practice questions Flashcards
1
Q
what is Zollinger-Elison syndrome
A
Zollinger-Ellison Syndrome is a Gastrin Secreting Tumour caused by non beta cells in the islets of langerhans
this leads to increased HCL and villous hyperplasia
2
Q
what is the threshold potential for GI smooth muscle
A
-40mV
resting is -50 -60mV
3
Q
where is the tail of the pancreas
A
in the lienorenal ligament, intraperitoneal
4
Q
what is the lower oesophageal sphincter controlled by
A
VIP nerves
this is the basis for alchalasia
5
Q
what does the cranial limb of the intestinal loop become
A
the jejenum and ileum
6
Q
what are the lengths of the parts of the colon
A
Ascending 13cm
Transverse 38cm
Descending 25cm
Sigmoid 25-38cm
7
Q
what drug is used to treat nematodes such as hook worm by may cause liver failure
A
albendazole
8
Q
what is barretts oesophagus
A
long standing reflux leading to risk of adenocarcinoma of the oesophagus
9
Q
what disorder is characterised by high serum amylase
A
acute pancreatitis
10
Q
what drug can be used to treat peptic ulcers but may have the side effect of galactorrhoea and gynaecomastia
A
cimetidine
H2 receptor antagonist
antagonises testosterone
11
Q
what GI tumour would look like a sheet of similar cells that have scant pink and granular cytoplasm
A
carcinoid
12
Q
name two steroid drugs effective against chemo induced emesis and nausea
A
methylprednisolone and dexamethazone
13
Q
what can hep C cause
A
acute liver inflammation
14
Q
what can schistomiasis cause
A
chronic liver inflammation
15
Q
what causes inhibition of gastric emptying
A
ph less than 3.5
hypertonic solution
fatty acid with long chain
tryptophan
16
Q
where is secretin synthesised
A
S cells in duodenal mucosa
17
Q
what is the intestinointestinal inhibitory reflex
A
inhibition of contractions in the adjacent regions of the small intestine
18
Q
what does hypotonic mean
A
water from the solution will tend to osmose into the cell
19
Q
describe the features of colonic carcinoid tumour
A
large intramural masses with polypoid excavations.
20
Q
describe a colonic adenoma
A
napkin ring encircling and exophytic growths
21
Q
describe a villous adenoma
A
1-3 cm velvety masses
22
Q
describe leimyosarcomas
A
large bulky intra mural masses that may ulcerate
23
Q
what hormones mediate the efferent limb of the gastrocolic reflex
A
cholecystokinin and acetylcholine
24
Q
what NSAID is best for a patient with GI problems
A
paracetamol
25
what vertebral level is the subcostal plane
L3
26
what structures does the sigmoid mesocolon cross in the left iliac fossa
bifurcation of the left common iliac artery
| left ureter
27
where does the base of the mesentery begin
left of the L2 vertebra
28
what is the purpose of a paramedian incision
avoids cutting the linea alba
29
which artery enters the rectus sheath between the sternal and costal attachments of the diaphragm
superior epigastric
30
what is a feature of the rome 3 criteria of IBS
reccurent abdo pain within the last 3 months
31
what drugs absorption is slowed by food in the stomach
paracetamol
32
what factors can affect oral drug absorption
GI motility
particle size
splanchnic blood flow
33
what microbiota are commonly found in the duodenum
lactobacili
34
what hormone inhibits glucagon
somatostatin
35
what cells secrete secretin
S cells
36
what is the only essential secretion of the stomach
intrinsic factor -vitamin b12
37
what is the function of somatostatin
inhibits glucagon and insulin secretion
| inhibits gastric acid production
38
what causes secretion of secretin
drop in pH
39
what cells produce somatostatin
delta cells in pylorus, duodenum and pancreas
40
what embryonic tissue gives rise to the liver
endoderm
41
what percentage of colon cancers does hereditary nonpolyposis coli account for
1-5%
42
how many life years are lost by a woman with a BMI of 30 as oppose to 25
7 years
43
which antiemetic causes sedation
haloperidol
44
what are the histological features of ulcerative colitis
crypt abscesses
crypt atrophy
inflammatory infiltration of lamina propria
45
what are the features of duodenal ulcer
even distrubution amongst social classes
| high or normal acid levels
46
which antihelminthic acts by increasing permeability of the nematode to calcium ions
praziquantel
47
what is a risk factor for adenocarcinoma of the oesophagus
smoking
48
what neoplasm accounts for 98% of colorectal cancers
