MB ChB Year 1: Nutrition and Energy

Nutrition & Energy Assessments

This page contains:

information about the assessments associated with this ICU
some new revision exercises on Dr Illingworth's lectures
practice EMQ and MCQ questions based on the course

EMQ section

Theme 1: Gastric acid secretion & peptic ulcers

Theme 2: Dietary guidelines

Theme 3: Malabsorption

Theme 4: Liver & alcohol abuse

Theme 5: Micronutrient intake

MCQ section

MCQs

a short poem by R.D. Laing

There are also practice questions in other areas of the website, and on the VLE relating to specific aspects of the course, e.g. histology and cross-sectional anatomy.

In Course Assessments

Formative Assessment

27 April

Formative short answer assessment based on Case Study 1.

Summative Assessment

Assessment of this ICU consists of 3 elements:

1.	20% of the in-course mark will be given for satisfactory completion of preparatory work set for each session.

2.	18 May	Short answer questions based on Work sessions (30%)

3.	Thursday 3 June Spot Test (50%)	A dissecting room-based spot test covering the gross anatomy, surface anatomy, cross-sectional anatomy, histology and embryology components of the course. The test will have 20 three-part questions

Compensation

The Spot Test must be passed in its own right, but standard compensation will be applied across the other 2 elements of assessment, i.e. one E grade may be compensated by C grades or above in the other assessment. Students must pass both components (Spot Test & written/preparatory work) to pass the course.

Resits

Anatomy Spot Test: Friday 20 August

Students who fail the written element of assessment will be set assignments (individualised according to student performance) to be completed by Monday 16 August.

All parts of this ICU, including the clinical lectures, practical classes and case studies will also be assessed in the integrated summative examinations in June.

Revision materials

The following self-assessment material includes topics covered in several lectures by Dr Hunter, Dr Whittle and Dr Illingworth. These pages were specifically designed as revision / study aids in response to student feedback. They integrate many diverse aspects of the course and they are therefore much longer than typical examination questions.

Message passing between tissues

The interactive table below shows the flow of metabolic information between some of the sensors and effector organs in the human body. There is one column for each sender, one row for each receiver and the signals or signalling routes are in the yellow cells where the row and column intersect. For example: the adipocyte column shows that adipocytes send only one message, leptin, to the hypothalamus, but the adipocyte row shows that adipocytes receive numerous messages from other tissues that help to regulate their fat storage activities. We have only included those signalling pathways that are well-documented in the medical and scientific literature. New routes are still being discovered, and 'ghrelin' (for example) is an important hormone that was identified only recently. We don't expect you reproduce the entire table from memory, but you should recognise these pathways when prompted for the information. Test your knowledge of these signalling routes by pointing at each entry in turn with the mouse to see more details about each message. If any are unfamiliar write them down - you won't remember anything if you just stare at them!

message receivers	message senders														message receivers
message receivers	adipo cytes	adrenal cortex	adrenal medulla	duod enum	alpha cells	beta cells	hypoth alamus	macro phage	liver	cortico trophs	somato trophs	thyro trophs	stomach	thyroid gland	message receivers
adipocyte		cortisol	adrenalin		glucagon	insulin					GH	TSH		T3+T4	adipocyte
adrenal cortex										ACTH					adrenal cortex
adrenal medulla							nerves								adrenal medulla
duodenum							nerves								duodenum
exocrine pancreas				CCK			nerves								exocrine pancreas
gall bladder				CCK											gall bladder
islets α cells						insulin	nerves		glucose						islets α cells
islets β cells			adrenalin	CCK	glucagon		nerves		glucose						islets β cells
hypothalamus	leptin	cortisol		CCK		insulin		TNFα	glucose				nerves	T3+T4	hypothalamus
liver		cortisol	adrenalin	CCK	glucagon	insulin		TNFα			GH			T3+T4	liver
macrophages		cortisol													macrophages
muscles		cortisol	adrenalin		glucagon	insulin					GH			T3+T4	muscles
corticotrophs		cortisol					CRH								corticotrophs
somatotrophs							GHRH						ghrelin		somatotrophs
thyrotrophs							TRH							T3+T4	thyrotrophs
stomach				CCK			nerves								stomach
thyroid												TSH			thyroid
message receivers	adipo cytes	adrenal cortex	adrenal medulla	duod enum	alpha cells	beta cells	hypoth alamus	macro phage	liver	cortico trophs	somato trophs	thyro trophs	stomach	thyroid gland	message receivers
message receivers	message senders														message receivers

A to Z of energy metabolism and blood glucose homeostasis

Blood glucose is vital for normal cerebral function, but the maximum glucose concentration must be controlled to prevent vascular damage. Circulating glucose is sufficient for only a few minutes normal activity, and the blood glucose concentration must be defended by the liver on instructions from the endocrine system and the hypothalamus. Liver glycogen reserves will last for an hour or so, but the body's protein and fat stores are good for several weeks.

