Atlas Formative Quiz

Front 1

Venous blood from the cecum and transverse colon drains most directly into which of the following vessels?

Back 1

A. Caudal vena cava
B. Hepatic portal veins
C. Internal pudendal veins
D. Renal veins
E. Umbilical vein

Hint 1

Hepatic portal veins

Front 2

What structure passes through the thoracic diaphragm to the right of the dog's median plane?

Back 2

A. Esophagus
B. Vagal trunks, dorsal and ventral
C. Aorta
D. Caudal vena cava
E. Hepatic portal vein

Hint 2

Caudal vena cava

Front 3

Order the following list of structures as a passing bolus of food would encounter them:

Back 3

1=Ascending duodenum
2=Cardia
3=Caudal flexure of duodenum
4=Descending duodenum
5=Fundus
6=Pharynx
7=Pylorus

Hint 3

6-2-5-7-4-3-1

Front 4

Puppies typically can stand and begin walking at what age?

Back 4

A. 1 week
B. 3 weeks
C. 5 weeks
D. 7 weeks

Hint 4

3 weeks

Front 5

Comparative studies of wolves and poodles by Erik Zimen indicate that:

Back 5

A. Wolves and poodles shared few if any behavior patterns
B. Wolves and poodles shared all the same behavior patterns
C. Wolves and poodles shared more similar (identical or modified) behavior
patterns than non-similar behavior patterns
D. Wolves and poodles shared fewer similar behavior patterns that non-similar.

Hint 5

Wolves & poodles shared more similar behavior patterns than non-similar ones

Front 6

A functional subunit of the liver (hexagonal hepatic lobule) includes the following except:

Back 6

A. Central vein/terminal hepatic venule
B. Hepatic cords
C. (peri)portal areas with biliary ducts
D. Branches of the hepatic artery and portal vein
E. Gall bladder

Hint 6

Gall bladder

Front 7

Neurotoxic factors associated with hepatic insufficiency &/or PSS include the following EXCEPT:

Back 7

A. Urea
B. Glutamine,
C. GABA, short-chain fatty acids
D. Phenylalanine
E. Tyrosine

Hint 7

Urea

Front 8

Atlas would like to know why his liver was described as small in his surgical rpt. Choose the best explanation statement below:

Back 8

A. Normally, the portal vein transports about 80% of total hepatic blood flow
and only about 20% of the hepatic blood supply is via the hepatic arteries.
B. Approximately 80% of portal blood is from the intestines and stomach, 20%
from the spleen and pancreas.
C. Hepatotrophic substances (insulin, glucagons) from the pancreas and
intestines do not reach the liver in patients with a portosystemic shunt.
D. All of the above.

Hint 8

Hepatotrophic substances (insulin, glucagons) from the pancreas and intestines do not reach the liver in patients with a PSS

Front 9

Why do ammonium biurate crystals sometimes form in the urine of patients with PSS?

Back 9

A. Hepatic conversion of ammonia to urea is decreased
B. Hyperammonemia leads to excessive urinary excretion of ammonia
C. Abnormal nitrogen metabolism results in hyperuricemia and increased
urinary excretion of uric acid
D. All of the above.

Hint 9

All of the above

Front 10

Extrahepatic portal venous anomalies occur due to:

Back 10

A. Failure of the fetal ductus venosus to close prior to parturition
B. Failure of the fetal ductus venosus to close within 2-3 days after parturition
C. An anomalous vessel connecting the fetal cardinal and vitelline venous
systems
D. Sustained portal hypertension

Hint 10

An anomalous vessel connecting the fetal cardinal and vitelline venous systems

Front 11

All of the conditions listed below are potential causes of increased serum alkaline phosphatase (ALP) activity.
Based on all case information you received about Atlas (puppy with portosystemic shunt), which one of the
disorders most likely contributed to increased ALP activity in this puppy?

Back 11

A. Normal bone growth
B. Extrahepatic biliary obstruction
C. Corticosteroid administration
D. Intestinal disease

Hint 11

Normal bone growth

Front 12

Of the following lab tests, which one is the best indicator of hepatic function?

