A 40-year-old woman has been diagnosed with systemic sclerosis and is now experiencing headaches and blurred vision. She has a history of asthma. During examination, her blood pressure is found to be 230/120 mmHg, and there are bilateral papilloedema and fundal haemorrhages. What medication should be prescribed immediately?
You are the Senior House Officer (SHO) in the Cardiology Clinic and wish to start an elderly male patient, who has recently been diagnosed with hypertension, on an agent in addition to his angiotensin-converting enzyme (ACE) inhibitor. He is a type II diabetic who is currently diet-controlled. His blood pressure is 155/90 mmHg.
Which of the following is the most suitable next medication?
A 45 year old man has been referred to the endocrinology clinic for investigation and management of his persistently raised blood pressure. Despite being on ramipril 5mg once daily for four weeks, his blood pressure remains elevated between 170/100 mmHg and 180/110 mmHg. During the consultation, the patient mentions experiencing headaches for the past year, along with increased stool frequency and looser stools. He also reports flushing episodes and feeling that his clothes are looser than they were a year ago. The patient’s family history includes his mother having a breast lump removed and his father having a pancreatic mass removed. On examination, the patient is tall with a wide arm span, and has a minor tachycardia of 95 bpm and a quiet systolic flow murmur. A 24h urinary catecholamine test arranged by the GP showed raised levels of total urine catecholamines at 210 mcg/24hr. A CT of the abdomen and pelvis was reported as normal, except for a few incidental simple renal cysts. Urinalysis in clinic today showed no leucocytes or blood, but did show glucose. Which test is most likely to determine the cause of the patient’s hypertension?
A 55-year-old man with a 3 year history of hypertension is referred for further evaluation due to his blood pressure being difficult to control. The following results were obtained prior to commencing medications:
Na+ 146 mmol/l
K+ 3.5 mmol/l
Creatinine 120 µmol/l
Renin 98 (7-50 IU/mL ambulatory)
Aldosterone 1000 (N: 80-800 ng/dL ambulatory)
Renin:Aldosterone Ratio 10.8 (< 500)
Plasma Metanephrines 0.40 (<0.50 nmol/L)
These results are most consistent with which of the following:
A 42-year-old Caucasian man presents to your clinic with a blood pressure reading of 145/95 mmHg. He reports not regularly monitoring his blood pressure at home and is currently asymptomatic. Upon examination, his cardiovascular and fundoscopic findings are unremarkable, and his 12-lead ECG shows no evidence of left ventricular hypertrophy. He is currently taking a regimen of 10 mg amlodipine, 10 mg ramipril, 1.5 mg indapamide, and 25 mg spironolactone. What would be the most appropriate next step in treating this patient?
An 83-year-old man visits his doctor to discuss his medication. He reports experiencing shortness of breath with minimal exertion and having to sleep upright in his armchair. His current medication includes lisinopril, metoprolol, spironolactone, furosemide, aspirin, simvastatin, nifedipine, and metformin.
During the physical examination, the patient’s heart rate is 69 beats per minute with a regular rhythm, and his blood pressure is 118/100 mmHg. His peripheries are cool, and his carotid pulse is difficult to palpate. The doctor notes a sustained apical impulse palpable in the 5th intercostal space in the mid-clavicular line. Additionally, the patient has a palpable thrill in the second intercostal space at the right sternal border, where the doctor hears a loud crescendo-decrescendo murmur that radiates into the neck. The patient has a quiet S1, an inaudible S2, and a loud S4. The doctor also observes 1+ peripheral edema.
Which of the following physical examination findings are most indicative of severe aortic stenosis?
A 75-year-old woman with advanced lung cancer arrives at the Emergency Department complaining of facial swelling, shortness of breath, and headache. Upon examination, an echocardiogram reveals cardiac tamponade, and an urgent pericardiocentesis is performed to alleviate her symptoms. What is the most likely finding on physical examination of a patient experiencing acute cardiac tamponade?
A 32-year-old woman who is 20 weeks pregnant presents to the Cardiology Department with complaints of heart palpitations. She has no significant medical history and is not taking any medications. On examination, her BP is 120/80 mmHg, her pulse is 80 bpm and regular, and there is a systolic murmur with a fixed splitting of the second heart sound. An ECG shows left-axis deviation with an RBBB, and an ECHO reveals an ostium primum ASD. What are the potential risks to the pregnancy, if any?
A 55-year-old male presents to the outpatient clinic for a routine check up. He has a five year history of type 2 diabetes mellitus and is currently diet controlled. He takes no other medication.
Examination reveals that he is obese with a BMI of 32 kg/m2, his blood pressure is 170/90 mmHg and he has a pulse of 75 beats per minute regular.
A check of his joint management record shows that the previous week his blood pressure was 160/90 mmHg and 170/95 mmHg. He has no evidence of any end organ damage and his pinprick sensation using a monofilament is normal.
Investigations show:
– Serum sodium 137 mmol/L (137-144)
– Serum potassium 4.2 mmol/L (3.5-4.9)
– Serum urea 6 mmol/L (2.5-7.5)
– Serum creatinine 105 µmol/L (60-110)
– Serum bicarbonate 25 mmol/L (20-28)
– Cholesterol 5.6 mmol/L (<5.2)
– Urine albumin 200 μmol/dL
– HbA1c 7.2% (5 – 6.8%)
Which of the following drugs is not supported by evidence for reducing the risk of developing a cardiac event in this man?
A 67-year-old man presents to the Emergency Department with complaints of lethargy, fever, and loss of appetite. He had undergone a prosthetic aortic valve replacement a year ago for progressive aortic stenosis and has been in good health since then. However, his symptoms have been persistent for the past two weeks. Laboratory tests reveal a CRP level of 215 mg/l, while the chest x-ray and urine dip are normal. A transoesophageal echocardiogram is performed, which shows a large vegetative lesion around the prosthetic aortic valve, raising suspicion of infective endocarditis. What is the most appropriate antibiotic therapy to initiate while awaiting blood culture results?