You start a patient on atorvastatin after their cholesterol was found to be raised in the context of a QRISK of 15%. You repeat the blood tests 6 months after starting treatment.
Which of the following blood results does NICE recommend using to determine the next course of action?
What additional action is mentioned in the latest NICE guidance for monitoring blood pressure in diabetic patients compared to non-diabetic patients?
You see a 65-year-old gentleman who was diagnosed with heart failure and an ejection fraction of 35%. He is currently on the maximum tolerated dose of an ACE-I and beta blocker. He reports to still be symptomatic from his heart failure.
What would be the next appropriate step in his management to improve his prognosis?
A national screening programme exists in the UK for abdominal aortic aneurysms.
Select the single correct statement regarding this process.
An 80-year-old gentleman presents with an infective exacerbation of his bronchiectasis. Following clinical assessment you decide to treat him with a course of antibiotics. He has a past medical history of atrial fibrillation for which he takes lifelong warfarin. His notes state he is penicillin allergic and the patient confirms a history of a true allergy.
You decide to prescribe a course of doxycycline, 200 mg on day 1 then 100 mg daily to complete a 14 day course.
You can see his INR is very well managed and is consistently between 2.0 and 3.0 and he has been taking 3 mg and 4 mg on alternate days for the last six months without the need for any dose changes.
What is the most appropriate management of his warfarin therapy during the treatment of this acute exacerbation?
A 62-year-old woman has been visiting the practice nurse for a few weeks for blood pressure (BP) checks. Her results have shown significant variability. She presents you with a diary of home readings that the nurse has instructed her to take twice daily over the past two weeks. Her average BP based on these readings is 135/80 mmHg. Her BP today in the clinic is 162/102 mmHg, and the nurse has recorded similar levels on the last two visits. She doesn’t want to take medication for her BP. She has no other medical conditions.
What is the most suitable course of action? Choose ONE option only.
A 67-year-old woman presents with exertional breathlessness and heart failure is suspected. She is not acutely unwell. She has a history of chronic hypertension and takes amlodipine but no other medication.
An NT-proBNP level is ordered and the result is 962 pg/mL.
What is the next best course of action in managing her condition?
A 49-year-old male with type 2 diabetes presents for review. He has a past medical history of hypertension, migraine, and obesity (BMI is 38). Currently, he takes metformin 1 g BD and ramipril 5 mg OD for blood pressure control. His latest HbA1c is 50 mmol/mol, and his total cholesterol is 5.2 with an LDL cholesterol of 3.5. His QRisk2 score is 21%.
During the consultation, you discuss the addition of lipid-lowering medication to reduce his cardiovascular risk, especially in light of his recently treated hypertension. You both agree that starting him on Atorvastatin 20 mg at night is an appropriate treatment for primary prevention of cardiovascular disease.
Before prescribing the medication, you review his latest blood results, which show normal full blood count, renal function, and thyroid function. However, his liver function tests reveal an ALT of 106 IU/L (<60) and an ALP of 169 IU/L (20-200). Bilirubin levels are within normal limits. Upon further investigation, you discover that the ALT rise has persisted since his first blood tests at the surgery over four years ago. However, the liver function results have remained stable over this time, showing no significant variation from the current values. A liver ultrasound done two years ago reports some evidence of fatty infiltration only. What is the most appropriate management strategy for this patient?
A 75-year-old man with a history of angina, well-controlled on a combination of aspirin 75 mg, atenolol 50 mg od, simvastatin 40 mg od, and isosorbide mononitrate 20 mg bd, presents with a pulse rate of 70 bpm and blood pressure of 134/84 mmHg. He also has type II diabetes mellitus, managed with metformin. What is the most effective medication that should be prescribed for optimal secondary prevention?
A 68-year-old man with a history of myocardial infarction is experiencing respiratory distress during your emergency home visit. He is sweating, pale, and tachypnoeic with severe chest pain. His heart rate is 140 bpm and blood pressure is 110/60 mmHg. You hear fine crackles in the lower parts of both lungs and determine that he requires immediate hospitalization.
What is the best initial management option to administer while waiting for hospital transfer for this patient?