ILA

Question 1

What are the components of a normal artery wall?

Answer 1

Tunica Intima
Tunica Media
Tunica Adventitia

Question 2

Where are the elastic arteries found?

Answer 2

Near the Heart

More elastin in media to withstand increased pressures and to elastic recoil

Question 3

Where are the muscular arteries found?

Answer 3

Further from the heart

More muscle in media to vasodilate and vasoconstrict

Question 4

Where is the site of greatest TPR?

Answer 4

Arterioles

Question 5

Where is the site of greatest TPR?

Answer 5

Arterioles

Have < 3 smooth muscle layers in media

Question 6

What are the basic stages of atherogenesis?

Answer 6

1. Endothelial Injury (often at bifurcations)
2. Fatty streak: (around 10 years old)
   - Foam cells form in intima
3. Inflammatory Rxn: Foam cells recruit other inflammatory cells such as neutrophils, macrophages, lymphocytes and fibroblasts/platelets
4. Fibroblasts produce smooth muscle fibrous cap which covers internal lumen side
5. plaque rupture to form platelet plug and occlude artery

Question 7

What is the Primary, Secondary and tertiary prevention of atherogenesis?

Answer 7

1’ RF modification

2’ Manage Sx: Statins, Aspirin, ACEi, BB,

3’ PCI stenting or CABG

Question 8

What are the stages of Anaphylaxis?

Answer 8

1: Sensitisation as IgE forms vs antigen and binds to Fc on mast cells

2: Secondary Exposure: Fab of IgE binds to allergen and results in Mast cell degranulation releasing Histamines, Leukotrienes and Tryptases

3. Systemic Effects:
   Bronchodilation - SMS muscle spasm
   Vasodilation - Histamine increase permeability
   CVR Sx - hypotension, tachycardia, shock

Question 9

What is the Treatment for anaphylactic shock?

Answer 9

ABCDE assessment

IM Adrenaline (500mg) - If ineffective then give second IM 500mg Adrenaline Dose

Then
Chlorphenamine - Anti-histamine (H1)
Hydrocortisone - Steroid

Question 10

Why is a Second dose of Adrenaline given if the first dose is ineffective?

Answer 10

Adrenaline has a very short 1/2 life and therefore if it has not worked first time round this may be due to the concentration of adrenaline dropping too quickly to have a good effect

Question 11

What is the blood test to confirm anaphylaxis?

Answer 11

SERUM MAST CELL TRYPTASE:
Most specific reading for most cell degranulation

Question 12

Define Prevalence?

Answer 12

Number of cases at a given point in time

Question 13

Define Incidence?

Answer 13

Number of new cases in a given time frame

Question 14

What properties of a drug will help induce anaesthesia quickly?

Answer 14

Low protein binding
Means more is free in circulation

Lipid soluble - can cross BBB easily

Question 15

How is General anaesthesia administered?

Answer 15

IV anaesthesia given first to sedate patient

Volatile anaesthesia given to keep the patient Unconscious

Question 16

Define Bioavailability?

Answer 16

Amount of drug reaching circulation unaltered

Question 17

What are the clinical signs of a arterial thrombus?

Answer 17

Reduced/absent pulse
Thin cool skin
Intermittent claudication

Question 18

What are the clinical signs of a Venous thrombus?

Answer 18

Increased pulse
Rubor and Tumour
Painful and erythematous

Question 19

What are the 6Ps of Acute Critical Limb Ischaemia?

Answer 19

Pain
Pallor
Pulselessness
Perishingly Cold
Paraesthesia
Paralysis

Question 20

What is the treatment of DVT?

Answer 20

1st Line:
DOACs (apixaban/Rivaroxaban) + LMWH

2nd Line:
Warfarin

Question 21

What do DOACs act on?

Answer 21

Directly act on Factor Xa and Factor II (thrombin) inhibiting the intrinsic pathway mainly

Question 22

What does LMWH act on?

Answer 22

Acts on Antithrombin to activate it which then reduces thrombin function

Question 23

What does Warfarin Act on?

Answer 23

Affects extrinsic Clotting pathway as it reduces the synthesis of Vitamin K dependent clotting factors (2, 7, 9, 10)

Warfarin is a Vitamin K antagonist

Question 24

What cause of AKI is least common?

Answer 24

Post-renal causes

Question 25

Give causes of pre renal AKI?

Answer 25

Reduced Renal Perfusion:
Reduced CO - HF
Renal artery stenosis
NSAIDs
Shock - Hypovolaemic
Dehydration

Question 26

Give Causes of Renal AKI?

Answer 26

Intrinsic Renal Damage:
Glomerulonephritis
Interstitial Nephritis
Nephrotoxic Drugs
Vasculitis
Tubular Acidosis (MC)

Question 27

Give Causes of Post-Renal AKI?

Answer 27

BPH
Nephrolithiasis
Malignancy

Question 28

What is the analgesic of choice in Renal Colic?

Answer 28

Diclofenac (NSAID)
But CI in AKI or CKD

Question 29

How do NSAIDs cause AKI?

Answer 29

Reduce renal perfusion and Reduce GFR (Pre-renal AKI)

Cause glomerulonephritis and interstitial nephritis (intra renal AKI)

Question 30

What is the most concerning thing in AKI?

Answer 30

Hyperkalaemia
Do an ECG to see changes

Question 31

What is seen on an ECG in hyperkalaemia?

Answer 31

Go, Go Tall, Go Long, Go Wide

Absent P wave
Tall tented T waves
Long PR interval
Wide QRS

Question 32

What is the treatment for Hyperkalaemia if there are cardiac (ECG) changes?

Answer 32

IV Calcium Gluconate STAT
To stabilise cardiac membrane

Then Insulin + Dextrose

Question 33

What is the treatment for Hyperkalaemia if there are No cardiac (ECG) changes?

Answer 33

Insulin + Dextrose

Insulin - Drives K+ into cells via Na/K/ATPase pump

Dextrose to prevent Hypoglycaemia

Question 34

What are signs of raised ICP?

Answer 34

N+V
Seizures
Loss of Consciousness

Cushing Triad (Bradycardia, Hypertension, Irregular Breathing)

Question 35

What is the Treatment for raised ICP?

Answer 35

IV Mannitol

Surgical - Burr Holes/Craniotomy