A 60-year-old woman with suspected heart failure undergoes open-access Doppler echocardiography and is diagnosed with heart failure with reduced ejection fraction. She has experienced increased shortness of breath since the diagnosis and now requires four pillows to sleep comfortably. Which medication is most likely to provide the quickest relief of symptoms for this patient?
A man of 65 comes to see you with a suspected fungal nail infection.
You notice he has not had his blood pressure taken for many years. The lowest reading observed is 175/105 mmHg. Fundoscopy is normal and his pulse is of normal rate and rhythm. He is otherwise well.
With reference to the latest NICE guidance on Hypertension (NG136), what is your next action?
A 53-year-old woman presents to the clinic with increasing shortness of breath. She enjoys walking her dog but has noticed a decrease in exercise tolerance. She reports experiencing fast, irregular palpitations at various times throughout the day.
During the examination, you observe flushed cheeks, a blood pressure reading of 140/95, and a raised JVP. You suspect the presence of a diastolic murmur. In a subsequent communication from the cardiologist, they describe a loud first heart sound, an opening snap, and a mid-diastolic rumble that is best heard at the apex.
What is the most probable diagnosis?
A 32-year-old man presents with a fasting lipid profile that shows a triglyceride level of 22 mmol/L. He denies excessive alcohol consumption and all other blood tests, including HbA1c, renal function, liver function, and thyroid function, are within normal limits. There is no clear explanation for the elevated triglyceride level, and there are no prior lipid profiles available for comparison. The patient has no significant medical history and is not taking any medications. He reports no symptoms or feelings of illness.
What is the most appropriate management strategy for this patient?
A 65-year-old man presents to his General Practitioner for his annual asthma review. He has no daytime symptoms and occasionally uses his ventolin inhaler at night when suffering from a viral infection. His only other medical history is of urinary incontinence, for which he has been fully investigated, and three episodes of gout in the last five years.
On examination, his respiratory rate is 16 breaths per minute, his heart rate 64 bpm and his blood pressure is 168/82 mmHg. Subsequent home blood pressure readings confirm isolated systolic hypertension.
Which of the following is the single most suitable medication for this patient?
A 35-year-old gentleman has come to discuss the result of a routine annual blood test at work. He is otherwise well with no symptoms reported.
He was found to have a serum phosphate of 0.7.
Other tests done include FBC, U+Es, LFTs, Calcium and PTH which were all normal.
Serum phosphate normal range (0-8-1.4 mmol/L)
What is the most appropriate next step in management?
A 55-year-old man with type 2 diabetes presents with widespread myalgia and limb weakness that has developed over the past few weeks. His simvastatin dose was recently increased from 40 mg to 80 mg per day. A colleague advised him to stop taking the statin and have blood tests taken due to the severity of his symptoms. Upon review, the patient reports some improvement in his symptoms but they have not completely resolved. Blood tests show normal renal, liver, and thyroid function but a creatine kinase level eight times the upper limit of normal. What is the most appropriate course of action in this case?
A 60-year-old man presents to his General Practitioner to discuss whether he requires a statin. His brother has encouraged him to book the appointment because ‘everyone in the family takes a statin’, due to familial hypercholesterolaemia. He has no significant medical history and rarely consults with a doctor. His total cholesterol is 8.2 mmol/l.
What is the most appropriate management option?
In this case where a 50-year-old man was diagnosed with hypertension and started on Ramipril 2.5mg, with subsequent blood tests showing a 20% reduction in eGFR but stable renal function and serum electrolytes, what would be the recommended course of action according to NICE guidelines?
An active 58-year-old woman comes to the General Practitioner for a consultation. She has a history of asthma and atrial fibrillation (AF) and has been assessed by her Cardiologist, who has diagnosed her with permanent AF. The Cardiologist recommends rate control. Her resting heart rate is 120 bpm.
Which of the following is the correct statement about rate control in these circumstances?