MRCGP AKT Category: Cardiovascular Health

AKT-0421

You have been asked to review the blood pressure of a 67-year-old woman. She was recently seen by the practice nurse for her annual health review and her blood pressure measured at the time was 148/90 mmHg. There is no history of headache, visual changes or symptoms suggestive of heart failure. Her past medical history includes hypertension, osteoporosis and type 2 diabetes. The medications she is currently on include amlodipine, alendronate, metformin, and lisinopril.

On examination, her blood pressure is 152/88 mmHg. Cardiovascular exam is unremarkable. Fundoscopy shows a normal fundi. The results of the blood test from two days ago are as follow:

Na+ 140 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Bicarbonate 26 mmol/L (22 – 29)
Urea 5.5 mmol/L (2.0 – 7.0)
Creatinine 98 µmol/L (55 – 120)

What is the most appropriate next step in managing her blood pressure?

AKT-0406

A 29-year-old woman has been diagnosed with familial hypercholesterolaemia due to being heterozygous for the condition. During the consultation, you suggest screening her family members. She mentions that her father has normal cholesterol levels. What is the likelihood that her brother will also be impacted?

AKT-0407

A 76-year-old female, recently diagnosed with hypertension, presents to the emergency department after collapsing. She reports feeling dizzy just before the incident and had recently begun a new medication prescribed by her GP. Her medical history includes type II diabetes mellitus, glaucoma, and diverticular disease.

Which medication is most likely responsible for her symptoms?

AKT-0408

Mrs. Smith is a 58-year-old patient who recently had her annual review with the practice nurse for her type 2 diabetes. During the review, the nurse found that her blood pressure was elevated. Mrs. Smith has since borrowed a friend’s BP monitor and has recorded her readings on a spreadsheet, which she has brought to show you. She has already calculated the average BP, which is 142/91 mmHg. Mrs. Smith has been researching on the internet and is interested in starting medication to reduce her cardiovascular risk, especially since she already has diabetes.

According to NICE, what antihypertensive medication is recommended for Mrs. Smith?

AKT-0409

After sending several invitations, 58-year-old Mrs. Johnson attends the clinic for her medication review. She has not been to the clinic for over a year due to her busy work schedule. Mrs. Johnson is currently taking allopurinol 200 mg, candesartan 8mg, indapamide 2.5mg, omeprazole 20 mg, and salbutamol inhaler as required.

During her visit, her blood pressure is measured several times and is found to be 168/96 mmHg. Mrs. Johnson reports taking her medications almost every day, but her blood pressure is still high. As per NICE guidelines, which class of antihypertensive medication should be added to her current treatment plan?

AKT-0410

A 45-year-old man presents for a follow-up of his hypertension. He is of Caucasian descent. He was diagnosed with essential hypertension six months ago and was prescribed ramipril, which has been increased to 10 mg daily. He also has a medical history of hypercholesterolemia and gout, and he takes atorvastatin 20 mg once nightly.

He provides a set of home blood pressure readings with an average of 140/95 mmHg.

What is the best course of action for managing his condition?

AKT-0411

A 72-year-old woman presents to her GP with breathlessness and leg swelling. She has heart failure (ejection fraction 33%), rheumatoid arthritis and type 2 diabetes mellitus. Her medications are 7.5mg bisoprolol once daily, 10 mg lisinopril once daily, 20 mg furosemide twice daily, 500mg metformin three times daily and 1g paracetamol four times daily.

During examination, she has mild bibasal crackles, heart sounds are normal and there is bilateral pedal pitting oedema. Heart rate is 72 beats per minute and regular, respiratory rate is 18 breaths per minute, oxygen saturations are 94% on room air, blood pressure is 124/68 mmHg and her temperature is 36.2oC.

Bloods from an appointment two weeks previously:

Na+ 140 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Bicarbonate 23 mmol/L (22 – 29)
Urea 6.2 mmol/L (2.0 – 7.0)
Creatinine 114 µmol/L (55 – 120)

What medication would be most appropriate to initiate?

AKT-0412

A 76-year-old woman presents for review. She underwent ambulatory blood pressure monitoring which revealed an average reading of 142/90 mmHg. Apart from hypothyroidism, there is no significant medical history. Her 10-year cardiovascular risk score is 23%. What is the best course of action for management?

AKT-0413

A 73-year-old man who underwent bioprosthetic aortic valve replacement three years ago is being evaluated. What type of antithrombotic treatment is he expected to be receiving?

AKT-0414

A 65-year-old man with a history of depression and lumbar spinal stenosis presents with a swollen and painful left calf. He is seen in the DVT clinic and found to have a raised D-dimer. As a result, he undergoes a Doppler scan which reveals a proximal deep vein thrombosis. Despite being active and otherwise healthy, the patient has not had any recent surgeries or prolonged periods of immobility. He is initiated on a direct oral anticoagulant.

What is the appropriate duration of treatment for this patient?