A 65-year-old man presents with symptoms of intermittent claudication and is referred to the local vascular unit. Peripheral arterial disease is diagnosed and his blood pressure is measured at 130/80 mmHg with a fasting cholesterol level of 3.9 mmol/l. According to the latest NICE guidelines, what medication should be prescribed for this patient?
You are assessing a 67-year-old woman with longstanding varicose veins. A couple of weeks ago, she experienced pain and redness around one of them, which resolved after using ibuprofen gel for a few weeks. Upon examination, her legs appear normal except for the varicose veins, and she has normal distal pulses. Based on current NICE guidelines, what is the most suitable next step in management?
A 29-year-old female patient complains of intermittent episodes of white fingers that turn blue and then red, accompanied by pain. The symptoms are more severe during winter but persist throughout the year, and wearing gloves doesn’t alleviate them. Physical examination of her hands, skin, and other joints reveals no abnormalities. Which of the following treatments might be helpful?
You are evaluating a 75-year-old man with longstanding varicose veins. He presents to you with a small painful ulcer near one of them. The pain improves when he elevates his leg.
During the examination, you observe normal distal pulses and warm feet. The ulcer is well-defined and shallow, with a small amount of slough and granulation tissue at the base.
The patient has never smoked, has no significant past medical history, and recent blood tests, including an HbA1c, were normal.
You suspect a venous ulcer and plan to perform an ankle-brachial pressure index (ABPI) to initiate compression bandaging.
As per current NICE guidelines, what is the most appropriate next step in management?
Which one of the following statements regarding QFracture is correct?
A 75-year-old man with a history of diabetes, hypertension, hypercholesterolaemia and previous myocardial infarction presents to his GP with intermittent abdominal pain that he has been experiencing for two months. The pain is dull in nature and radiates to his lower back. During examination, a pulsatile expansile mass is detected in the central abdomen. The patient had undergone an abdominal ultrasound 6 months ago which showed an abdominal aortic diameter of 5.1 cm. The GP repeats the ultrasound and refers the patient to the vascular clinic. The vascular surgeon reviews the patient’s ultrasound report which shows no focal pancreatic, liver or gallbladder disease, trace free fluid, a 5.4 cm diameter abdominal aorta, no biliary duct dilation, and normal-sized and mildly echogenic kidneys.
What aspect of the patient’s medical history suggests that surgery may be necessary?
An asymptomatic 63-year-old man is found to have an irregular pulse during a routine check-up. A 12-lead ECG confirms atrial fibrillation. His blood pressure is 130/80 mmHg and his heart rate is 106bpm. He is not taking any regular medications and his blood and urine tests are normal. The physician prescribes bisoprolol to manage his condition.
What is the most appropriate next step in managing this patient’s atrial fibrillation?
A 67-year-old man presents with a recent diagnosis of angina pectoris. He is currently on aspirin, simvastatin, atenolol, and nifedipine, but is still experiencing frequent use of his GTN spray. What would be the most suitable course of action for further management?
A 52-year-old man is currently on lisinopril, nifedipine and chlorthalidone for his high blood pressure. During his clinic visit, his blood pressure is measured at 142/88 mmHg and you believe that he requires a higher level of treatment. The patient’s blood test results are as follows: Serum Sodium 135 mmol/L (137-144), Serum Potassium 3.6 mmol/L (3.5-4.9), Urea 8 mmol/L (2.5-7.5), and Creatinine 75 µmol/L (60-110). Based on the most recent NICE guidelines on hypertension (NG136), what would be your next course of action?
A 62-year-old male smoker comes to see you. His BMI is 35 and has a 60-pack/year smoking history. His uncle and father both died in their 50s of a myocardial infarction.
He is found to have a blood pressure of 146/92 mmHg in the clinic. He has no signs of end organ damage on examination and bloods, ACR, urine dip and ECG are normal. His 10-year cardiovascular risk is >10%. He has ambulatory monitoring which shows a blood pressure average of 138/86 mmHg.
As per the latest NICE guidance, what is the most appropriate action?