A 68-year-old female presents with fatigue and episodic palpitations.
She presents during one of these episodes and the ECG reveals atrial fibrillation which resolves within 30 minutes.
What would be the most appropriate next investigation for this patient?
A 58-year-old man presents with complaints of leg pains. He has a medical history of hypertension and hypercholesterolaemia, and is a smoker of 20 cigarettes a day.
He reports experiencing pain in his right calf after walking about 50 yards, which occurs every time he walks. The pain subsides when he stops and sits down, but returns upon further walking. He denies any pain at rest and has only experienced symptoms while walking.
Upon examination, no pulses can be palpated in the right foot, but there is no evidence of acute ischaemia. Femoral and popliteal pulses are present, and capillary refill time in the right foot is three to four seconds. There are no ulcers or tissue loss affecting the feet. The patient is otherwise well, with a blood pressure of 154/92 mmHg and a regular pulse rate of 72 bpm.
In addition to referring the patient for ankle-brachial pressure index measurements to confirm the clinical diagnosis, what other assessments should be performed as part of his primary care evaluation?
An 82-year-old man and his wife come to see you with concerns about his memory. He has forgotten how to do simple tasks in the kitchen and has become confused about his whereabouts. His medical history is unremarkable except for hypertension, which is managed with ramipril. On examination, he appears well with a BP of 142/84 mmHg, a pulse of 75 regular, and an MMSE score of 22. You are fortunate to be in the catchment area for the local university hospital and have access to further investigations. What is the best approach to managing his condition?
What is the most suitable first-line medication for a 75-year-old woman with depression in primary care, assuming there are no contraindications?
A 78-year-old man has cerebrovascular disease and his memory has been getting slowly worse for the past three years. He is diagnosed with an abdominal aortic aneurysm and ideally should have an operation.
Which one of the following is correct?
A 65-year-old man presents to the GP clinic for follow-up. He reports experiencing shortness of breath on exercise, which has worsened over the past few months. He can now only walk 200-300 yards on flat ground and has difficulty climbing stairs. The patient has a history of hypertension and is currently taking amlodipine 5 mg and indapamide 2.5 mg. In the clinic, his blood pressure is 195/90, and he has bibasal crackles indicative of heart failure, but no ankle edema is present.
The following investigations were conducted:
– Haemoglobin: 139 g/L (115-165)
– White cells: 7.1 ×109/L (4-11)
– Platelets: 203 ×109/L (150-400)
– Sodium: 139 mmol/L (135-146)
– Potassium: 4.3 mmol/L (3.5-5)
– Creatinine: 129 μmol/L (79-118)
– Ejection fraction: 55%
What is the most appropriate next therapy for this patient?
A 72-year-old man presents to his GP with a complaint of rapidly worsening shortness of breath over the past four to five weeks. He reports bilateral ankle swelling and has experienced two episodes of gasping for breath in the past week. The patient has a history of hypertension and takes indapamide and amlodipine. On examination, his BP is 122/72, his pulse is 90 and regular, and he has bibasal crackles on chest auscultation and bilateral pitting edema. Laboratory investigations reveal a hemoglobin level of 122 g/L (135-177), white cells of 8.3 ×109/L (4-11), platelets of 182 ×109/L (150-400), sodium of 141 mmol/L (135-146), potassium of 4.7 mmol/L (3.5-5), creatinine of 122 μmol/L (79-118), and BNP of 520 pg/mL (<100). Based on the latest NICE guidance, what is the most appropriate next step?
You are called to a nursing home to see a 85-year-old lady who has become acutely confused.
She has a past medical history of hypertension and hypothyroidism. These are well controlled on bendroflumethazide 2.5 mg OD and thyroxine 100 mcg OD.
On arrival she is disoriented to time and place; and the nursing staff report that earlier she seemed to be hallucinating. On examination, she has a temperature of 38.1°C, pulse rate of 92 regular and a blood pressure of 108/88 mmHg. Blood sugar is 4.6.
What is the next most appropriate acute action?
An 85-year-old man patient of yours is discharged from hospital after receiving treatment for a urinary tract infection.
Three days after discharge the lab calls you to say that they received a urine sample before his discharge and there was E. coli present in the urine. However, there are no signs of infection. You call the man back to your surgery to check that he is okay. He has no pain while urinating and says he feels much better.
Which of the following is the best course of action?
A 72-year-old man with treated cardiac failure comes to the GP surgery for a three month review after a recent admission for medication stabilisation.
He is currently taking ramipril 10 mg, bisoprolol 10 mg and 40 mg of furosemide. On examination his BP is 122/72, his pulse is 75 and regular. There are sparse crackles at both lung bases but there are no signs of peripheral oedema.
Haemoglobin 127 g/L (115-165)
White cells 6.9 ×109/L (4-11)
Platelets 208 ×109/L (150-400)
Sodium 139 mmol/L (135-146)
Potassium 4.1 mmol/L (3.5-5)
Creatinine 149 μmol/L (79-118)
BNP 230 pg/mL (<100)
Ejection fraction 38%
Which of the following is the NICE recommended next step?