A 40-year-old male smoker with a family history of hypertension has persistently high resting blood pressure.
Ambulatory testing revealed a level of 146/84 mmHg. He has no signs of end organ damage on standard testing.
According to the latest NICE guidance (NG136), what would be your most appropriate course of action?
A study investigated the effectiveness of a new statin therapy in preventing ischaemic heart disease in a diabetic population aged 60 and above. Over a five year period, 1000 patients were randomly assigned to receive the new therapy and 1000 were given a placebo. The results showed that there were 150 myocardial infarcts (MI) in the placebo group and 100 in the group treated with the new statin. What is the number needed to treat to prevent one MI in this population?
A 32-year-old man presents for an insurance medical. He has no significant medical history. During the examination, his BMI is 23 kg/m2, blood pressure is 110/70 mmHg, and auscultation of the heart reveals a mid-systolic click and a late systolic murmur (which are more pronounced when he stands up).
What is the most likely diagnosis based on these findings?
A 65-year-old man with a history of hypertension and dyslipidaemia visits the clinic. His wife is worried about his increasing forgetfulness. He frequently loses things around the house and struggles to find his way back home when he goes to the shops alone. What characteristic would strongly suggest vascular dementia?
A 78-year-old man has an average home blood pressure of 156/88 mmHg. He is in good health for his age and takes only finasteride for benign prostatic hyperplasia. As per the NICE guidelines, what is the recommended target clinic blood pressure for this individual?
A 65-year-old man undergoes an abdominal ultrasound as part of investigations for persistent mildly abnormal liver function tests. The liver appears normal but he is found to have an abdominal aortic aneurysm (AAA).
Select from the list the single correct statement regarding an unruptured abdominal aortic aneurysm.
A 68-year-old male presents with a sudden onset of loss of vision in his right eye which lasted approximately 30 minutes.
He was aware of a an initial blurring of his vision and then cloudiness with inability to see out of the eye.
He has been generally well except for a recent history of hypertension for which he takes atenolol. He drinks modest quantities of alcohol and is a smoker of five cigarettes per day.
Examination reveals that he has now normal vision in both eyes with visual acuities of 6/12 in both eyes. He has a pulse of 72 beats per minute regular, a blood pressure of 162/88 mmHg and a BMI of 30.
Examination of the cardiovascular system including auscultation over the neck is otherwise normal.
What investigation would you request for this patient?
A 50-year-old man with a history of hypertension and type II diabetes mellitus presents with intermittent chest pain which tends to occur when out walking. He describes the pain as radiating to his neck, jaw, and left arm. He feels dizzy and short of breath. The symptoms tend to last for around five minutes after he stops walking and then resolve.
What feature is most indicative of angina in a patient complaining of chest pain?
A 40-year-old man requests a check-up after the unexpected passing of his 45-year-old brother. He denies experiencing any specific symptoms. His blood pressure is 132/88 and heart rate 90 and regular. His cardiovascular system examination is unremarkable. An ECG reveals left bundle branch block and a chest X-ray shows cardiomegaly.
What is the most probable reason for these abnormalities?
A 58-year-old man has persistent atrial fibrillation.
Which of the following is the single risk factor that places him most at risk of stroke?