E) mucosa, submucosa, muscularis externa, serosa
: E
Section Title: Anatomy of the Digestive System
Learning Outcome: 21.2
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)

7) The lamina propria and mucous epithelium are components of the
A) serosa.
B) adventitia.
C) muscularis mucosa.
D) mucosa.
E) submucosa.
: D
Section Title: Anatomy of the Digestive System
Learning Outcome: 21.2
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)
8) The layer of loose connective tissue beneath the digestive epithelium is the
A) lamina propria.
B) muscularis mucosae.
C) submucosa.
D) submucosal plexus.
E) myenteric plexus.
: A
Section Title: Anatomy of the Digestive System
Learning Outcome: 21.2
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)


9) Contraction of the ________ alters the shape of the intestinal lumen and moves epithelial pleats and folds.
A) mucosa
B) submucosa
C) submucosal plexus
D) muscularis mucosa
E) adventitia
: D
Section Title: Anatomy of the Digestive System
Learning Outcome: 21.4
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)

10) Rugae, plicae, and villi are all features that accomplish
A) secretion of enzymes.
B) secretion of hormones.
C) an increase in surface area.
D) immune function.
E) mechanical digestion.
: C
Section Title: Anatomy of the Digestive System
Learning Outcome: 21.2
: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 11) The motor activity of the muscularis externa is controlled by the A) submucosal plexus. B) myenteric plexus. C) migrating motor complex. D) extrinsic neurons. E) motilin.: B Section Title: Motility Learning Outcome: 21.7: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 12) Intestinal crypts A) only increase the surface area of the mucosa of the small intestine. B) only carry products of digestion that will not pass through the walls of blood capillaries. C) only produce new cells for the mucosa of the small intestine. D) only function in the absorption of nutrients. E) increase the surface area of the mucosa of the small intestine and produce new cells for the mucosa of the small intestine.: E Section Title: Digestion and Absorption Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 13) Chief cells secrete A) pepsinogen. B) gastrin. C) mucus. D) hydrochloric acid. E) intrinsic factor.: A Section Title: Integrated Function: The Gastric Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 14) G cells of the stomach secrete A) cholecystokinin. B) secretin. C) gastrin. D) enterokinase. E) pepsin.: C Section Title: Integrated Function: The Gastric Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 15) In the intestine, the epithelial cells have A) leaky junctions. B) tight junctions. C) electrical gap junctions.: A Section Title: Secretion Learning Outcome: 21.12: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 16) The subepithelial connective tissue of the GI tract, immediately beneath the epithelium, is the A) muscularis mucosae. B) lamina propria. C) submucosa. D) serosa. E) submucosal plexus.: B Section Title: Anatomy of the Digestive System Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 17) Sandwiched between the layer of circular and longitudinal muscle in the muscularis externa is the A) mucosa. B) submucosa. C) muscularis mucosa. D) myenteric plexus. E) submucosal plexus.: D Section Title: Anatomy of the Digestive System Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 18) The myenteric plexus is A) a layer of circular smooth muscle. B) a layer of longitudinal smooth muscle. C) a network of neurons. D) the mucus secreting layer of the digestive tract. E) primarily composed of connective tissue.: C Section Title: Anatomy of the Digestive System Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 19) Peyer's patches are characteristic of the A) stomach. B) esophagus. C) pancreas. D) small intestine. E) colon.: D Section Title: Anatomy of the Digestive System Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 20) Features of the submucosa include A) blood and lymph vessels. B) a major nerve network. C) Peyer's patches. D) blood, lymph vessels, and a major nerve network. E) blood, lymph vessels, a major nerve network, and Peyer's patches.: D Section Title: Anatomy of the Digestive System Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 21) The ________ are double sheets of peritoneal membrane that hold some of the visceral organs in their proper position. A) serosa B) adventitia C) mesenteries D) fibrosa E) lamina propria: C Section Title: Motility Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 22) Slow waves are A) cycles of smooth muscle contraction and relaxation. B) spontaneous cycles of depolarization and repolarization. C) reflexes that originate and are integrated in the enteric nervous system. D) peristaltic contractions. E) segmental contractions.: B Section Title: Motility Learning Outcome: 21.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 23) ________ are pacemakers for slow wave activity. A) Interstitial cells of Cajal B) Intrinsic neuron cells C) Extrinsic neuron cells D) G cells E) Chief cells: A Section Title: Motility Learning Outcome: 21.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 24) Powerful contractions that occur a few times each day in the colon are called A) segmentation. B) tonic contractions. C) phasic contractions. D) peristalsis. E) mass movements.: E Section Title: Motility Learning Outcome: 21.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 25) The swallowing center in the brain, which coordinates the muscular reflexes, is located in the A) cerebrum. B) medulla oblongata. C) pons. D) cerebellum. E) hypothalamus.: B Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 26) Which of the following events does NOT occur when you swallow? A) Respiration is inhibited. B) The upper esophageal sphincter closes. C) The glottis and epiglottis close. D) The lower esophageal sphincter relaxes.: B Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 27) Mucus functions in A) protection only. B) lubrication only. C) enzyme activation only. D) protection and lubrication. E) protection, lubrication, and enzyme activation.: D Section Title: Digestive Function and Processes Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 28) In the digestive system, HCl is released by ________, whereas HCO3- is secreted primarily from the ________. A) parietal cells of the stomach, pancreas B) the pancreas, parietal cells of the stomach C) parietal cells of the stomach, liver D) the liver, parietal cells of the stomach: A Section Title: Secretion Learning Outcome: 21.5: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 29) Nutrient absorption occurs primarily in the A) stomach. B) liver. C) small intestine. D) large intestine. E) stomach and small intestine.: C Section Title: Digestion and Absorption Learning Outcome: 21.12: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 30) Amylases, the enzymes used to digest carbohydrates, are secreted by A) salivary glands into the mouth only. B) gastric glands into the stomach only. C) the pancreas into the intestine only. D) salivary glands into the mouth and gastric glands into the stomach. E) salivary glands into the mouth and the pancreas into the intestine.: E Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 31) When eaten, nearly 90% of our dietary calories from fat are in the form of A) steroids. B) phospholipids. C) triglycerides. D) cholesterol. E) fat-soluble vitamins.: C Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 32) Bile is A) secreted by hepatocytes only. B) manufactured by the gallbladder only. C) released into the stomach only. D) secreted by hepatocytes and manufactured by the gallbladder. E) secreted by hepatocytes, manufactured by the gallbladder, and released into the stomach.: A Section Title: Digestion and Absorption Learning Outcome: 21.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 33) Functions of the large intestine include A) chemical digestion of chyme. B) temporary food storage. C) resorption of water and compaction of feces. D) absorption of the products of digestion. E) All of these answers are correct.: C Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.12: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 34) The release of many GI tract hormones is stimulated by a particular food or substance. Which hormone is INCORRECTLY paired with its stimulus? A) CCK — fatty foods B) secretin — acid in the small intestine C) GIP — glucose in the small intestine D) motilin — acid in the stomach E) gastrin — peptides, increased sympathetic activity: D Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 35) During the cephalic phase of gastric secretion, A) the stomach responds to distention. B) secretin inhibits parietal and chief cells. C) there is an increased flow of action potentials along the vagus nerve to the stomach. D) the intestine reflexively inhibits gastric emptying. E) production of gastric juice slows down.: C Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 36) The gastric phase of gastric secretion is triggered by A) the sight, thought, or smell of food. B) the entry of food into the stomach. C) the entry of chyme into the small intestine. D) the entry of chyme into the large intestine. E) the release of cholecystokinin and secretin by the small intestine.: B Section Title: Integrated Function: The Gastric Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 37) An enzyme that will digest proteins into peptides is A) lipase. B) amylase. C) nuclease. D) maltase. E) trypsin.: E Section Title: Digestion and Absorption Learning Outcome: 21.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 38) Most products of fat digestion are absorbed by A) capillaries. B) veins. C) lymphatic vessels. D) arterioles.: C Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 39) Which of the following statements is true about GI muscle contractions? A) Phasic contractions last only seconds and occur in the stomach and small intestine. B) Tonic contractions are sustained for minutes and occur in the small intestine. C) Cycles of smooth muscle contraction and relaxation are associated with fast wave potentials. D) Contractions of the smooth muscle do not depend on calcium. E) None of these statements are true.: A Section Title: Motility Learning Outcome: 21.