Back 12

A. Serum alanine aminotransferase (ALT) activity
B. Urine bilirubin concentration
C. Urine ammonia concentration
D. Serum albumin concentration

Hint 12

Serum albumin concentration

Front 13

Histological findings associated w/the congenital PSS include the following except:

Back 13

A. Lobular or hepatocellular atrophy,
B. Numerous small arterioles in the (peri)portal areas,
C. Small or absent portal veins
D. Distended portal veins

Hint 13

Distended portal veins

Front 14

Why does blood flow through the extrahepatic shunt vessel rather than its normal route?

Back 14

A. Normal portal venous pressure is 8 to 13 cm H2O and normal vena caval
pressure is 0-6 cm H2O. In patients with a shunt, the portal venous pressure
is lower than normal so the gradient favors bypassing the portal circulation.
B. Portal venous pressure is higher in patients with an extrahepatic
portosystemic shunt.
C. Portal hypertension leads to shunting of blood flow through the single,
congenital extrahepatic shunt vessel.
D. B & C

Hint 14

Normal portal venous pressure is 8-13cm H2O & normal vena cava pressure is 0-6cm H2O. In patients w/ a shunt, the portal venous pressure is lower than normal so the gradient favors bypassing the portal circulation

Front 15

Which choice is LEAST likely to result in hyperammonemia and elevated bile acids?

Back 15

A. Portocaval shunt
B. Microhepatia
C. Renal failure
D. Cholestasis

Hint 15

Renal failure

Front 16

If PCO2, as primary disturbance, is above normal and HCO3- is above normal what is the primary disorder A?

Back 16

A. Respiratory Acidosis
B. Respiratory Alkalosis
C. Metabolic Acidosis
D. Metabolic Alkalosis

Hint 16

Respiratory acidosis

Front 17

From the following values, calculate anion gap (all units in meq/L)
Na+ = 154, K+ = 5, Cl- = 112, HCO3- = 15

Back 17

A. 17
B. 22
C. 32
D. 57

Hint 17

32

Front 18

Core lipids of emulsion droplets can contain all of the following EXCEPT:

Back 18

A. Triglycerides
B. Diglycerides
C. Cholesteryl esters
D. Bile salts

Hint 18

Bile salts

Front 19

Free fatty acids are liberated from mixed micelles near the enterocyte brush border via

Back 19

A. Protonation
B. Bacterial degradation
C. Conjugation
D. Lipase

Hint 19

Protonation

Front 20

The general mechanism by which bicarbonate enters hepatocytes is via cotransportation with:

Back 20

A. Sodium
B. Chloride
C. Hydrogen
D. Potassium

Hint 20

Sodium

Front 21

The substrate for bile acid synthesis is:

Back 21

A. Triglycerides
B. Cholesterol
C. Free fatty acids
D. Glycerol

Hint 21

Cholesterol

Front 22

Hepatocytes secrete bile acids into bile canaliculus in the following forms except

Back 22

A. Glucuronidated
B. Sulfated
C. Charged
D. Taurinated

Hint 22

Charged

Front 23

Which of the following is an acinar-produced active enzyme?

Back 23

A. Amylase
B. Trypsinogen
C. Proelactase
D. Lithostathine

Hint 23

Amylase

Front 24

Which hormone from the stomach stimulates the cephalic phase of the pancreas?

Back 24

A. Gastrin
B. Secretin
C. Somatostatin
D. Histamine

Hint 24

Gastrin

Front 25

Which of the following is FALSE with regard to the enzyme Alkaline Phosphatase?

Back 25

A. There are several isoenzymes of AP in the dog, including liver, bone,
placental, corticosteroid and intestinal.
B. Liver, bone, and corticosteroid isoenzymes are the most common sources of
AP increases in the dog due to their relatively long half-lives.
C. AP is anchored in cell membranes.
D. Cholestasis increases AP levels in plasma.
E. Elevated AP is an indicator of liver dysfunction/insufficiency.

Hint 25

Elevated AP is an indicator of liver dysfunction/insufficiency.

Front 26

Which of the following accurately describes one mechanism of vomiting in a canine patient with hepatic
encephalopathy?

Back 26

A. Humoral stimulation of the emetic center
B. Vagosympathetic neural stimulation of the chemoreceptor trigger zone
C. Humoral stimulation of the chemoreceptor trigger zone
D. Cerebrocortical neural stimulation of the emetic center
E. Vestibular neural stimulation of the emetic center

Hint 26

C. Humoral stimulation of the chemoreceptor trigger zone