A 60-year-old gentleman is seen for review. He had a myocardial infarction 10 months ago and was started on atorvastatin 80 mg daily. His latest lipid profile shows that he has not managed to reduce his non-HDL cholesterol by 40%.
Which of the following is the most appropriate ‘add-on’ treatment to be considered at this stage?
A 68-year-old woman has weight loss and heat intolerance.
Investigations:
Free T4 32.9 pmol/L (9.8-23.1)
TSH <0.02 mU/L (0.35-5.50) Free T3 11.1 pmol/L (3.5-6.5) She is taking medication for atrial fibrillation, ischaemic heart disease and type 2 diabetes. Which drug is most likely to be responsible for these results?
A 50-year-old Caucasian man has been diagnosed with mild hypertension following ambulatory blood pressure monitoring. Despite reducing caffeine, increasing exercise and losing 4 kg, his BP has not reduced.
Investigations reveal:
Renal ultrasound scan shows two normal sized kidneys.
Which of the following is the most appropriate treatment for his BP?
A 65-year-old man presented with an episode of right-sided weakness that lasted 10 minutes and fully resolved.
Examination reveals that he is in atrial fibrillation.
Assuming he remains in atrial fibrillation which of the following is the most appropriate management regime?
A 58-year-old woman presents to the General Practitioner for a consultation. She has recently been discharged from hospital after an episode of non-ST-elevation acute coronary syndrome. She has no other significant medical conditions.
Which of the following is the most appropriate antiplatelet therapy?
A 60-year-old man who was active all his life develops sudden severe anterior chest pain that radiates to his back. Within minutes, he is unconscious.
He has a history of hypertension, but a recent treadmill test had revealed no evidence for cardiac disease.
What is the most probable diagnosis?
A 45-year-old man presents with complaints of dyspnea.
On auscultation, you detect a systolic crescendo-decrescendo murmur that is most audible at the right upper sternal border. The murmur is loudest during expiration and decreases in intensity when the patient stands. The second heart sound is faint. The apex beat is forceful but not displaced.
What is the probable diagnosis?
A 56-year-old man presents to his General Practitioner with a 4-month history of shortness of breath on exertion. Recently, he has also started waking at night with shortness of breath, which is relieved by sitting up in bed. On examination, crepitations are heard on auscultation of both lung bases and mild ankle oedema. There is no significant past medical history.
What is the most appropriate next step according to current National Institute for Health and Care Excellence guidance?
A 52-year-old heavy smoker with a long history of self-neglect presents to his GP with severe leg pain. On examination there are several, small punched-out ulcers situated on the lower third of both legs. Both dorsalis pedis and posterior tibial pulses appear absent.
Select from the list the single most likely diagnosis.