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  • Question 1 - Samantha is a 64-year-old woman who presents to you with a new-onset headache...

    Incorrect

    • Samantha is a 64-year-old woman who presents to you with a new-onset headache that started 3 weeks ago. Samantha's medical history includes type 2 diabetes and hypercholesterolaemia, and she has a body mass index of 29 kg/m².

      During your examination, you measure Samantha's blood pressure which is 190/118 mmHg. A repeat reading shows 186/116 mmHg. Upon conducting fundoscopy, you observe evidence of retinal haemorrhage.

      What would be the most appropriate initial management?

      Your Answer: Commence a calcium channel blocker immediately

      Correct Answer: Refer for same-day specialist assessment

      Explanation:

      NICE released updated guidelines in 2019 for the management of hypertension, building on previous guidelines from 2011. These guidelines recommend classifying hypertension into stages and using ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension. This is because some patients experience white coat hypertension, where their blood pressure rises in a clinical setting, leading to potential overdiagnosis of hypertension. ABPM and HBPM provide a more accurate assessment of a patient’s overall blood pressure and can help prevent overdiagnosis.

      To diagnose hypertension, NICE recommends measuring blood pressure in both arms and repeating the measurements if there is a difference of more than 20 mmHg. If the difference remains, subsequent blood pressures should be recorded from the arm with the higher reading. NICE also recommends taking a second reading during the consultation if the first reading is above 140/90 mmHg. ABPM or HBPM should be offered to any patient with a blood pressure above this level.

      If the blood pressure is above 180/120 mmHg, NICE recommends admitting the patient for specialist assessment if there are signs of retinal haemorrhage or papilloedema or life-threatening symptoms such as new-onset confusion, chest pain, signs of heart failure, or acute kidney injury. Referral is also recommended if a phaeochromocytoma is suspected. If none of these apply, urgent investigations for end-organ damage should be arranged. If target organ damage is identified, antihypertensive drug treatment may be started immediately. If no target organ damage is identified, clinic blood pressure measurement should be repeated within 7 days.

      ABPM should involve at least 2 measurements per hour during the person’s usual waking hours, with the average value of at least 14 measurements used. If ABPM is not tolerated or declined, HBPM should be offered. For HBPM, two consecutive measurements need to be taken for each blood pressure recording, at least 1 minute apart and with the person seated. Blood pressure should be recorded twice daily, ideally in the morning and evening, for at least 4 days, ideally for 7 days. The measurements taken on the first day should be discarded, and the average value of all the remaining measurements used.

      Interpreting the results, ABPM/HBPM above 135/85 mmHg (stage 1 hypertension) should be

    • This question is part of the following fields:

      • Cardiovascular Health
      52.6
      Seconds
  • Question 2 - A 70-year-old man visits a neurovascular clinic for a check-up. He had a...

    Incorrect

    • A 70-year-old man visits a neurovascular clinic for a check-up. He had a stroke caused by a blood clot 3 weeks ago but has been recovering well. However, the patient had to discontinue taking clopidogrel 75 mg due to severe abdominal discomfort and diarrhea after switching from aspirin 300 mg daily. Since then, the symptoms have subsided.

      What would be the best medication(s) to recommend for preventing another stroke in this case?

      Your Answer: No additional treatment needed

      Correct Answer: Aspirin 75 mg plus modified release dipyridamole

      Explanation:

      When clopidogrel cannot be used, the recommended treatment for secondary stroke prevention is a combination of aspirin 75 mg and modified-release dipyridamole. Studies have shown that this combination is more effective than taking aspirin or modified-release dipyridamole alone. Ticagrelor is not currently recommended by NICE for this purpose, and prasugrel is contraindicated due to the risk of bleeding. Oral anticoagulants like warfarin are generally not used for secondary stroke prevention, with antiplatelets being the preferred treatment.