The following diagram shows some of the main regulatory enzymes that are involved in blood glucose and energy homeostasis in humans. Non-regulatory enzymes that operate close to equilibrium and groups of closely-related metabolites have been rolled together, so as to emphasise the principal control points. Click the letters for a series of mini self-assessment tests on each topic. Look for patterns in your answers: this isn't an isolated list of facts to be learned by rote, but a working piece of machinery that makes excellent biological sense. Click here for a printable version of this diagram on a single A4 page.

The diagram above isn't intended to be a complete list of regulatory enzymes or of their activators and inhibitors - these are already too numerous to learn, and new ones are being discovered all the time. Many regulatory enzymes have multiple effectors and participate in several control systems. We don't want you to remember every minute detail - we want you to understand how it works. The exam will give you plenty of clues and you should be able to deduce most of the answers using common sense with minimal rote learning. The reason for asking about the signal transduction mechanisms is that these determine the physiological response time: allosteric effects happen in milliseconds, protein kinases in seconds or minutes, but changes in gene expression take hours or days.

Practice EMQ & MCQ exercises 2009

These practice questions have an adjustable feedback level. We strongly urge students not to look at the crib unless you are completely stuck. If you go straight to the answers you will not learn very much, and gain a misleading idea of your own performance.

EMQ Section: Match each statement with the appropriate option.

Theme 1: Gastric acid secretion & Peptic ulcers

Select the compound responsible for the actions described below. Each option may be used once, more than once or not at all.

Acetylcholine
Aspirin
Cimetidine
Gastrin
Histamine
Misoprostol
Omeprazole
Prostaglandin E2

Question 1. Which of the above options correspond to the following statements?

Statement	Options
1. Ibuprofen inhibits the synthesis of this molecule
2. This compound increases H⁺ secretion by parietal cells by activating the Gs protein
3. This compound directly inhibits the H⁺ / K⁺ ATPase
4. This compound mimics the actions of prostaglandins on the parietal cell
5. H. pylori infection increases release of this molecule

feedback options:

Theme 2: Dietary Guidelines

option	gender	BMI	% calories supplied by fat	Weekly alcohol intake (units)	Daily iron intake (mg)
A	male	22	30	8	18
B	male	23	27	0	12
C	male	26	42	17	14
D	male	21	29	5	9
E	male	33	50	21	11
F	female	18	42	0	12
G	female	20	20	6	9
H	female	22	34	14	14
I	female	21	32	20	15
J	female	29	35	11	17

Question 2. For each patient described below, select the most likely data line. Each option may be used once, more than once or not at all.

Statement	Options
1. An individual of height 1.80m and weight 74.5kg
2. A 42 year old consults their doctor for work-related stress, and intermittent stomach pain. Blood tests show raised levels of g-glutamyl transferase.
3. An elderly individual, whose partner died six months earlier, is being treated for clinical depression.
4. This patient was recently diagnosed with Type II diabetes, and complains of joint pains, and breathlessness on climbing stairs.
5. This 24 year old visited the doctor because they felt "tired all the time". When questioned by the GP, the patient complained of headaches, occasional dizziness and breathlessness on exertion.

feedback options:

Theme 3: Malabsorption:

Options

Antiport Transport
Bicarbonate Ion
Chloride Ion
Duodenum
Small intestine
Facilitated Diffusion
Inflammatory Diarrhoea
Large Intestine
Osmotic Diarrhoea
Pancreas
Secretory Diarrhoea
Sodium Ion

Question 3. For each of the following, select the appropriate option from the above list. Each option may be used once, more than once, or not at all.

