A 55-year-old woman who has previously had breast cancer visits her nearby GP clinic complaining of swelling in her left calf for the past two days. Which scoring system should be utilized to evaluate her likelihood of having a deep vein thrombosis (DVT)?
A 49-year-old accountant presents with severe central chest pain. An ECG shows ST elevation in leads II, III and aVF. The patient undergoes percutaneous coronary intervention and a right coronary artery occlusion is successfully stented. Post-procedure, there are no complications and echocardiography shows an ejection fraction of 50%. The patient inquires about the impact on his driving as he relies on his car for commuting to work. What guidance should you provide regarding his ability to drive?
A 65-year-old man with a history of type 2 diabetes, moderate aortic stenosis, and stage 3b chronic kidney disease presents for hypertension management. His blood pressure in the clinic is 150/90 mmHg, and he has been recording an average of 155/84 mmHg for the past month. He has previously refused antihypertensive medication due to concerns about dizziness and falls. What is the appropriate initial antihypertensive to consider in this case?
A 57-year-old man presents for follow-up. He was diagnosed with hypertension two years ago and is currently taking ramipril 10 mg od, amlodipine 10 mg od, indapamide 2.5mg od, and spironolactone 25 mg od. A trial of doxazosin was discontinued due to dizziness. Despite these medications, his blood pressure in clinic today is 160/100 mmHg, which is confirmed with a 24-hour blood pressure reading averaging 156/98 mmHg. What is the most appropriate course of action for management?
A 41-year-old man is worried about his risk of heart disease due to his family history. His father passed away at the age of 45 from a heart attack. During his medical check-up, his lipid profile is as follows:
HDL 1.4 mmol/l
LDL 5.7 mmol/l
Triglycerides 2.3 mmol/l
Total cholesterol 8.2 mmol/l
Upon clinical examination, the doctor notices tendon xanthomata around his ankles. What is the most probable diagnosis?
A 72 year old woman presents to your clinic complaining of ankle swelling that has persisted for the past 2 weeks. The swelling is present in both ankles and there is pitting edema up to the mid-shin. She recently had a modification in her medication 2 weeks ago. Which medication is the most probable cause of this symptom?
An 80-year-old woman is admitted to the hospital for symptomatic first-onset atrial fibrillation. She has a history of two falls in the past year and the doctors are preparing to discharge her home after rate control treatment. One of the doctors has been requested to assess her bleeding risk using an ORBIT score.
Considering the patient’s risk factors, what is the best course of action regarding her anticoagulation?
A 64-year-old man who underwent mechanical mitral valve replacement four years ago is being evaluated. What is the probable long-term antithrombotic treatment he is receiving?
An 80 year old woman presents to the clinic with a history of progressive dyspnea for the past four months. She reports experiencing left-sided chest pain and dizziness upon exertion, which subside with rest. During the physical examination, you detect an ejection systolic murmur that radiates to the carotids. What other clinical manifestation might you anticipate observing during the assessment?
A 65-year-old man visits your GP practice, who is typically healthy. He had come to see you a few weeks ago with a viral infection, during which you recorded his clinic blood pressure as 168/105 mmHg. You have since arranged for ambulatory blood pressure monitoring (ABPM), blood tests, urine dip, an ECG, and are now reviewing the results with him.
The ABPM average shows his blood pressure to be 157/100 mmHg. You have also conducted blood tests to check his plasma glucose, electrolytes, creatinine, estimated glomerular filtration rate, serum total cholesterol, and HDL cholesterol. His renal function and glucose levels are normal, and a urine dip for protein and ECG are also normal. Upon checking the back of his eyes, you find that the fundi are normal. His QRisk is calculated to be 28%.
You discuss potential treatment options with the patient. What should be included in your management plan?