You are conducting a medication review for a 65-year-old man who has a history of cerebrovascular disease (having suffered a stroke 2 years ago), depression, and knee osteoarthritis. He is currently taking the following medications:
– Clopidogrel 75 mg once daily
– Simvastatin 20 mg once daily
– Amlodipine 5mg once daily
– Ramipril 10 mg once daily
– Diclofenac 50 mg as needed
– Sertraline 50 mg once daily
What changes would you recommend to his medication regimen?
You assess a 65-year-old man who has just begun taking a beta-blocker for heart failure. What is the most probable side effect that can be attributed to his new medication?
You receive a call from a nursing home about a 90-year-old male resident. The staff are worried about his increasing unsteadiness on his feet in the past few months, which has led to several near-falls. They are also concerned that his DOAC medication puts him at risk of a bleed if he falls and hits his head.
His current medications include amlodipine, ramipril, edoxaban, and alendronic acid.
What steps should be taken in this situation?
A 65-year-old man comes in for a blood pressure check. His at-home readings have consistently been high at 155/94 mmHg. He reports feeling fine. He is currently on the maximum dose of amlodipine. An echocardiogram done recently showed moderate to severe aortic stenosis.
What is the most suitable course of action for management?
You are evaluating a 75-year-old patient who has just been diagnosed with heart failure after an echocardiogram revealed a left ventricular ejection fraction of 35%. He has been experiencing mild shortness of breath during physical activity and has no other known medical conditions. He is not currently taking any medications.
What is the most suitable recommendation to provide?
You are a GPST1 working in a general practice. A practice nurse seeks your guidance on a routine ECG performed on a 50-year-old man. Upon examining the ECG, you observe that the patient is in regular sinus rhythm with a rate of 70 beats per minute. However, the patient has a long QT interval and small T waves.
What could be the reason for this distinct ECG pattern?
You assess a patient who has been hospitalized with a non-ST elevation myocardial infarction in the ED. They have been administered aspirin 300 mg stat and glyceryl trinitrate spray (2 puffs). As per the latest NICE recommendations, which patients should be given ticagrelor?
A 67-year-old woman presents to the emergency department with a 3-day history of pain and swelling in her left lower leg. She denies any recent injury.
Upon examination, you observe that her left calf is swollen and red, measuring 3 cm larger in diameter than the right side. She experiences localised tenderness along the deep venous system.
Based on your clinical assessment, you suspect a deep vein thrombosis (DVT) and order blood tests, which reveal a D-Dimer level of 900 ng/mL (< 400). You initiate treatment with therapeutic doses of apixaban and schedule a proximal leg ultrasound for the next day. However, the ultrasound doesn’t detect any evidence of a proximal leg DVT. What is the most appropriate course of action?
Which one of the following would not be considered a normal variant on the ECG of an athletic 29-year-old man?
A 68-year-old man presents for follow-up of his atrial fibrillation. He recently underwent catheter ablation for atrial fibrillation and it was successful.
The patient has a medical history of hypertension and type 2 diabetes. His most recent blood pressure reading was 150/92 mmHg.
What is the optimal approach for managing his anticoagulation?