A 75-year-old man with a history of type II diabetes mellitus presents with worsening dyspnea. His ECG reveals normal sinus rhythm and an echocardiogram confirms the diagnosis of congestive heart failure with reduced left ventricular ejection fraction. Which of the following medications is most likely to decrease mortality in this patient? Choose ONE answer only.
A 72-year-old man presents to the General Practitioner with complaints of leg pain while walking. Upon examination, his feet appear cool and dusky, with the right foot being more affected than the left. An ankle brachial pressure index is measured at 0.8 on the right and 0.9 on the left. Both femoral pulses are present, but posterior tibial and dorsalis pedis pulses are absent in both legs. His blood pressure is 140/85 mmHg.
Which of the following medications is LEAST likely to provide relief for his symptoms?
A 32-year-old man presents to the General Practitioner for a consultation. He has been diagnosed with Raynaud’s phenomenon and is struggling to manage the symptoms during the colder months. He asks if there are any medications that could help alleviate his condition.
Which of the following drugs has the strongest evidence to support its effectiveness in improving this patient’s symptoms?
A 59-year-old man visits his General Practitioner to discuss his medication for hypertension. He is currently taking ramipril 10 mg daily, amlodipine 10 mg daily, and immediate-release indapamide 1.5 mg daily. Despite tolerating this treatment without any side-effects, his clinic blood pressure remains high at an average of 155/100 mmHg. The patient has no adverse lifestyle factors and a family history of hypertension and stroke. Secondary causes for hypertension have been ruled out, and routine blood tests including renal function, electrolytes, lipids, and glucose are all normal. His serum potassium level is 4.7 mmol/l (normal range 3.5-5.5 mmol/l). What is the most appropriate modification to this patient’s treatment?
A 72-year-old man visits his General Practitioner for a medication review for his chronic congestive heart failure. His recent echocardiogram indicates an ejection fraction of 35%. He reports experiencing more shortness of breath, especially when lying down, gaining 2 kg in weight over the past few weeks, and having ankle swelling. What is the appropriate medication class to prescribe for quick relief of symptoms?
A previously healthy 70-year-old woman attends with her daughter, who noted that her mother has had a poor appetite, lost at least 4.5 kg and has lacked energy three months. The patient has not had cough or fever, but she tires easily.
On examination she is rather subdued, is apyrexial and has a pulse of 100 per minute irregular and blood pressure is 156/88 mmHg. Examination of the fundi reveals grade II hypertensive changes. Her JVP is elevated by 8 cm but the neck is otherwise normal.
Examination of the heart and lungs reveals crackles at both lung bases. The abdomen is normal. She has generalised weakness that is most marked in the hip flexors but otherwise neurologic examination is normal.
Investigations reveal:
Haemoglobin 110 g/L (115-165)
White cell count 7.3 ×109/L (4-11)
Urea 8.8 mmol/L (2.5-7.5)
Which of the following would be most useful in establishing the diagnosis?
An 80-year-old gentleman attends surgery for review of his heart failure.
He was recently diagnosed when he was admitted to hospital with shortness of breath. Echocardiography has revealed impaired left ventricular function. He also has a past medical history of type 2 diabetes mellitus, hypertension and hypercholesterolaemia.
His current medications are: aspirin 75 mg daily, furosemide 40 mg daily, metformin 850 mg TDS, ramipril 10 mg daily, and simvastatin 40 mg daily.
He tells you that the ramipril was initiated when the diagnosis of heart failure was made and has been titrated up to 10 mg daily over the recent weeks. His symptoms are currently stable.
Clinical examination reveals no peripheral oedema, his chest sounds clear and clinically he is in sinus rhythm at 76 beats per minute. His BP is 126/80 mHg.
Providing there are no contraindications, which of the following is the most appropriate treatment to add to his therapy?
A 55-year-old carpenter comes to see you in surgery following an MI three months previously.
He has made a full recovery but wants to ask about his diet.
Which one of the following foods should he avoid?
A 50-year-old man comes to see you to ask about travel to India to visit his relatives. He has been discharged recently from the local district general hospital after suffering an inferior myocardial infarction. He had an exercise test prior to discharge and has made a good recovery. He looks well wants to return to his family home to Mumbai to recuperate.
According to the UK Civil Aviation Authority, what is the minimum time after an uncomplicated MI that he would be OK to fly home?
A 78-year-old man comes to you to discuss blood pressure management.
He has been seen by the nurse three times in the past six months, and each time his BP has been above 160/95 mmHg. He has no significant medical history except for a hernia repair eight years ago. He complains of mild dyspnea on exertion and mild ankle swelling at the end of the day.
During today’s examination, his BP is 155/92 mmHg, his pulse is 70 and regular, and his BMI is 27 kg/m2.
Investigations reveal:
– Hb 123 g/L (135 – 180)
– WCC 5.1 ×109/L (4 – 10)
– PLT 190 ×109/L (150 – 400)
– Na 141 mmol/L (134 – 143)
– K 4.5 mmol/L (3.5 – 5.0)
– Cr 145 µmol/L (60 – 120)
What is the best course of action for managing this man’s blood pressure?