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 40) Which of the following statements is true? A) Glucose and galactose absorption uses an apical Na+-glucose SGLT symporter. B) Fructose moves across the apical membrane by active transport. C) Glucose and galactose use different transporters in absorption. D) A basolateral GLUT5 transporter moves glucose out of the intestinal epithelial cell. E) None of the statements are true.: A Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 41) Bicarbonate secretion A) neutralizes acid entering from the stomach into the duodenum. B) is secreted by apical Cl--HCO3- antiport. C) is not dependent on high levels of carbonic anhydrase to maintain bicarbonate production. D) is secreted by the acinar cells. E) neutralizes acid entering from the stomach into the duodenum and is secreted by apical Cl--HCO3- antiport.: E Section Title: Secretion Learning Outcome: 21.5: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 42) Saliva is A) slightly acidic, with a pH of 6-7. B) controlled by the autonomic nervous system. C) stimulated by sympathetic innervation. D) secreted from endocrine glands. E) slightly acidic, with a pH of 6-7 and controlled by the autonomic nervous system.: E Section Title: Secretion Learning Outcome: 21.5: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) Match the following structures with the appropriate description. A. appendix B. colon C. duodenum D. ileum E. jejunum 43) location of most peptic ulcers: C Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 44) section where chyme is processed to remove water and electrolytes, leaving waste products of digestion: B Section Title: Anatomy of the Digestive System Learning Outcome: 21.12: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 45) located at the ventral end of the cecum: A Section Title: Anatomy of the Digestive System Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 46) distal-most section of small intestine: D Section Title: Anatomy of the Digestive System Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the following structures with their functions. A. pancreas B. pylorus C. rectum D. small intestine E. stomach 47) chyme is released from here: E Section Title: Anatomy of the Digestive System Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 48) organ that adds exocrine secretions to the duodenum via a duct: A Section Title: Anatomy of the Digestive System Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 49) location of the sphincter that prevents premature emptying of the stomach: B Section Title: Anatomy of the Digestive System Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 50) organ where most digestion occurs: D Section Title: Anatomy of the Digestive System Learning Outcome: 21.12: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the structure to its function. A. mouth B. stomach C. rectum D. small intestine E. large intestine 51) Carbohydrate digestion begins here.: A Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 52) Carbohydrate digestion is completed here.: D Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.12: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 53) Protein digestion begins here.: B Section Title: Integrated Function: The Gastric Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 54) Protein digestion is completed here.: D Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 55) Fat digestion begins here.: A Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 56) Fat digestion is completed here.: D Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) Match each product with the cell or region that secretes or contains it. A. enzymes B. HCl C. HCO3- D. mucus E. more than one of these 57) parietal cells: B Section Title: Secretion Learning Outcome: 21.5: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 58) goblet cells: D Section Title: Secretion Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 59) brush border: A Section Title: Digestion and Absorption Learning Outcome: 21.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 60) pancreatic cells: E Section Title: Secretion Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 61) The largest collection of ________ tissue in the body is the gut-associated lymphoid tissue (GALT).: lymphoid Section Title: Immune Functions of the GI Tract Learning Outcome: 21.13: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 62) Digestion is essentially completed in the ________.: small intestine Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 63) The three sections of the small intestine, in order according to movement of its contents, are ________, ________, and ________.: duodenum, jejunum, ileum Section Title: Anatomy of the Digestive System Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 64) Most absorbed nutrients first enter the blood of the ________ system.: hepatic portal Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 65) The primary complex carbohydrate ingested and digested by people is ________.: starch Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 66) After processing in the stomach, the gastric contents are referred to as ________.: chyme Section Title: Anatomy of the Digestive System Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 67) Bile salts aid in the digestion of fats by ________ large fat droplets.: emulsifying Section Title: Secretion Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 68) ________ is intestinal gas produced by bacteria in the colon during the metabolism of undigestible carbohydrates.: Flatus Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 69) The enzyme that digests starch into disaccharides and trisaccharides is ________.: amylase Section Title: Secretion Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 70) Maltose is broken down by maltase into two molecules of ________.: glucose Section Title: Digestion and Absorption Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 71) ________ are tiny droplets of fatty acids, monoglycerides, and bile salts.: Micelles Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 72) Slow waves originate in modified smooth muscle cells called ________.: interstitial cells of Cajal Section Title: Motility Learning Outcome: 21.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 73) The ________ is a "housekeeping function" that sweeps food remnants and bacteria out of the upper GI tract and into the large intestine.: migrating motor complex Section Title: Motility Learning Outcome: 21.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 74) ________ are short segments of intestine that alternately contract and relax. They are responsible for ________.: Segmental contractions; mixing Section Title: Motility Learning Outcome: 21.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 75) The exocrine portion of the pancreas consists of lobules called ________, which secrete ________.: acini, digestive enzymes Section Title: Secretion Learning Outcome: 21.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 76) ________ digests terminal peptide bonds to release amino acids.: Endopeptidase Section Title: Digestion and Absorption Learning Outcome: 21.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 77) Bile is produced in the ________ and stored in the ________.: liver, gallbladder Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 78) Digestive reflexes originating in the CNS are called ________.: long reflexes Section Title: Regulation of GI Function Learning Outcome: 21.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 79) Long reflexes that originate completely outside the digestive system include ________ and ________, which are called ________ reflexes.: feedforward reflexes, emotional reflexes, cephalic Section Title: Regulation of GI Function Learning Outcome: 21.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 80) Short reflexes of the digestive system are integrated in the ________.: enteric nervous system Section Title: Regulation of GI Function Learning Outcome: 21.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 81) The primary products of protein digestion are ________, ________, and ________.: free amino acids, dipeptides, tripeptides Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 82) Fat digestion is carried out by the enzyme ________, which breaks down triglyceride into ________.: lipase, two fatty acids and one monoglyceride Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 83) ________ is a protein cofactor that is secreted by the pancreas and that allows lipases to access fats inside the bile coating.: Colipase Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 84) Vitamin ________ must be complexed with a protein called ________ to be absorbed from the small intestine.: B12, intrinsic factor Section Title: Digestion and Absorption Learning Outcome: 21.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 85) Defects in ________ structure or function lead to the disease cystic fibrosis. What ion does this channel transport?: cystic fibrosis transmembrane regulator (or CFTR chloride channel); it transports chloride. Section Title: Secretion Learning Outcome: 21.5: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 86) What is the ENS, and when was it discovered? What is its significance, what is its nickname, and what are the characteristics that justify that nickname?: ENS is the enteric nervous system, discovered over 100 years ago. The ENS controls reflexive peristalsis in the intestine, independent of the CNS. The ENS is nicknamed the "little brain" because it shares these characteristics with the actual brain: secretion of neurotransmitters and neuromodulators, and the presence of glial cells, a diffusion barrier, and integrating centers. Section Title: Anatomy of the Digestive System Learning Outcome: 21.7: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 87) What are short reflexes? What types of behaviors do they regulate? What are long reflexes? Give examples of each.: Reflexes controlled by the enteric nervous system are short reflexes. They regulate motility, secretion, and growth. Long reflexes are digestive reflexes that are integrated in the CNS. Long reflexes include feedforward reflexes and emotional reflexes. Section Title: Regulation of GI Function Learning Outcome: 21.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 88) List and briefly describe the action of peptides in the GI tract.: Generally, GI peptides stimulate or inhibit motility and secretion. The peptides classified as hormones include gastrin, cholecystokinin, secretin, GIP, motilin, and glucagon-like peptide I. Section Title: Regulation of GI Function Learning Outcome: 21.