Anatomy and Physiology

Division B
University of Texas Invitational
November 11, 2017

Team Name and Number: ________________________________________________ B-____

Participant 1: ____________________________________________________

Participant 2: ____________________________________________________
Austin Invitational Science Olympiad Tournament
Anatomy and Physiology Exam – GI, Immuno, Respiratory
For questions 1-7, select the answer that best addresses each question (3 points each):

1. Vitamin B12 is unique among water-soluble vitamins in that it requires intrinsic factor to
be absorbed in the gut. In a disease called pernicious anemia, patients lack intrinsic
factor and thus cannot absorb vitamin B12. Vitamin B12 is primarily absorbed in which
portion of the GI tract?
a. Stomach
b. Duodenum
c. Jejunum
d. Ileum
e. Colon
2. A 60 year old man with a history of alcohol abuse presents to the emergency room with
epigastric pain, hypotension, and diarrhea with oily, foul-smelling, floating stools
(steatorrhea). The character of this patient’s stools can be attributed to a decrease in
the intraluminal (inside the small bowel) concentration of which of the following
enzymes?
a. Chymotrypsin
b. Enteropeptidase
c. Colipase
d. Amylase
e. Lipase

3. A 23-year old woman with no past surgical history complains of periumbilical pain
associated with nausea and vomiting. Several hours later, her pain moves to the right
lower quadrant of her abdomen. Pressure on her left lower quadrant reproduces the
pain on her right side. This woman’s condition is best explained by which of the
following?
a. Kidney stone
b. Appendicitis
c. Hepatitis
d. Small bowel obstruction
e. Ectopic pregnancy

4. The churning action of the stomach is an example of:

a. Chemical digestion
b. Absorption
c. Mechanical Digestion
d. Secretion
 5. A 60 year old man with no past medical history who presents with a 20 pound weight
loss over 2 months, fatigue, and trace amounts of blood in his feces is most concerning
for which of the following conditions?
a. Esophageal cancer
b. Pancreatic cancer
c. Small Bowel Cancer
d. Hepatocellular Cancer
e. Colon Cancer

6. All of the following are associated with duodenal ulcers except:

a. Caffeine
b. NSAIDs
c. Burns
d. H. pylori
e. Gastrin-producing tumor

7. Bobby is a 40 year old man who returned from India 1 month ago and who presents
with decreased appetite, jaundice, and an enlarged liver. Bobby denies any exposure to
needles and is not sexually active, raising suspicion for a Hepatitis A infection. Which of
the following is the most likely prognosis (outcome) of Bobby’s condition?
a. Acute Liver Failure
b. Chronic infection leading to cirrhosis
c. Acute infection resolving with complete recovery of liver function
d. Acute infection resolving with partial recovery of liver function
e. Chronic infection leading to hepatocellular carcinoma

For Questions 8-16, match the enzyme (or digestive fluid) with the corresponding
macromolecule it primarily digests (1 point each):

8. Maltase
9. Lipase A. Carbohydrates
10. Bile B. Proteins
11. Trypsin C. Fats
12. Amylase
13. Sucrase
14. Pepsin
15. Chymotrypsin
16. Lactase
 17. Describe the process of carbohydrate digestion and absorption in the small bowel (14
points).

18-21. For each of the GI layers listed below, select the letter that best defines each layer. (2
points each, 8 points max)

18. Serosa
19. Submucosa
20. Muscularis Propia
21. Mucosa

Adapted from: http://bio.rutgers.edu/~gb102/lab_9/tissues/mucosa_layers_diagram.jpg

22. Which of the following pathways best describes the typical circulation pattern of
lymphocytes, starting in the lymph nodes?
a. Lymph Node -> Afferent lymphatic vessels -> thoracic duct -> left brachiocephalic vein
->pre-capillary arterioles->efferent lymphatic vessels->Lymph Node
b. Lymph Node->Efferent Lymphatic Vessels->thoracic duct->left brachiocephalic vein-
>post-capillary venules->afferent lymphatic vessels->Lymph Node
c. Lymph Node->Efferent Lymphatic Vessels->thoracic duct->left brachiocephalic vein-
>pre-capillary arterioles->afferent lymphatic vessels->Lymph Node
d. Lymph Node -> Afferent lymphatic vessels -> thoracic duct -> left brachiocephalic vein
->post-capillary venules->efferent lymphatic vessels->Lymph Node
e. Lymph Node -> Efferent Lymphatic Vessels -> Right Lymphatic Duct -> Right
subclavian vein -> pre-capillary arterioles -> Afferent Lymphatic Vessels -> Lymph Node

23. A first-year medical student is studying microscopic slides for his microanatomy course
when a fire-ant bites his left hand. Within minutes, a red rash spreads across the back of his
hand, and he notes swelling and itchiness. On a molecular level, what is the most likely cause of
this inflammatory reaction?
a. IgG-mediated cell destruction
b. Immune-complex deposition
c. Complement Activation
d. T cell-mediated inflammation
e. IgE-mediated activation of mast cells

24. All of the following are common symptoms of anaphylaxis EXCEPT:

a. Fever
b. Hypotension
c. Angioedema (swelling of the skin)
d. Itching
e. Blurred vision

25. Which of the following foods commonly cause anaphylaxis in teens and adults?
a. Peanuts
b. Shellfish
c. Tree nuts
d. Fish
e. All of the above
f. A and B only
“Oxyhemoglobin Dissociation Curve of HbA.” Oxygen Transport and Internal Respiration, Thoracic
Key, 10 July 2016, thoracickey.com/wp-
content/uploads/2016/07/B9780721684222500102_gr9.jpg.