adenocarcinoma
49
what IBD is more common among non smokers
ulcerative colitis
50
what proportion of bile salts are reabsorbed
95%
| all in the small intestine
51
what can cause gastroenteritis
salmonella
52
what is active helminth transmission
lavae penetrate the skin
53
what is intermediate transmission
ingestion of the parasite
54
what do parietal cells secrete
acid and intrinsic factor
55
omeprazole
PPI
56
Ranitidine
histamine receptor antagonist
57
pepto bismol
antacid and anti inflammatory
58
skip lesions
crohns disease- patchy mucosal inflammation
59
what part of the intestine is most commonly infected in crohns
terminal ileum and ascending colon
60
what layers does UC affect
superficial layer
| crohns disease can affect all layers
61
in what disease is crypt hypertrophy and villous atrophy seen
coeliac disease
62
what bacteria is associated with food esp rice
B. cereus
63
what bacteria cause rice water stools with severe dehydration and often caused by shellfish consumption
V. cholerae or V.volnificus
64
what bacteria causes haemolytic uraemic syndromw
enterohaemorrhagic e. coli
65
what is the most common cause of viral enteritis in infants
rotavirus
66
what is the most common cause of viral enteritis in adults
norovirus
67
where is the pain of diverticulitis usually felt
LIF
68
what enzyme is released in bile duct disease
ALP
69
what enzymes are released by damaged hepatocytes
aspartamate and alanine aminotransferase
70
what is normal body temperature
36.5 - 37.2
71
what bacteria might cause bloody stools and severe septic shock and haemolytic uraemic syndrome
e. coli
72
what bacteria is associated with antibiotic therapy
c. diff
73
what is the surface marker for the femoral pulse
along the inguinal ligament, midway
74
what is the function of secretin
increases volume and alkalinity of pancreatic juice
75
what is the function of substance P
increases peristalsis
76
what are the immune functions of the liver
protein synthesis
kupffer cells which phagocytose bacteria
pro inflammatory cytokines
77
what percentage of secretions are formed in the cephalic phase
30%
78
what do cheif cells produce
pepsinogen
79
what receptors does the vomiting centre contain
muscarinic and Histamine1
80
what receptors does the CTZ contain
dopamine 2 receptors
81
what are antimuscarinics used for
vestibular apparatus stimulated vomiting but not CTZ induced
82
what is swan neck deformity of the oesophagus a sign of
alchalasia
| may show dilation of the oesophagus
83
what type of mesoderm do the kidneys develop from
intermediate mesoderm
84
what do the glomruli develop from
the mesonepros
85
what do the gonads develop from
intermediate mesoderm
86
what do the adrenal glands develop from
intermediate mesonephros
87
when does organogenesis happen
6 weeks
88
what are the features of extrahepatic jaundice
```
pale stools due to bile not entering the intestine
conjugated bilirubin (water soluble) - dark urine
pruritis due to increased bile salts
raised ALP
```
89
what is pre hepatic jaundice
increased haemolysis
90
how long does it take food to reach the stomach
9 seconds
91
what hormone stimulates ECL cells and gastric acid secretion
gastrin
92
what is the function of the posterior fibres of temporalis
retraction of the mandible
93
what is the function of medial pterygoid
elevation and protrusion
94
what is the function of lateral pterygoid
depression and protrusion
95
what does coeliac disease predispose to
small bowel lymphoma
96
where in the stomach is mucin secreted
pylorus and cardia
97
what nerves are carried to the hindgut along the IMA
least splanchnic nerve and parasympathetic from S2-4
98
what is an omphacele
herniation of the stomach through the umbilicus. covered by peritoneum
99
what does the ventral mesentery form
lesser omentum and falciform ligament
100
what structures form the stomach bed
central tendon of diaphragm
left colic flexure
spleen
101
what may result from a patent tunica vaginalis
cytocele
hydrocele
indirect hernia
102
how much rotation of the intestine happens around the SMA
270 degrees anticlockwise
103
which of the forces in the nephron is the weakest
oncotic pressure of the tubule
104
what is tubuloglomerular feedback
increased flow rate of sodium past the macula densa sends a message to afferent arterioles when BP increases
105
what ion is found a lot in saliva