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 89) List the six types of epithelial cells associated with gastric glands. Briefly describe each one's role in the stomach.: Parietal cells secrete HCl and intrinsic factor; chief cells secrete pepsinogen; D cells secrete somatostatin; ECL cells secrete histamine; G cells secrete gastrin; mucous cells secrete mucus and bicarbonate. Section Title: Secretion Learning Outcome: 21.5: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 90) Name two functions of cholecystokinin.: Functions include stimulation of pancreatic enzyme secretion, bicarbonate secretion, gallbladder contraction, sense of satiety, and inhibition of gastric emptying. See Table 21.1 in the chapter. Section Title: Regulation of GI Function Learning Outcome: 21.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 91) Put the following steps of fat digestion and absorption in order: 1. Bile salts coat fat droplets. 2. Cholesterol is transported into cells. 3. Chylomicrons are formed. 4. Chylomicrons are released into lymphatic system. 5. Monoglycerides and fatty acids move out of micelles. 6. Pancreatic lipase and colipase break down fats. A) 1, 6, 5, 2, 3, 4 B) 1, 2, 3, 4, 6, 5 C) 2, 6, 5, 1, 3, 4 D) 6, 3, 4, 1, 2, 5 E) None of the answers are correct.: A Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 92) During defecation, A) stretch receptors in the rectal wall activate sympathetic centers in the spinal cord. B) stretch receptors in the rectal wall activate parasympathetic centers in the spinal cord. C) stretch receptors in the rectal wall activate both sympathetic and parasympathetic centers in the spinal cord. D) the internal anal sphincter is consciously relaxed. E) the external anal sphincter contracts.: B Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 93) Decreased levels of bile salts in the bile would interfere with digestion of A) protein. B) fat. C) carbohydrates. D) nucleic acids. E) vitamins and minerals.: B Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 94) In response to the arrival of acidic chyme in the duodenum, the blood levels of A) secretin rise. B) cholecystokinin fall. C) gastrin rise. D) enterocrinin fall. E) All of these answers are correct.: A Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 95) A blockage of the ducts from the parotid glands would A) result in the production of more viscous saliva. B) impair the lubricating properties of saliva. C) interfere with carbohydrate digestion in the mouth. D) eliminate the sense of taste. E) cause all of these effects.: C Section Title: Anatomy of the Digestive System Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 96) In response to the hormone secretin, the pancreas secretes a fluid A) rich in enzymes. B) rich in bicarbonate. C) rich in bile. D) that contains only proteases. E) that contains only amylase.: B Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 97) In response to the hormone cholecystokinin, the pancreas secretes a fluid A) rich in enzymes. B) rich in bicarbonate. C) rich in bile. D) that contains only proteinases. E) that contains only amylase.: A Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 98) Digestion of a carbohydrate results in large amounts of the monosaccharides glucose and galactose. This carbohydrate was probably A) sucrose. B) maltose. C) lactose. D) cellulose. E) glycogen.: C Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 99) Diarrhea often accompanies intestinal infections. Why? A) The immune system increases the production of enzymes for added protection. B) Bacterial toxins enhance the secretion of KCl from the cells, which causes water movement into the intestine. C) Dehydration of the body will kill the bacteria causing the infection. D) Loss of electrolytes will kill bacteria.: B Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 100) A drug that blocks the action of carbonic anhydrase in parietal cells would result in A) a lower pH during gastric digestion. B) a higher pH during gastric digestion. C) decreased production of pepsinogen by chief cells. D) increased protein digestion in the stomach. E) decreased gastrin production.: B Section Title: Secretion Learning Outcome: 21.5: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 101) A drug that blocks the action of the hormone cholecystokinin would affect A) the amount of bile produced by the liver. B) the composition of pancreatic secretions. C) the level of intestinal gastrin. D) secretions of the duodenal glands. E) All of the answers are correct.: B Section Title: Regulation of GI Function Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) Match the hormone with the correct statement. A. gastrin B. cholecystokinin C. secretin D. motilin E. gastric inhibitory peptide 102) secreted by cells in the stomach: A Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 103) inhibits gastric emptying: C Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 104) stimulates bile release: B Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 105) stimulates insulin release: E Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 106) smooth muscle of duodenum is a target: D Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) Match the structure or compound to its function. A. ezetimbe B. ferroportin C. hepcidin D. DMT1 E. NPC1L1 107) transporter for iron absorption: D Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 108) transports iron to the blood: B Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 109) hormone that decreases iron absorption: C Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 110) blocks cholesterol absorption: A Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 111) transporter for cholesterol absorption: E Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 112) What are the end products of carbohydrate digestion? What are the enzymes involved; where are they located; and what reactions do they catalyze?: See Figure 21.8 in the chapter. Amylases are secreted into the mouth and small intestine, and disaccharidases are located on the intestinal brush border. Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 113) The mucosa of the majority of the digestive tract contains simple columnar epithelium, while the esophagus and the anus have stratified squamous epithelium. Why is this the case? What purpose does each type of epithelium serve in the digestive tract?: Columnar epithelium is primarily responsible for secreting and absorbing materials across its membranes whereas stratified squamous epithelium is primarily present for protection of the tissues beneath it. Since the stomach and intestines secrete enzymes and other chemicals important for digesting food and since they absorb nutrients and water, they have simple columnar epithelium. Since the esophagus is carrying undigested food from the mouth to the stomach and not absorbing anything, it makes sense that it would have stratified squamous epithelium to protect the tissues beneath it from the ingested food particles. Since the anus is primarily a passageway for feces to leave the body and it would not be beneficial for the feces to come into contact with the tissue beneath it, stratified squamous epithelium also makes sense in the anus. Section Title: Anatomy of the Digestive System Learning Outcome: 21.2: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 114) List the key components of bile. Is bile action similar to the action of lipases? Explain.: Bile salts, bile pigments, and cholesterol are the key components. Bile does not contain enzymes or have enzymatic action; rather bile emulsifies lipids so that lipases have sufficient access to their lipid substrates. Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 115) List the four basic processes of the digestive system, and describe each.: 1. Digestion is the chemical and mechanical breakdown of foods into smaller units. 2. Absorption is the active or passive transfer of substances from the lumen of the GI tract to the extracellular fluid. 3. Motility is the movement of material in the GI tract as a result of muscle contraction. 4. Secretion refers to both transepithelial transfer of water and ions from the ECF to digestive tract lumen and the release of substances synthesized by GI epithelial cells. Section Title: Digestive Function and Processes Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 116) Proteins must first be enzymatically degraded to single amino acids before entering the capillaries of the hepatic portal system. Is this true or false? What is the significance of this? Is absorption of carbohydrates and lipids restricted to monomers? Explain.: False. Absorption of small peptides allows peptides to provoke food allergies. The transporters for peptides are also responsible for absorption of some drugs. Carbohydrates are digested to monosaccharides because there are no transporters for larger carbohydrates. Lipids are absorbed as cholesterol, fatty acids, and monoglycerides, primarily by simple diffusion because they are lipophilic. Section Title: Digestion and Absorption Learning Outcome: 21.10: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 117) Draw a cell that secretes bicarbonate into the lumen of the pancreas, selecting transporters from the following list (you may not need them all): chloride channel CFTR channel GLUT4 H+-K+-ATPase Cl- - HCO3- Antiport Cl- - HCO3- Symport K+ leak channel leaky junctions Na+-K+-ATPase Label the cell showing the lumen, interstitial fluid, the basolateral membrane, and the apical membrane.: See Figure 21.5 in the chapter. Section Title: Secretion Learning Outcome: 21.5: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 118) Compare and contrast gastrin, CCK, secretin, GIP, motilin, and glucagon-like peptide 1. In your answer, include the following details for each term: secreted by, target(s), effects, and stimulus for release.: See Table 21.1 in the chapter. Section Title: Integrated Function: The Cephalic Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Analysis) 119) Draw a map of the enteric nervous system response and include: stimuli, receptors, integrating centers, efferent path, and tissue response.: Maps will vary. See Figure 21.11 in the chapter. Section Title: Regulation of GI Function Learning Outcome: 21.7: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 120) Diagram peptide absorption from the lumen into the portal vein. Be sure to include transporters and label the lumen, portal vein, apical membrane, and basolateral membrane.: See Figure 21.8d in the chapter. Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 121) Make a map of the following terms: amino acid chief cell D cell ECL cell enteric sensory neuron enteric plexus G Cell gastrin H+ histamine parietal cell pepsin pepsinogen somatostatin vagus nerve Where appropriate, indicate stimulatory or inhibitory effect. Terms may be added as needed.: Maps will vary. See Figure 21.16 in the chapter. Section Title: Integrated Function: The Gastric Phase Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 122) Name the proenzymes that the pancreas secretes. Which one is involved in the activation of the other proenzymes? What are their active forms?: Proenzymes include: trypsinogen, chymotrypsinogen, procarboxypeptidase, procolipase, and prophospholipase. Trypsinogen is converted to trypsin, which activates the other proenzymes. The active forms of the enzymes can be found in Figure 21.17 in the chapter. Section Title: Digestion and Absorption Learning Outcome: 21.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 123) The enteric nervous system and the brain have several similarities. What are they?: See "The Enteric Nervous System Can Act Independently" section of the chapter. Section Title: Regulation of GI Function Learning Outcome: 21.7: Level II: Reviewing Concepts (Bloom's Taxonomy: Analysis) 124) Draw a cell that secretes HCl into the lumen of the stomach, selecting transporters from the following list (you may not need them all): chloride channel CFTR channel GLUT4 H+-K+-ATPase Cl- - HCO3- Antiport Cl- - HCO3- Symport Na+-K+-ATPase Label the cell showing the lumen, interstitial fluid, the basolateral membrane, and the apical membrane.: See Figure 21.5 in the chapter. Section Title: Secretion Learning Outcome: 21.5: Level II: Reviewing Concepts (Bloom's Taxonomy: Analysis) 125) One way to determine the total energy in calories of a food is to burn it in a device called a bomb calorimeter. The heat produced during combustion minus the heat added to begin the combustion is the total calories in the food. The typical human digestive tract does not absorb all of the calories in food; thus it is not 100% efficient. Furthermore, calories in undigestible organic compounds may not be absorbed at all, and thus can be considered to be zero calorie relative to human nutrition. Artificial sweeteners and fats are designed to produce desired sensation in the mouth without being absorbed. These are organic compounds that would release heat in a bomb calorimeter, thus they technically have calories. A. What does this suggest about the accuracy of the bomb calorimeter in determining available food calories for humans? What would be the results of bomb calorimetry of human feces? B. What is it about a particular food substance that may prevent absorption of its calories? C. What happens to the "zero-calorie" molecules as they pass through the digestive tract? What are the potential effects on defecation?: A. Bomb calorimetry is not 100% accurate, because it does not take into account that some calories are not absorbed. Human feces would be determined to contain some calories. B. In order for nutrients in a food to be usable by the body, they must be chemically digested and absorbed. Digestive enzymes exhibit specificity, so they do not digest molecules that are different in structure from their substrate. If an artificial food additive is undigestible, this simply means that the body lacks the appropriate enzyme. C. Gut bacteria may be able to digest and absorb these compounds. Extra organic solute present in the gut may cause retention of water and production of bacterial gas as the bacteria digest the substance in question. This can lead to distention, discomfort, and diarrhea. Section Title: Digestion and Absorption Learning Outcome: 21.10: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 126) Cody has always carefully controlled her caloric intake, and is lean. During her unplanned pregnancy, she continued to eat the same, hoping that taking prenatal vitamins and minerals would ensure that her fetus would grow normally. Her only complication during pregnancy was persistent constipation and consequent hemorrhoids. She gained only the minimum weight suggested by her doctor, and delivered a healthy, full-term infant; her pre-pregnancy weight was rapidly reestablished. Propose an explanation for how she managed to gain enough weight, did not violate the law of conservation of mass, and for her only complication. What does this suggest about "eating for two" that some pregnant women do?: She must have inefficiently absorbed calories prior to her pregnancy, losing many potential calories in her feces. When she became pregnant, one of her physiological changes included an increase in nutrient (and thus calorie) absorption. This would also contribute to her constipation, as her feces retained less water than normal and thus were more difficult to eliminate. It is not possible for her to have gained more weight than she ate; no one can violate the law of conservation of mass. Most obstetricians recommend only a slight increase in calories during pregnancy for this reason, and women who indulge in overeating too often are likely to gain unnecessary body fat and may produce a fetus that is larger than it should be. Section Title: Integrated Function: The Intestinal Phase Learning Outcome: 21.10: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 127) A condition known as lactose intolerance is characterized by painful abdominal cramping, gas, and diarrhea. The cause of the problem is an inability to digest the milk sugar, lactose. How would this cause the observed symptoms? Why is yogurt less likely to trigger the symptoms?: If an individual cannot digest lactose, then the sugar will pass through to the large intestine in an undigested form. The presence of the extra sugar in the chyme increases the osmolarity of the chyme, resulting in less water being reabsorbed by the intestinal mucosa. The bacteria that inhabit the large intestine can metabolize the lactose, and in the process they produce large amounts of carbon dioxide. The gas overstretches the intestine, which stimulates local reflexes that increase peristalsis. The combination of more fluid contents and increased peristalsis produces the symptom of diarrhea. The overexpansion of the intestine by gas causes the severe pain and abdominal cramping, and of course, the increase in intestinal gas release is directly related to increased gas production by the bacteria. Yogurt contains bacteria that digest the lactose prior to the consumption of the yogurt. Section Title: Digestion and Absorption Learning Outcome: 21.10: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 128) Erica came down with the flu. She experienced severe vomiting, determined to be primarily stomach contents, for three days, and now is having chest pains. She is calling one of her symptoms "heartburn," but reported that it felt as if she had swallowed a small apple whole. Certain that she was having a heart attack, Erica rushed to the doctor. The doctor took her history and symptoms, and reassured her that she only had esophagitis. How did the physician conclude this? Is her blood pH higher or lower than normal?: Acid reflux irritated the esophageal lining, causing it to swell. Her pH is higher than normal due to loss of H+ from her stomach. Section Title: Anatomy of the Digestive System Learning Outcome: 21.1: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 129) Eric has had trouble sleeping the last two nights and is currently experiencing heart burn which he attributes to the stress of being in finals week and eating too much pizza. His lab partner in Physiology class tells him he should take some diphenhydramine (Benadryl) before he goes to bed because that will help him sleep and his upset stomach. Is this a good suggestion or not.: While longstanding heartburn or insomnia may both be symptoms of more severe underlying conditions that require a visit to a health professional, his lab partner is correct. Diphenhydramine is an antihistamine that is found in many over-the-counter sleep medications and it will block the effects of histamine in the stomach preventing acid production. Section Title: Secretion Learning Outcome: 21.5: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 130) In some severe cases, a person suffering from stomach ulcers may have surgery to cut the branches of the vagus nerve that innervates the stomach. How would this help the problem?: The vagus nerve carries neurons of the parasympathetic nervous system. These neurons control gastric secretions, notably the secretion of acid and enzymes. Severing these branches would eliminate neural stimulation from the central nervous system, thus eliminating the release of gastric fluids in response to anxiety and other higher-order stimuli when there is no food in the stomach. Normal digestive function would still occur, governed by various hormones and intramural neural reflexes. Section Title: Regulation of GI Function Learning Outcome: 21.6: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 131) Essential nutrients are those that our cells require but cannot make, and thus they must be present in the diet. Only some amino acids and some fatty acids are essential. What does that suggest about extreme diets that eliminate fats or proteins? What does that suggest about our carbohydrate intake? Describe the typical American diet, in terms of relative amounts of ingested carbohydrates, fats, proteins, and nucleic acids. Propose some explanations for why one of those is predominant.: Complete elimination of proteins or fats would eventually be fatal. Carbohydrates need not be consumed at all, from the standpoint of essential nutrients. In reality, however, a carbohydrate-free diet would cause metabolic problems because of consequences of manufacturing glucose from lipids and proteins, as described in Chapter 22 in the text. About half of the typical dietary intake is carbohydrate, with most of the remainder in the form of fats and proteins. Carbohydrates are the primary molecule in plant products, which makes up most of what we eat because of abundance and price. Section Title: Digestive Function and Processes Learning Outcome: 21.10: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 132) What would be the nutritional consequence of excessive antacid use?: Antacids make the stomach pH higher than normal, which will interfere with protein digestion because the enzymes would not be as efficient. Section Title: Integrated Function: The Gastric Phase Learning Outcome: 21.5: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 133) You and your lab partners in a human anatomy course have just removed the intestines from an adult cadaver, and cut away connective tissues as