26. The HbA (the primary hemoglobin found in adults) oxyhemoglobin dissociation curve
can be described as sigmoidal in shape (S-shaped). What role, if any, does this sigmoidal
shape play in allowing hemoglobin to deliver oxygen to the body? (5 points)

27. On a molecular level, what property (or properties) of hemoglobin account for the
sigmoidal shape of HbA? Describe how this property (or properties) affect oxygen
binding and release. (5 points)
 28. As opposed to adults, fetuses primarily use HbF. How does the oxyhemoglobin
saturation curve compare to that of HbA? (2 points max)

29. Why, on a molecular level, does HbF’s curve look different from that of HbA? (5 points
max)

30. What function does the saturation curve difference between HbF and HbA serve in the
fetus? (Bonus: What condition can be treated by artificially inducing HbF? Why?) (7
points max, including bonus)

31. Many environmental factors can affect the position of hemoglobin saturation curve. For
each of the following factors, determine (circle) if the change will shift the curve LEFT,
RIGHT, or induce NO CHANGE (1 pt each):
a. Increasing pH in blood Left No Change Right
b. Increasing pCO2 in blood Left No Change Right
c. Increasing 2,3-BPG in blood Left No Change Right
d. Increasing Temperature in blood Left No Change Right

Questions 32-37 are worth 3 points each; select the best option for each question.
32. All of the following are examples of macrophages except?
a. Kupffer cells (liver)
b. Sinus histiocytes (lymph nodes)
c. Langerhans cells (skin and mucosa)
d. Microglia (central nervous system)
e. Osteoblasts (bone)

33. Alexa is a 67-year old female who presents with fever, cough, and fatigue. Chest X-Ray
shows an haziness in the lower lobe of her right lung. She has no mobility impairments
and no history of dementia or difficulty swallowing. Which of the following best
describes her condition?
a. Asthma
b. Flu
c. Tuberculosis
d. Pneumonia
e. Bronchitis

34. As a continuation from question 33, which of the following interventions could have
best prevented Alexa’s condition?
a. BCG vaccine
b. Flu Vaccine
c. Tdap (tetanus, diphtheria, and acellular pertussis) Vaccine
d. Pneumococcal Vaccine
e. Decreasing intake of opiates

35. A 55 year old obese man complains of a daily morning headache and poor restfulness
even when getting 8 hours of sleep. His daytime fatigue that impairs his ability to work
and drive, and his wife complains of his loud snoring. The mechanism of his most likely
conditions involves which of the following?
a. Repetitive collapse of the pharyngeal airway during sleep
b. Dilation of blood vessels to the head
c. Dehydration
d. Pineal gland dysfunction resulting in a disturbed circadian rhythm
e. Poor sleep hygiene

36. The Human Immunodeficiency Virus (HIV) primarily infects what kind of white blood
cell?
a. Cytotoxic T cell
b. Macrophage
c. Helper T cell
d. Neutrophils
e. NK Cells
 37. Nikita is a 70 year old man with a 30 pack year history of smoking who presents with
progressive shortness of breath for the past year. Spirometry yields an FEV1/FVC ratio of
0.5 (normal is ~0.8), consistent with an obstructive lung disease. Which of the following
does NOT typically contribute to the pathogenesis of COPD?
a. Excess mucus production
b. Increased elastase activity
c. Infiltration of neutrophils into the lungs
d. Increased a1-antitrypsin activity
e. Air trapping in the lungs

For questions 37-40, match the spirometry term with its corresponding description. (2 points
each)

38. Tidal Volume A. Max volume that can be

inhaled from the end-
39. Functional Residual Capacity inspiratory level
B. Volume of air moved into
40. Inspiratory Reserve Volume or out of lungs during
quiet breathing
41. Vital Capacity C. Volume of air breathed
out after the deepest
inhalation
D. Volume of in the lungs at
the end-expiratory
position
Case Presentation

History of Present Illness: A 66 year old male complains of fatigue and weakness that started 6
months ago. He states that he feels tired all day, his appetite is poor, and he unintentionally lost
20 pounds in the past 6 months. He also complains of occasional nausea and deep epigastric
discomfort that radiates to his back starting 4 months ago. This pain decreases when he leans
forward and increases when he lies on his back. There is no relationship of the pain to food.
Bowel movements occur at regular frequency, but he has recently noticed more foul-smelling,
greasy-looking stools. He denies blood in the stool.

Allergies: No known drug allergies

Medications: Takes ibuprofen for pain
Past medical history: None
Past surgical history: Appendectomy at age 16 (removed appendix)
Social History: Smoked 1 pack per day for 40 years, but stopped 6 months ago. Drinks 3 beers
daily and 4 or more beers on weekends
Family History: Father with diabetes, died accidentally. Mother died from breast cancer

Physical Exam: Patient is in no acute distress, looks sad

Vital Signs:
Blood Pressure: 135/85 mmHg
Temperature: 98.6oF (37oC)
Respiratory Rate: 13 breaths/minute
Heart Rate: 70 beats/minute, regular

Head, eyes, ear, nose, throat: No conjunctival pallor, mouth and pharynx are normal
Neck: Supple, no jugular venous distension, no lymph node swelling, thyroid normal
Chest: Clear to auscultation bilaterally
Heart: Regular rate and rhythm; normal S1, S2; no murmurs, rubs, or gallops
Abdomen: Soft, non-distended; mild tenderness over the epigastric region, no rebound
tenderness; negative Murphy’s sign (positive could suggest gallstone obstruction -> gallbladder
inflammation), normal bowel sounds; no enlargement of the liver or spleen
Extremities: No edema (swelling)

Imaging: CT Scan of the Abdomen reveals a mass in the tail of the pancreas
42. What condition best explains these findings? (3 points)

43. Which aspects of this case suggest a pancreatic condition? (15 points max)

44. How might this man’s presentation be different if the mass had affected the head of the
pancreas? (7 points)