Statements	Options
1. This is the major site of nutrient and water absorption
2. In the small intestine, the combined movement of sodium and potassium occurs by this type of transport system
3. This type of diarrhoea is common in individuals suffering from glucose-galactose intolerance
4. Steatorrhoea may result from insufficiency in this organ
5. The basis of oral rehydration therapy is the co-transport of glucose with this other ion

feedback options:

Theme 4: liver & alcohol abuse

Options:

Unconjugated (indirect) bilirubin
Vitamin K
Disulphiram
Albumin
Alcohol
Vitamin A
g-glutamyl transferase
Bile salts
Thiamine

Question 4. For each of the following, select the SINGLE most appropriate response from the above list. Each option may be used once, more than once, or not at all.

Statements	Options
1. Jaundice arises from increased deposition of this in tissues.
2. Wernicke-Korsakov syndrome can arise in alcohol addicts as a result of deficiency in this.
3. Increased risk of bruising and bleeding in alcohol addicts is due to deficiency in this.
4. Oedema can arise from severely depleted circulating levels of this.
5. This compound has been shown to have a beneficial effect on heart attacks and strokes when ingested in moderate amounts.

feedback options:

Theme 5: Inadequate or excessive micronutrient intake

Options

Vitamin A
Vitamin C
Vitamin D
Folic acid
Riboflavin
Pyridoxal phosphate (B6)
Calcium
Thiamin
Iron

Question 5. For each of the following, select the SINGLE most appropriate vitamin or mineral from the above list. Each option may be used once, more than once, or not at all.

Statements	Options
1. Lack of this substance may cause rickets.
2. Beri-beri may result from insufficient intake of this substance.
3. Deficiency in childhood causes xerophthalmia.
4. Lack of this substance causes macrocytic anaemia.
5. Excess intake may cause liver and bone damage.

feedback options:

MCQ Section.

Select one correct answer from four

Statement & options	Choice
1. Which of the following is secondarily retroperitoneal at birth? Pancreas Stomach Transverse colon Spleen
2. Concerning swallowing and taste: The chorda tympani conveys the sensation of taste from the posterior 2/3 of the tongue. Superior constrictor elevates the larynx during swallowing. Swallowing is entirely voluntary. The soft palate contracts to prevent food entering the nasopharynx.
3. Which of the following factors protect against invasion by gastrointestinal pathogens? IgG Bacterial flora Complement All of the above
4. Bicarbonate secretion by the pancreas is maximally stimulated by: GIP Substance P VIP Secretin
5. Which of the following amino acids can, after deamination, give rise directly to a component of the TCA (Krebs) Cycle? Glutamic acid Lysine Alanine Glycine
6. The function of bile is: To emulsify dietary lipids To dissolve gall stones To get rid of broken down haem To solubilise bilirubin
7. Which of the following is an ATP-dependent enzyme present in human liver cytosol that is strongly activated by citrate ions? Acetyl CoA carboxylase Fructose 1,6-bisphosphatase Pyruvate kinase Pyruvate carboxylase
8. In the diagnosis of diabetes: The presence of ketone bodies in the urine after a standard glucose tolerance test would suggest type II (NIDDM) rather than type I (IDDM) diabetes. A fasting glucose level below normal would usually be found in Type I diabetes. Weight loss is a common finding in Type I diabetes. Type I, but not Type II, would show an increased level of glycosylated haemoglobin.
9. Palpitations, sweating and anxiety would be caused directly by the release of: Insulin Adrenalin Leptin ACTH

feedback options:

A Poem

There is something that I don't know
   that I am supposed to know.
I don't know what it is that I don't know
   and yet am supposed to know,
and I feel I look stupid
   if I seem both not to know it
      and not know what it is I don't know.
Therefore I pretend I know it.
   This is nerve-racking
   since I don't know what I must pretend to know.
Therefore I pretend to know everything.

I feel that you know what I am supposed to know
but you can't tell me what it is
because you don't know that I don't know what it is.

You may know what I don't know, but not
      that I don't know it,
and I can't tell you. So you will have to tell me everything.

[Reproduced with permission from "Knots" p. 56 by R.D. Laing
first published by Tavistock Publications, London 1970; reprinted
April 1999 Routledge ISBN: 0415198240 hardback & paperback]

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Study Guide

Timetable

Lectures

Anatomy

Work Sessions

Self-directed

Assessments