necessary to uncoil the intestines into a straight line that could be measured. Your professor told you that the intestinal tract of an adult of this size and gender is typically about 13 ft. Your measurement is 22 ft. One of the lab partners insists that everything is smaller in preserved cadavers due to dehydration. Address this suggestion, and propose some other explanations for the difference.: There is no doubt of some individual variation, so the measurement is expected to be at least a little different. Most of the difference is due to loss of living muscle tone, which normally keeps the tract contracted. While it is true that preserved tissues may shrink from dehydration, this is more than compensated by the loss of muscle tone. Section Title: Anatomy of the Digestive System Learning Outcome: 21.1: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 134) You are studying the toxic effects of a newly discovered tropical plant extract. From preliminary studies, it appears that the toxin prevents H+-dependent membrane transport. Explain which digestive processes may thus be impaired.: Absorption of some amino acids, dipeptides, and tripeptides may be impaired, as well as iron and sodium absorption, because these are dependent upon an H+ exchanger or cotransporter. HCl secretion into the stomach, which acidifies the lumen for protein digestion, may also be impaired. Section Title: Digestive Function and Processes Learning Outcome: 21.5: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 135) Cholesterol is absorbed without being digested into smaller pieces. How does this compare to absorption of carbohydrates and proteins? What characteristic of cholesterol suggests it would be transported by simple diffusion? What is the evidence that transport proteins are involved in cholesterol absorption? Does this discovery rule out transport by simple diffusion? Explain.: Carbohydrates are digested to monosaccharides before they are absorbed. Proteins are absorbed as amino acids, di- or tripeptides, or even oligopeptides. As a lipid, cholesterol can dissolve in the phospholipid bilayer and therefore cross membranes by simple diffusion. The drug ezetimibe inhibits cholesterol absorption, suggesting there must be a membrane transporter. This discovery does not rule out additional transport of cholesterol by simple diffusion, but does suggest there is a significant amount of transport dependent upon a transport molecule. Section Title: Digestion and Absorption Learning Outcome: 21.10: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 136) Chronic inflammation of the pancreas, or pancreatitis, impairs the digestive functions of this organ. What would be the effect on digestion and absorption of carbohydrates, fats, and proteins if acinar cells are impaired? What if duct cells are impaired? Which hormones may be used to treat pancreatitis?: Acinar cells secrete digestive enzymes for all three classes of molecule, therefore nutrient digestion and consequent absorption would be decreased. Duct cells secrete bicarbonate, which counteracts the acidic nature of the chyme entering from the stomach and allows the pancreatic enzymes to function. The loss of these cells would also decrease digestion and absorption of the three classes of nutrient. Cholecystokinin stimulates pancreatic enzyme secretion and secretin stimulates bicarbonate secretion. Section Title: Secretion Learning Outcome: 21.11: Level III: Problem Solving (Bloom's Taxonomy: Analysis) 137) In the body, 80% of all lymphocytes, a type of immune system cell, are thought to be present in the A) small intestine. B) large intestine. C) appendix. D) stomach. E) mouth.: A Section Title: Digestive Function and Processes Learning Outcome: 21.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension)Human Physiology: An Integrated Approach, 6e (Silverthorn) Chapter 23 Endocrine Control of Growth and Metabolism 1) The action of a hormone on a target cell involves effects on A) receptor proteins. B) nonreceptor proteins. C) lipids. D) receptor and nonreceptor proteins. E) receptor proteins and lipids.: D Section Title: Review of Endocrine Principles Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 2) The endocrine gland that is a modified sympathetic ganglion is the A) thyroid. B) anterior pituitary. C) posterior pituitary. D) adrenal cortex. E) adrenal medulla.: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 3) All of the hormones secreted by the adrenal gland play a major role in growth and metabolism. A) True B) False: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 4) Cholesterol is a precursor for the synthesis of A) progesterone. B) aldosterone. C) estradiol. D) calcitonin. E) progesterone, aldosterone, and estradiol.: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 5) Crossover effects are sometimes seen among A) most hormones. B) all hormones. C) peptide/protein hormones. D) steroid hormones.: D Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 6) The precursor chemical for ACTH synthesis is A) CRH. B) POMC. C) beta-endorphin. D) MSH. E) TRH.: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 7) The adrenal medulla produces A) androgens. B) glucocorticoids. C) mineralocorticoids. D) catecholamines. E) corticosteroids.: D Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 8) Which of the following could describe the function of 11 Beta-hydroxysteroid dehydrogenase? A) An enzyme located in renal tubules that acts on cortisol . B) It converts cortisol to a less active form. C) It aids in preventing crossover effects from cortisol. D) It converts cortisol to a form with a lower specificity for mineralocorticoid receptors there. E) All of these answers are correct.: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Comprehension) 9) Cortisol secretion peaks between ________ and ________. A) early morning, noon B) midnight, early morning C) noon, early evening D) early evening, midnight: A Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 10) CRH stimulates the release of A) ACTH. B) cortisol. C) DHEA. D) MSH. E) None of these answers are correct.: A Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 11) Cortisol has the following effects: A) suppresses the immune system. B) causes positive calcium balance. C) influences brain function. D) suppresses the immune system and causes positive calcium balance. E) suppresses the immune system and influences brain function.: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 12) Without cortisol's permissive effect on ________, an animal would die. A) insulin B) glucagon C) thyroid hormone D) parathyroid hormone E) aldosterone: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 13) Melanocortins includes one or more of the following: A) ACTH B) cortisol C) growth hormone D) MSH E) ACTH and MSH: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 14) Thyroid hormone contains the mineral A) sodium. B) thallium. C) iron. D) iodine. E) zinc.: D Section Title: Thyroid Hormones Learning Outcome: 23.7: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 15) The C cells of the thyroid gland produce A) only thyroxine. B) only TSH. C) only calcitonin. D) only parathyroid hormone. E) thryoxine and TSH.: C Section Title: Thyroid Hormones Learning Outcome: 23.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 16) Pendrin is an anion transporter important in the production of A) parathyroid hormone. B) calcitonin. C) TRH. D) TSH. E) thyroid hormone.: E Section Title: Thyroid Hormones Learning Outcome: 23.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 17) Iodine accumulation in thyroid cells involves symport with A) hydrogen. B) sodium. C) potassium. D) chloride.: B Section Title: Thyroid Hormones Learning Outcome: 23.7: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 18) Thyroid hormones A) are lipophilic. B) are hydrophilic. C) must bind to plasma proteins for transport to target cells. D) are lipophilic and must bind to plasma proteins for transport to target cells. E) are hydrophilic and must bind to plasma proteins for transport to target cells.: D Section Title: Thyroid Hormones Learning Outcome: 23.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 19) The Thyroid hormones T3 and T4 are lipophilic so they do not require transporters to cross cell membranes. A) True B) False: B Section Title: Thyroid Hormones Learning Outcome: 23.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 20) Which of the following transporters are known to transport thyroid hormones into target cells? A) CaSR (calcium sensing receptor) B) TRPV6 C) Sodium-iodide symporter D) MCT8 E) Mineralocorticoid receptor: D Section Title: Thyroid Hormones Learning Outcome: 23.8: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 21) The pituitary hormone that triggers the release of thyroid hormone from the thyroid gland is A) TSH. B) ACTH. C) FSH. D) TRH E) CRH.: A Section Title: Thyroid Hormones Learning Outcome: 23.9: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 22) Hyperthyroidism A) decreases oxygen consumption. B) increases protein catabolism. C) decreases protein synthesis. D) slows heart rate. E) causes cold intolerance.: B Section Title: Thyroid Hormones Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 23) The effects of thyroid hormone on peripheral tissue include A) decreased oxygen consumption. B) decreased heart rate. C) increased sensitivity to sympathetic stimulation. D) increased activity of osteoclasts. E) All of these answers are correct.: C Section Title: Thyroid Hormones Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 24) GH A) is secreted by the anterior pituitary. B) is secreted by the posterior pituitary. C) binds to a plasma protein. D) is secreted by the anterior pituitary and binds to a plasma protein. E) is secreted by the posterior pituitary and binds to a plasma protein.: D Section Title: Growth Hormone Learning Outcome: 23.