A 32-year-old woman presents with dizziness to her General Practitioner. She reports a similar episode six months ago, which was also accompanied by some discomfort in her chest lasting for a short period. Upon further questioning, she admits to feeling her heart beating rapidly in her chest. She is currently stable, with a blood pressure of 120/80 mmHg, oxygen saturation of 99%, and a heart rate of 110 bpm. What is the best investigation to guide further management?
A 55-year-old woman with a history of diabetes, obesity, and smoking developed sudden pain in her left foot with a dusky colour change. On examination, in the Emergency Department, she had a cold, blue, painful foot with an absent dorsalis pedis and posterior tibial pulse.
Which of the following will be the most appropriate investigation for this patient?
An 80-year-old man presents with leg swelling and nocturnal dyspnea. His BNP levels are elevated and an echocardiogram confirms heart failure with reduced ejection fraction. He has a history of diabetes and is currently on metformin. Besides furosemide, what other medication should be initiated for his heart failure management?
A 24-year-old male is undergoing a medical review at a professional football club when an ejection systolic murmur is found. He is sent for echocardiogram and subsequently diagnosed with hypertrophic obstructive cardiomyopathy (HOCM).
Despite a normal electrocardiogram (ECG) and regular pulse, which complication of this condition is most likely to result in sudden death for this athlete?
A 65 year old man comes to you with complaints of palpitations. Upon conducting an electrocardiogram, you diagnose him with atrial fibrillation. He has no history of cardiovascular or cerebrovascular disease and his recent blood tests, including a random glucose test, were normal. His BMI is 28 kg/m² and his blood pressure today is 135/82 mmHg. Determine his CHA2DS2 VASc score for stroke risk.
A 31-year-old pilot comes in for his yearly physical examination. He has no significant medical history, does not take any regular medication, and reports no concerning symptoms. He maintains a healthy lifestyle and enjoys participating in ultramarathons as a runner.
During the physical examination, an ECG is conducted, which was normal during his last check-up the previous year. What would be the most worrisome ECG characteristic?
A 29-year-old male patient informs you that he has Long QT syndrome and you are contemplating prescribing an antibiotic. Which antibiotic should you avoid prescribing to him?
You are requested to evaluate a 65-year-old woman who has been admitted to your ward with a lower respiratory tract infection. She has a medical history of hypertension and gout and is currently taking amlodipine 10mg once daily and allopurinol 100mg once daily. You observe that her blood pressure has been consistently high over the past three days, with readings of 149/76 mmHg, 158/88 mmHg, and 150/82 mmHg. Which antihypertensive medication would be the most suitable to initiate?
A 56-year-old man with difficult hypertension comes to the GP clinic for follow-up. His average blood pressure over the past two weeks has been 168/100 mmHg and today in the clinic it is 176/102 mmHg. He is currently taking a combination of telmisartan 80 mg and hydrochlorothiazide 25mg tablets, as well as amlodipine 10mg daily. The latest laboratory results are as follows:
Na+ 136 mmol/L (135 – 145)
K+ 3.8 mmol/L (3.5 – 5.0)
Bicarbonate 25 mmol/L (22 – 29)
Urea 5 mmol/L (2.0 – 7.0)
Creatinine 135 µmol/L (55 – 120)
What would be the most appropriate next step?
A 50-year-old man arrives at the emergency department complaining of severe chest pain that radiates to his left arm, accompanied by nausea and sweating. His ECG reveals widespread ST depression with T wave inversion, and his blood tests show a haemoglobin level of 75g/L. What is the appropriate treatment for his anaemia?