Gastrointestinal: pancreatic exocrine reserve and steatorrhoea: practice question

A Physiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Physiology · Gastrointestinal: pancreatic exocrine reserve and steatorrhoea

Sample item

A 52-year-old man with chronic alcoholic pancreatitis loses pancreatic exocrine function gradually. Which digestive abnormality appears first and is most prominent?

AStarch malabsorption, as pancreatic amylase is the only enzyme digesting starchBWater malabsorption from the small bowelCFat malabsorption, as pancreatic lipase is the main source of lipolysisDProtein malabsorption, as pepsin is the only protease

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Fat malabsorption, as pancreatic lipase is the main source of lipolysis

Pancreatic lipase is the main enzyme digesting triglycerides, and its output falls earlier and more completely than other enzymes; steatorrhoea appears when lipase secretion falls to a small fraction of normal. Starch digestion is partly covered by salivary amylase and brush-border enzymes, and protein digestion by gastric pepsin and brush-border peptidases.

Option by option

A. Starch malabsorption, as pancreatic amylase is the only enzyme digesting starch
Salivary amylase and brush-border enzymes partly cover starch digestion, so it is not the first to fail.
B. Water malabsorption from the small bowel
Water absorption is not impaired by loss of pancreatic enzymes.
C. Fat malabsorption, as pancreatic lipase is the main source of lipolysis (correct)
Correct. Lipase has few substitutes, so fat malabsorption appears first.
D. Protein malabsorption, as pepsin is the only protease
Pepsin and brush-border peptidases partly cover protein digestion, and pepsin is not the only protease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Physiology question

What is the answer to this Physiology question?

The best answer is C, Fat malabsorption, as pancreatic lipase is the main source of lipolysis. Pancreatic lipase is the main enzyme digesting triglycerides, and its output falls earlier and more completely than other enzymes; steatorrhoea appears when lipase secretion falls to a small fraction of normal.

Why is "Starch malabsorption, as pancreatic amylase is the only enzyme digest…" not the answer?

Salivary amylase and brush-border enzymes partly cover starch digestion, so it is not the first to fail.

Why is "Water malabsorption from the small bowel" not the answer?

Water absorption is not impaired by loss of pancreatic enzymes.

Why is "Protein malabsorption, as pepsin is the only protease" not the answer?

Pepsin and brush-border peptidases partly cover protein digestion, and pepsin is not the only protease.

What concept does this question test?

It tests Gastrointestinal: pancreatic exocrine reserve and steatorrhoea in Physiology. Starch digestion is partly covered by salivary amylase and brush-border enzymes, and protein digestion by gastric pepsin and brush-border peptidases.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal: pancreatic exocrine reserve and steatorrhoea?

For each system, sketch the key graph (pressure–volume loop, oxygen dissociation curve, nephron handling) and explain it aloud. Then use the flashcards and the other Physiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.