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 25) Excess secretion of growth hormone during adulthood will cause A) goiter. B) exophthalmus. C) giantism. D) acromegaly. E) diabetes.: D Section Title: Growth Hormone Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 26) Somatostatin is another name for A) growth hormone. B) growth hormone-releasing hormone. C) growth hormone-inhibiting hormone. D) thyroid hormone. E) parathyroid hormone.: C Section Title: Growth Hormone Learning Outcome: 23.12: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 27) Excess growth hormone prior to puberty would result in A) osteoporosis. B) cretinism. C) rickets. D) giantism. E) dwarfism.: D Section Title: Growth Hormone Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 28) Mature, less active bone cells are termed A) osteocytes. B) osteoblasts. C) osteoclasts. D) chondrocytes. E) osteons.: A Section Title: Tissue and Bone Growth Learning Outcome: 23.17: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 29) Transcellular transport of intestinal calcium is accomplished by entry into the epithelial enterocytes via A) a sodium-iodide transporter. B) osteoclasts. C) apical calcium channels (TRPV6 = ECaC). D) CaSR (calcium sensing receptor). E) an amino acid transporter (MCT8).: C Section Title: Calcium Balance Learning Outcome: 23.19: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 30) Parathyroid hormone A) stimulates osteoclast activity. B) increases the rate of calcium absorption. C) decreases the rate of calcium excretion. D) raises the level of calcium ion in the blood. E) All of these answers are correct.: E Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 31) The parathyroid glands produce a hormone that A) stimulates the formation of white blood cells. B) increases the level of calcium ions in the blood. C) increases the level of sodium ions in the blood. D) increases the level of potassium ions in the blood. E) increases the level of glucose in the blood.: B Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 32) Elevated levels of calcium ion in the blood stimulate the secretion of the hormone A) calcitonin. B) thyroid hormone. C) parathyroid hormone. D) growth hormone. E) testosterone.: A Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 33) A condition that produces a reduction in bone mass or density sufficient to compromise normal function is A) cretinism. B) osteoporosis. C) osteomyelitis. D) osteitis. E) acromegaly.: B Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 34) Calcium reabsorption at the kidneys is promoted by the hormone A) calcitonin. B) calcitriol. C) aldosterone. D) cortisol. E) ADH.: B Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 35) A hormone that can lower blood levels of calcium ion is A) parathyroid hormone. B) thyroxine. C) calcitonin. D) glucagon. E) oxytocin.: C Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 36) Parathyroid hormone is A) a lipid. B) dissolved in plasma. C) bound to a carrier. D) an amine hormone. E) the cause of Graves' disease.: D Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 37) Vitamin D (calcitriol) A) is formed by sunlight only. B) is bound to plasma protein for transport only. C) synthesis is stimulated by high calcium levels. D) is formed by sunlight and bound to plasma protein for transport. E) is formed by sunlight and synthesis is stimulated by high calcium levels.: D Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the disease with the description. A. Addison's disease B. Cushing's disease C. Graves' disease D. Paget's disease 38) hypercortisolism: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 39) hyperthyroidism: C Section Title: Thyroid Hormones Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 40) involves endocrine stimulation by antibodies: C Section Title: Thyroid Hormones Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 41) Some symptoms mimic diabetes mellitus.: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 42) associated with overactive osteoclasts: D Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 43) Calcitonin may be an appropriate treatment.: D Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 44) may be an autoimmune disease: A Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 45) may result from adrenal tumor: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 46) may result from a pituitary tumor: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the condition with the description. A. acromegaly B. adrenogenital syndrome C. cretinism D. dwarfism E. exophthalmus 47) associated with Graves' disease: E Section Title: Thyroid Hormones Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 48) caused by growth hormone deficiency in childhood: D Section Title: Growth Hormone Learning Outcome: 23.14: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 49) caused by growth hormone excess in adulthood: A Section Title: Growth Hormone Learning Outcome: 23.14: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 50) mental retardation associated with infantile hypothyroidism: C Section Title: Growth Hormone Learning Outcome: 23.14: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 51) This condition results from excess androgens in females.: B Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) Match the condition with its description. A. giantism B. kyphosis C. moon face D. myxedema E. goiter 52) caused by growth hormone excess in childhood: A Section Title: Growth Hormone Learning Outcome: 23.14: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 53) hunchback appearance associated with osteoporosis: B Section Title: Calcium Balance Learning Outcome: 23.20: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 54) puffy appearance associated with hypothyroidism: D Section Title: Thyroid Hormones Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 55) easily observable symptom of hypercortisolism: C Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 56) caused by elevation of TSH: E Section Title: Thyroid Hormones Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 57) Structurally similar steroids sometimes bind to the same receptor, producing ________ effects.: crossover Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 58) Cortisol secretion shows a ________ pattern of secretion, normally peaking in the ________.: circadian, morning Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 59) The hypothalamic-pituitary-adrenal pathway begins with secretion of ________ into the ________ and transported to the ________.: corticotropin-releasing-hormone (CRH), hypothalamic-hypophyseal portal system, anterior pituitary (See Figure 23.2 in the chapter.) Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 60) The most important metabolic effect of ________ is protection against ________, crucial to surviving significant stress.: cortisol, hypoglycemia Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 61) The thyroid gland is composed of many ________ that produce and store thyroid hormones.: thyroid follicles Section Title: Thyroid Hormones Learning Outcome: 23.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 62) Thyroid hormones are structural derivatives of the amino acid ________.: tyrosine Section Title: Thyroid Hormones Learning Outcome: 23.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 63) ACTH is synthesized from a large glycoprotein called ________, which also produces ________ in the pituitary.: pro-opiomelanocortin (POMC), beta endorphin Section Title: Adrenal Glucocorticoids Learning Outcome: 23.5: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 64) What are the two distinct endocrine cell types that comprise the thyroid gland, and what do they secrete?: C cells secrete calcitonin, and follicle cells secrete thyroid hormones. Section Title: Thyroid Hormones Learning Outcome: 23.6: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 65) ________ is a result of deficient thyroid hormone secretion in infancy.: Cretinism Section Title: Growth Hormone Learning Outcome: 23.10: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 66) List four factors that affect normal body growth.: 1. growth hormone and other hormones 2. adequate diet 3. absence of stress 4. genetics Section Title: Growth Hormone Learning Outcome: 23.11: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 67) GH stimulates the secretion of ________ from the liver and other tissue. This hormone has ________ feedback effect on growth hormone secretion.: insulin-like growth factor; negative Section Title: Growth Hormone Learning Outcome: 23.13: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 68) In bone, the calcium phosphate forms crystals of ________.: hydroxyapatite Section Title: Tissue and Bone Growth Learning Outcome: 23.16: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 69) Name four physiological functions of calcium.: 1. signal molecule 2. part of intercellular cement that holds cells together at tight junction 3. cofactor in the coagulation cascade 4. affects the excitability of neurons See Figure 23.11b in the chapter. Section Title: Calcium Balance Learning Outcome: 23.18: Level I: Reviewing Facts and Terms (Bloom's Taxonomy: Knowledge) 70) Damage to cells of the zona fasciculata of the adrenal cortex would result in A) the disappearance of axillary and pubic hair. B) increased volume of urine formation. C) decreased levels of sodium ion in the blood. D) decreased ability to convert lipids to glucose. E) increased water retention.: D Section Title: Adrenal Glucocorticoids Learning Outcome: 23.1: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 71) A rise in cortisol would cause each of the following except one. Identify the exception. A) enhanced rate of glucose synthesis by the liver B) increased rate of glycogen usage by the liver C) higher levels of fatty acids in the blood D) suppression of the immune system E) increased ACTH levels: E Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 72) Premature closure of the epiphyseal plates could be caused by A) high levels of vitamin D3. B) too much calcium in the diet. C) elevated levels of sex hormones. D) too little thyroxine. E) an excess of growth hormone.: C Section Title: Tissue and Bone Growth Learning Outcome: 23.17: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 73) Increased blood calcium levels result in increased A) secretion of calcitonin. B) secretion of parathyroid hormone. C) retention of calcium by the kidneys. D) osteoclast activity. E) excitability of neural membranes.: A Section Title: Calcium Balance Learning Outcome: 23.20: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 74) Pick one hormone from Chapter 23 and design a concept map showing the feedback pattern, types of hormone receptors and how this relates to normal cellular / tissue responses, and areas in the map which could be the cause of pathologies (i.e., hyposecretion, hyperresponsiveness, ...).: The primary hormones covered are adrenal glucocorticoids (Fig. 23.2), thyroid hormones (Fig. 23.5) and calcitonin (Tbl. 23.1), growth hormone (Fig. 23.8), parathyroid hormone (Fig. 23.12), and calcitriol (Fig. 23.13). If the hormone uses a cell membrane receptor, then the effects should be fairly rapid and short-lived. If the hormone uses an intracellular or nuclear receptor, then the effects will take longer and be longer lasting, as this will typically involve gene transcription. (See Chapter 6, Signal Pathways.) Section Title: Review of Endocrine Principles Learning Outcome: 23.1: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 75) Draw a map of steroid hormone synthesis.: See Figure 23.1 in the chapter. Section Title: Review of Endocrine Principles Learning Outcome: 23.1: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 76) Describe the hypothalamic-pituitary-endocrine organ pathways for the adrenal cortex and thyroid gland. Do releasing and/or trophic hormones exert effects outside this pathway? Explain.: See Figures 23.2 and 23.5 in the chapter. CRH and ACTH receptors have been identified in cells of the immune system and are thought to mediate the association between stress and the immune system. Section Title: Review of Endocrine Principles Learning Outcome: 23.2: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 77) What is a permissive hormone effect? Provide an example, explaining what would result if the permissive hormone was absent.: A permissive hormone effect is the dependence of one hormone on the presence of another in order to fully exert its effects. An example is that cortisol is required for full glucagon effect. Without cortisol, glucagon cannot adequately perform its role in glucose regulation, and death results. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 78) Explain how cortisol suppresses the immune system, and why this is sometimes a useful therapy. What are some negative side effects of cortisol therapy? Why do doctors prescribe cortisol in doses that taper off at the end of the therapy period? Why do doctors sometimes prefer to prescribe nonsteroidal anti-inflammatory drugs?: Cortisol prevents cytokine release and antibody production by white blood cells and decreases leukocyte mobility and migration; cortisol is thus an effective anti-inflammatory and antirejection drug for transplant patients. Cortisol weakens the skeleton and alters brain function, in addition to suppressing the immune system. Because cortisol suppresses ACTH production by negative feedback, the adrenal cortex atrophies during cortisol therapy. Tapering off of dosing allows adrenal cortex function to return gradually. Nonsteroidal anti-inflammatories avoid the negative side effects of cortisol therapy and are therefore more appropriate for minor inflammation. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 79) Billy has been serving in a noncombat position in the army for two years and has just been informed that he is leaving on a combat mission tomorrow. Billy is feeling very stressed. How has his endocrine system responded to this bad news? Which hormones are involved, and what effects do they have?: Increased cortisol secretion by the adrenal cortex is stimulated via corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH). Cortisol generally has catabolic effects, to protect against hypoglycemia. These effects include gluconeogenesis in the liver, breakdown of skeletal muscle proteins, enhanced lipolysis, immune suppression, and bone loss. Additionally, this discouraging news may be accompanied by a fight-or-flight reaction, in which increased sympathetic activity will result in increased heart and respiratory rates, increased perfusion of skeletal musculature, and decreased digestive activity. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 80) List and explain the effects of cortisol.: Effects include promoting gluconeogenesis, breakdown of skeletal muscle proteins and lipolysis, immune suppression, negative calcium balance, alteration of cerebral function. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 81) Which hormones of growth and metabolism have a permissive effect on other hormones of growth and metabolism?: Cortisol is required for glucagon to be fully effective against a hypoglycemic challenge. In children, thyroid hormone is necessary for the full expression of growth hormone. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.3: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 82) What are the three common causes of hypercortisolism?: 1. adrenal tumor autonomously secretes cortisol (primary hypercortisolism) 2. pituitary tumor autonomously secretes ACTH (secondary hypercortisolism) 3. iatrogenic hypercortisolism (physician-caused) Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 83) What are the symptoms and causes of Cushing's disease? How do they compare and contrast with symptoms and causes of Addison's disease?: Cushing's disease is hypercortisolism, which can arise from adrenal or pituitary tumors or exogenous administration of cortisol. Symptoms include gluconeogenesis and consequent hyperglycemia, tissue wasting (especially in the limbs) from breakdown of protein and fat, excess fat deposition in trunk and face, mood elevation followed by depression, and difficulty with learning and memory. Addison's disease, far less common, is hyposecretion of cortisol as well as other adrenal steroids. It is usually caused by autoimmune destruction. Symptoms include darkening of the skin due to effects of ACTH on melanocytes. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.4: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 84) Explain how the mutant agouti mouse is proving useful as a model for obesity-related disease.: See the "Emerging Concepts: Melanocortins and the Agouti Mouse" section of the chapter. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 85) Define hypertrophy and hyperplasia, and describe their hormone regulation.: Hypertrophy is increase in cell size, and hyperplasia is increase in cell number. Both are regulated by growth hormone, thyroid hormone, and insulin. Section Title: Growth Hormone Learning Outcome: 23.11: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 86) Bill does not begin puberty until he is 16. What effect would you predict this will have on his stature? A) Bill will probably be taller than if he had started puberty earlier. B) Bill will probably be shorter than if he had started puberty earlier. C) Bill will probably be a dwarf. D) Bill will have bones that are denser than normal. E) The late onset of puberty will have no effect on Bill's stature.: A Section Title: Tissue and Bone Growth Learning Outcome: 23.5: Level II: Reviewing Concepts (Bloom's Taxonomy: Application) 87) Describe the endocrine regulation of bone growth.: Bone growth is regulated by many hormones, including growth hormone, insulin-like growth factor, sex steroids, and hormones that regulate calcium metabolism. Section Title: Tissue and Bone Growth Learning Outcome: 23.17: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 88) Describe the sources, targets, and primary effects of the hormones of calcium metabolism.: Parathyroid hormone, calcitonin, and calcitriol are the primary hormones. See Table 23.1 and Figures 23.12 and 23.13 in the chapter. Section Title: Calcium Balance Learning Outcome: 23.20: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 89) Describe differences in effects of hormones of growth and metabolism in children compared to effects in adults.: While all the hormones discussed in this chapter will have effects on adults and children, some have very specific effects at different stages of life. 1. Cortisol provides a catabolic protective effect against hypoglycemia, enhancing the effectiveness of glucagon, important in response to stress. In children, excess cortisol released due to stress can result in stunted growth or a failure to thrive 2. Thyroid hormone provides substrates for oxidative metabolism in adults, but has the additional effect of providing for full expression of growth hormone and mental development in infants and young children. In adults, Thyroid hormones cause protein catabolism while it has anabolic effects in children. Thyroid hormone deficiency in children will be developmentally delayed and short in stature and may have mental retardation. In adults, hypothyroidism may cause cold-intolerance, slow reflexes, fatigue, slow heart rate, and many other conditions. 3. Growth hormone is anabolic, essential for tissue growth and maintenance. Its effects are most dramatically seen in children (rapid growth spurts). Growth hormone deficiency causes dwarfism and excess causes giantism in children. Acromegaly characterizes GH excess in adults. 4. Calcitonin's primary role is likely in providing normal skeletal growth in children. In adults it is important when net bone deposition is needed, such as during pregnancy. Section Title: Review of Endocrine Principles Learning Outcome: 23.2: Level II: Reviewing Concepts (Bloom's Taxonomy: Comprehension) 90) Precocious puberty in girls can result from hypersecretion of nongonadal steroids. In such girls, there is early breast development, onset of menses, and ovulation of viable eggs. This can occur by age 7 or even earlier. Which hormone(s) and nongonadal endocrine gland(s) may be responsible? Can the responsible gland(s) be safely removed? Explain. How might this condition be treated without surgery? What permanent nonsexual consequences may result from not treating this condition?: Adrenal sex hormones include estrogens. Hypersecretion of estrogen would stimulate puberty. The adrenal glands can be removed, if cortisol and aldosterone are replaced. Drugs such as aromatase inhibitors, which block estrogen production, may be appropriate. An effect of estrogen is stimulation then cessation of skeletal growth, which after precocious puberty could result in shorter final stature due to premature closure of growth plates in long bones. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2: Level III: Problem Solving (Bloom's Taxonomy: Synthesis) 91) Carmen has just given birth to her third child, and as with the first two, she stayed home and used the services of a nurse-midwife. While her recovery from the births of the first two children was normal and she was able to breast-feed both for two years, she is not lactating this time and is experiencing other difficulties. Her symptoms also include vomiting, fatigue, cold intolerance, and myxedema, which worsen over the coming weeks. She ignored her midwife's suggestion to see her doctor the day after giving birth, but has finally gone to an Ob-Gyn during the third week postpartum. Her newborn baby is healthy and thriving on human breast milk purchased from a milk bank. Diagnostic tests indicate decreased amounts of several hormones, as well as edema and poor blood flow into the pituitary. What do her symptoms indicate? Which hormones are likely decreased? What may be the root cause?: A lack of several pituitary hormones is apparent: PRH stimulates prolactin secretion and lactation, vomiting and fatigue could indicate lack of ACTH and consequent cortisol, and cold intolerance and myxedema indicate lack of TSH and consequent thyroid hormone. Abnormal function of the anterior pituitary can result from lack of hypothalamic-releasing hormones, pituitary adenoma, or pituitary infarction related to pregnancy (Sheehan syndrome; this syndrome is not described in the text, but the student may be able to reason decreased pituitary function due to decreased blood flow). Section Title: Adrenal Glucocorticoids Learning Outcome: 23.2: Level III: Problem Solving (Bloom's Taxonomy: Synthesis) 92) In an effort to impress her physiology instructor, your roommate did an Internet search on cortisol. In her exuberance, she failed to read the book chapter, the instructor has not yet lectured on this chapter, and frankly she knows next to nothing about this hormone. She discovers such seemingly unrelated therapeutic effects as treatment for bee stings and rejection of transplanted organs. You, however, completed your physiology course last semester, and she turns to you for enlightenment. What can you tell her about some other therapeutic uses for cortisol, and what functional connections do these illustrate? What are some of the negative side effects?: Cortisol suppresses the immune system by preventing cytokine release, inhibiting antibody production, and inhibiting the inflammatory response. Allergic reactions to bee stings, poison ivy, and pollen involve the immune system; thus cortisol can be used to suppress these responses. Rejection of a transplanted organ is also an immune response. Negative feedback from the exogenous hormone inhibits ACTH production, which can result in atrophy of the adrenal cortex. Hypercortisolism can also result, with symptoms similar to diabetes mellitus, and extra fat deposition leading to "moon face," and changes in mood and cognition. Section Title: Adrenal Glucocorticoids Learning Outcome: 23.5: Level III: Problem Solving (Bloom's Taxonomy: Application) 93) Therapeutic surgical removal of the thyroid gland was documented more than 1000 years ago. In the 19th century, a surgeon performing that procedure had only about 50% patient survival, and patient death was often unrelated to nonspecific complications such as infection or bleeding. What condition of the thyroid is so easily diagnosed that ancient surgeons would think to remove it? What hormonal problem unrelated to thyroid hormones may account for the 50% mortality of thyroidectomy patients in the 19th century (and probably throughout history)? Why didn't the surgeons anticipate this problem? Why wasn't the mortality closer to 100%?: Goiters develop from lack of iodine in the diet or from Graves' disease, producing an obvious enlargement in the neck. Loss of parathyroid hormone following thyroidectomy with inadvertent parathyroidectomy caused death in patients due to lack of calcium for excitable cells such as heart and nerve cells. The role of the parathyroid glands was not fully understood in the 19th century. Mortality was not 100% because the amount of parathyroid tissue varies in individuals, and some had parathyroid tissue that was not removed by thyroidectomy. Section Title: Thyroid Hormones Learning Outcome: 23.10: Level III: Problem Solving (Bloom's Taxonomy: Application) 94) A diagnosis of thyroid cancer may be treated with removal of the thyroid gland. Which hormone or hormones may now be deficient? Considering each hormone individually, which ones should be restored and why? Explain any age-related considerations. Which nonthyroid hormone may be affected by careless thyroidectomy? Explain your answer, indicating whether or not it is critical to maintain this hormone.: The thyroid gland is the source of thyroid hormones and calcitonin. Thyroid hormones should be replaced in children to maintain normal growth and in adults to maintain quality of life. Calcitonin replacement is not necessary in adults, because parathyroid hormone and calcitriol should be unaffected, and they are sufficient to maintain normal calcium balance. It is unclear how important calcitonin replacement may be in children. Careless thyroidectomy could result in removal of parathyroid glands. If parathyroid hormone is not restored, death results. Section Title: Calcium Balance Learning Outcome: 23.20: Level III: Problem Solving (Bloom's Taxonomy: Application) 95) Carl is suffering from hypothyroidism. How could his physician determine if his symptoms result from problems at the level of the hypothalamus and pituitary or at the level of the gland itself?: The physician could order blood tests to determine the levels of TSH, T3, and T4 in the blood. If the condition is due to disease of the thyroid gland, you would expect to see elevated levels of TSH because of a lack of feedback inhibition by thyroid hormones. If, on the other hand, the problem is due to problems at the level of the hypothalamus or pituitary, you would expect to see decreased levels of TSH. Section Title: Thyroid Hormones Learning Outcome: 23.10: Level III: Problem Solving (Bloom's Taxonomy: Application) 96) An adult with cretinism has incomplete manifestation of puberty (e.g., scant pubic hair), abnormal facial features, dwarfism, and mental retardation. Explain what causes these symptoms. How is cretin dwarfism different from pituitary dwarfism? How could cretinism be prevented?: Cretinism results from lack of thyroid hormones during early childhood. Thyroid hormones are permissive for growth hormones and play an important role in the development of the nervous system. The incomplete puberty may be related to lack of thyroid hormone and growth hormone effects on the sexual tissues. Pituitary dwarfism results from lack of growth hormone, unrelated to thyroid hormones. Prevention of thyroid cretinism is aimed at adequate prenatal care (especially dietary iodine) and administration of exogenous thyroid hormones to the infant. Section Title: Thyroid Hormones Learning Outcome: 23.10: Level III: Problem Solving (Bloom's Taxonomy: Application) 97) The approach to treating patients who secrete abnormal amounts of hormone sometimes depends upon the age of the patient. List the hormones of growth and metabolism for which this statement is true, and explain in each case how and why the approach would differ for a prepubertal patient compared to a postpubertal patient.: Thyroid hormone and growth hormone are the main hormones of growth and development with differing roles in childhood compared to adulthood. Students may wish to discuss calcitonin as well, but there is little detail in the text and incomplete understanding of its role, especially in adults. 1. Thyroid hormone is essential for normal growth and development in children, although this hormone is not essential for living, regardless of age. Thyroid imbalances must be promptly corrected in children, or else the patients will be developmentally delayed. Thyroid hormone has a permissive effect for growth hormone, is anabolic in children, and is required for normal neural development. These effects are not seen with thyroid hormone imbalance in adulthood, but to maintain a normal quality of life, amount of circulating thyroid hormone should be corrected in adults as well. 2. Children cannot grow normally without adequate amounts of growth hormone, and imbalances should be corrected promptly. Secretion of GH peaks during the teens. Excess GH in childhood can lead to giantism, while lack of GH leads to pituitary dwarfism. Lack of GH in adulthood is not problematic, but excess production stimulates the growth of cartilage, causing acromegaly. Section Title: Growth Hormone Learning Outcome: 23.11: Level III: Problem Solving (Bloom's Taxonomy: Application) 98) Juan has great hopes that his 12-year-old son will play professional basketball and wants to do anything that might be helpful. He has heard that the administration of testosterone or other androgens might increase his son's height. Alarmed, you tell him that this may be a treatment that would actually limit his future athletic potential. Why?: The administration of sex hormones may cause a quick increase in height, but could also contribute to the premature closure of the epiphyseal plates, limiting the final height this child may attain. Section Title: Tissue and Bone Growth Learning Outcome: 23.17: Level III: Problem Solving (Bloom's Taxonomy: Application) 99) Rani has read how important Ca2+ ions are to muscle contraction and neuron function. Rani, age 25, hates milk and most dairy products, and doesn't think she eats many foods that are sources of calcium, nor does she take supplements. Why don't Rani's muscles and nerves show problems related to calcium deficiency? What problems might Rani encounter later in life if she continues this lifestyle?: Rani's skeleton contains enough Ca2+ to, under the influence of PTH, release Ca2+ to maintain normal blood levels. The muscles, nerves, and other cells are thus able to obtain sufficient Ca2+. It is also likely that Rani consumes at least small amounts of Ca2+ in her diet. Rani will eventually lose enough bone density to be prone to fractures. Section Title: Calcium Balance Learning Outcome: 23.20: Level III: Problem Solving (Bloom's Taxonomy: Application) 100) Todd is in the emergency room, complaining of severe back pain and pain when trying to urinate. The physician has ordered blood tests and urinalysis to measure levels of parathyroid hormone (PTH) and phosphates. What possible reason would the physician have for doing this? What would the physician conclude if the results of the blood test show high levels of PTH and calcium and the urinalysis shows high levels of phosphate? How are calcium and phosphates related?: Based on the symptoms that Todd is experiencing, the physician is likely considering kidney stones to be the cause of severe back pain. If there is a problem with hypersecretion of parathyroid hormone, this would cause increased calcium levels in the blood, and cause the kidneys to exchange more phosphates for calcium, leading to high urine levels of phosphates. If calcium levels in the blood are very high, the kidney will not be able to reabsorb all of the calcium, leading to the formation of kidney stones out of calcium phosphate. Section Title: Calcium Balance Learning Outcome: 23.20: Level III: Problem Solving (Bloom's Taxonomy: Application)