potassium
106
what factors decrease the rate of action potentials in slow waves
sympathetic
gastrin
gip
secretin
107
where is the second part of the duodenum
anterior to the hilum of the right kidney, right side of L2,3 vertebrae
108
what is an indicator of acute pancreatitis
low serum calcium
109
what are the features of pancreas secretion
amylase, lipase and protease
(cholecystokinin reduces secretion)
high bicarbonate content
isotonic
110
what is the blood supply to the lower pharynx
inferior thyroid
111
what percentage of gastric secretions is the gastric phase responsible for
60%
112
loose foul smelling fatty stools
giardiasis
113
what paracrines are secreted from the stomach
somatostatin
| histamine
114
what is the only endocrine secretion of the stomach
gastrin
115
what are the exocrine secretions of the stomach
HCl
intrinsic fx
pepsinogen
ions
116
what are the borders of the epiploic foramen
porta hepatis- ant
IVC- post
duodenum-inf
caudate lobe-sup
117
what are vitamins
essential to life but cannot be made by the body
118
what is enterokinase
converts trypsinogen to trypsin
119
what is the ph of pancreatic juice
8
120
what is the nerve supply of the small intestine
lesser splanchnic nerve t10 and 11 and vagus nerve via the superior mesenteric plexus
referred pain is peri umbilical
121
where are the peyers patches
ileum
122
where does small intestinal wall lymph drain to
mesenteric nodes on the SMA and then the cysterna chyli
123
what is meckel's diverticulum
a patent remnant of the vitello intestinal duct
2 inches long, 2 feet from the end of the ileum in 2% of people
it may ulcerate - feels like apendicitis
faecal discharge at the umbilicus
124
how big is the caecum
7.5 cm. covered by peritoneum but not on a mesentery. RIF
125
which part of the appendix contains lymphoid tissue
submucosa
126
what are the possible locations of the appendix
pelvic; subcaecal; retrocaecal; retro-ileal; pre-ileal
| use the taenia coli to locate
127
what is the blood and nerve supply of the appendix
ileocolic branch of the superior mesenteric, from the aorta at L1 with nerves derived from T10/11,
128
what is the blood supply of the caecum
iliocolic, anterior and posterior caecal plus appendicular artery from posterior caecal
129
where does the sigmoid start and end
pelvic brim and s3
130
what are the ascending and descending colons related to
kidneys
131
what do the branches of the IMA cross
ureter and gonadal vessels
132
what is the nerve supply of the hindgut
least splanchnic nerves s2,3,4 -para
T12- sympathetic
referred pain is to t12 -supra pubic region
133
where is the rectum
S3
134
is alpha 1 antitrypsin dominant or recessive
recessive
135
what does scarpa's fascia go on to form
fascia lata
| and buck's and colle's in the penis and scrotum
136
what aponeurosis forms the inguinal ligament
external oblique
137
what is the most common cause of kidney stone
calcium oxalate
138
what is the most common cause of chronic renal failure
DM
139
what are the possible causes of kidney stones
uric acid
magnesium ammonium phosphate
cystine
140
what factors contribute to renal stones
poor urine output
infection
low pH
low concentration of factors that inhibit stones such as citrate
141
name some causes of metabolic acidosis
```
increased renal bicarbonate loss
hypokalaemia
increased fixed H+ production
increased intake of dietary acid
decreased renal H+ secretion
```
142
furosemide
loop diuretic
143
what proportion of an adult is water
60%
increased adiposity mean decreased water proportion
144
what proportion of water is intracellular
40%
145
what proportion of body water is extracellular
20%
146
what proportion of water is plasma
5%
147
what proportion of body water is interstitial fluid
15%
148
increases the tubular reabsorption of sodium
aldosterone
149
what hormone increases renal blood flow
dopamine
150
is tubular fluid in the distal tubule hypotonic or hypertonic
hypotonic
151
henderson hasselback equation
ph = pk + log10 base/ acid
152
what bacteria can reduce nitrates to nitrites
Most gram negs
153
S cells in duodenal mucosa
stimulates bicarbonate and fluid secretion by the pancreas
secretin
presence of hydrocholoric acid in the small intesting
154
D cells
somatostatin
155
itching, rectal pain and rectal bleeding
haemorrhoids
156
left iliac fossa pain, mass, nausea, bleeding
diverticulitis
