Miscellaneous

Question 1

Situations in which lipids should be measured

Answer 1

MI, CVA, other vascular disease, acute pancreatitis, family history, clinical signs

Question 2

Clinical signs involving lipids

Answer 2

Xanthomata (deposits around eye), xanthelasma (deposits under skin usually on hands), corneal arcus (ring around eye), milky blood/serum

Question 3

Considerations for comparison of drugs within/between class

Answer 3

Efficacy, safety, cost, interactions, evidence

Question 4

Drug interactions with statins

Answer 4

Ketoconazole, erythromycin, diltiazem, mibefradil, itraconazole, grapefruit

Question 5

How does hypertriglyceridaemia cause acute pancreatitis?

Answer 5

• Chylomicrons are large and may obstruct capillaries leading to local ischaemia and acidaemia
• Local damage can expose triglycerides to pancreatic lipases
• Degradation of triglycerides or free fatty acids can lead to cytotoxic injury

Question 6

Varicose veins

Answer 6

Dilated, tortuous superficial veins due to the abnormal transmission of deep vein pressure

Question 7

Conditions that can increase the deep veins pressure

Answer 7

Deep vein obstruction, deep valve incompetence

Question 8

Risk factors for varicose veins

Answer 8

Age, pregnancy, obesity

Question 9

Signs of varicose veins

Answer 9

Dilated and tortuous superficial veins, more prominent when standing and more common arising in the groin or behind the knee

Question 10

Complications of varicose veins

Answer 10

Bleeding and bruising, superficial thrombophlebitis, ulceration, lipodermosclerosis

Question 11

Superficial thrombophlebitis

Answer 11

Inflammation of a vein caused by a blood clot

Question 12

Investigations for chronic venous diseases

Answer 12

Duplex scan

Question 13

2 main issued a duplex scan focuses on

Answer 13

State of the deep veins, saphenofemoral or saphenopopliteal incompetence

Question 14

Non-interventional management for chronic venous diseases

Answer 14

4 layer bandaging for ulcers, stockings for ulcer prevention and symptomatic relief (except in low ABPI_

Question 15

Interventional management for chronic venous diseases

Answer 15

Foam scleropathy, endovenous ablation (mechanical, laser or radiofrequency)

Question 16

Surgical management for chronic venous diseases

Answer 16

High tie, distal foam ablation

Question 17

Complications of interventional management for chronic venous diseases

Answer 17

Thrombophlebitis, skin staining, local ulceration, wound infection, nerve damage, recurrence of the veins

Question 18

What regulates regional blood flow to capillary bed in most tissues?

Answer 18

Terminal arterioles

Question 19

How do small, water-soluble molecules cross the capillary wall?

Answer 19

Through pores

Question 20

How do lipid-soluble substances cross the capillary wall?

Answer 20

Through endothelial cells

Question 21

What is transcapillary fluid flow driven by?

Answer 21

Passively driven by pressure gradients

Question 22

Forces involved in transcapillary fluid flow:

• Forces favouring filtration
• Forces opposing filtration

Answer 22

Favouring = capillary hydrostatic pressure and interstitial fluid osmotic pressure
Opposing = capillary osmotic pressure and interstitial fluid hydrostatic pressure

Question 23

Where do Starling forces favour filtration and reabsorption

Answer 23

Filtration = arteriolar end of capillary
Reabsorption = venular end of capillary

Question 24

Oedema

Answer 24

Accumulation of fluid in the interstitial space

Question 25

Causes of oedema

Answer 25

Raised capillary pressure, reduced plasma osmotic pressure, lymphatic insufficiency, changes in capillary permability

Question 26

What can result in raised capillary pressure?

Answer 26

Arteriolar dilatation, raised venous pressure

Question 27

Oedema related to left ventricular failure

Answer 27

Pulmonary oedema

Question 28

Oedema related to right ventricular failure

Answer 28

Peripheral oedema

Question 29

Causes of oedema through reduced plasma osmotic pressure

Answer 29

Malnutrition, protein malabsorption, excessive renal excretion protein, hepatic failure

Question 30

CXR findings of pulmonary oedema

Answer 30

Haziness in perihilar region