      The Royal College of Physicians (RCP) and NICE have published guidelines on the diagnosis and management of patients following a stroke. The guidelines provide recommendations for the management of acute stroke, including maintaining normal levels of blood glucose, hydration, oxygen saturation, and temperature. Blood pressure should not be lowered in the acute phase unless there are complications. Aspirin should be given as soon as possible if a haemorrhagic stroke has been excluded. Anticoagulants should not be started until brain imaging has excluded haemorrhage, and usually not until 14 days have passed from the onset of an ischaemic stroke. If the cholesterol is > 3.5 mmol/l, patients should be commenced on a statin.

      Thrombolysis with alteplase should only be given if it is administered within 4.5 hours of onset of stroke symptoms and haemorrhage has been definitively excluded. There are absolute and relative contraindications to thrombolysis, including previous intracranial haemorrhage, intracranial neoplasm, and active bleeding. Mechanical thrombectomy is a new treatment option for patients with an acute ischaemic stroke. NICE recommends considering thrombectomy together with intravenous thrombolysis for people last known to be well up to 24 hours previously.

      Secondary prevention recommendations from NICE include the use of clopidogrel and dipyridamole. Clopidogrel is recommended ahead of combination use of aspirin plus modified-release dipyridamole in people who have had an ischaemic stroke. Aspirin plus MR dipyridamole is recommended after an ischaemic stroke only if clopidogrel is contraindicated or not tolerated. MR dipyridamole alone is recommended after an ischaemic stroke only if aspirin or clopidogrel are contraindicated or not tolerated. Carotid artery endarterectomy should only be considered if carotid stenosis is greater than 70% according to ECST criteria or greater than 50% according to NASCET criteria.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 3 - What additional action is mentioned in the latest NICE guidance for monitoring blood...

    Incorrect

    • What additional action is mentioned in the latest NICE guidance for monitoring blood pressure in diabetic patients compared to non-diabetic patients?

      Your Answer:

      Correct Answer: Measure BP standing and sitting

      Explanation:

      Monitoring Treatment for Hypertension

      When monitoring treatment for hypertension, it is recommended by NICE to use clinic blood pressure (BP) measurements. However, for patients with type 2 diabetes, symptoms of postural hypotension, or those aged 80 and over, both standing and sitting BP should be measured. Patients who wish to self-monitor their BP should use home blood pressure monitoring (HBPM) and receive proper training and advice. Additionally, for patients with white-coat effect or masked hypertension, ambulatory blood pressure monitoring (ABPM) or HBPM can be considered in addition to clinic BP measurements.

      It is important to note that for adults with type 2 diabetes who have not been previously diagnosed with hypertension or renal disease, BP should be measured at least annually. By following these guidelines, healthcare professionals can effectively monitor and manage hypertension in their patients.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 4 - Your next appointment is with a 48-year-old man. He has come for the...

    Incorrect

    • Your next appointment is with a 48-year-old man. He has come for the results of his ambulatory blood pressure monitoring (ABPM). This was arranged as a clinic reading one month ago was noted to be 150/94 mmHg. The results of the ABPM show an average reading of 130/80 mmHg. What is the most suitable plan of action?

      Your Answer:

      Correct Answer: Offer to measure the patient's blood pressure at least every 5 years

      Explanation:

      If the ABPM indicates an average blood pressure below the threshold, NICE suggests conducting blood pressure measurements on the patient every 5 years.

      NICE released updated guidelines in 2019 for the management of hypertension, building on previous guidelines from 2011. These guidelines recommend classifying hypertension into stages and using ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) to confirm the diagnosis of hypertension. This is because some patients experience white coat hypertension, where their blood pressure rises in a clinical setting, leading to potential overdiagnosis of hypertension. ABPM and HBPM provide a more accurate assessment of a patient’s overall blood pressure and can help prevent overdiagnosis.

      To diagnose hypertension, NICE recommends measuring blood pressure in both arms and repeating the measurements if there is a difference of more than 20 mmHg. If the difference remains, subsequent blood pressures should be recorded from the arm with the higher reading. NICE also recommends taking a second reading during the consultation if the first reading is above 140/90 mmHg. ABPM or HBPM should be offered to any patient with a blood pressure above this level.

      If the blood pressure is above 180/120 mmHg, NICE recommends admitting the patient for specialist assessment if there are signs of retinal haemorrhage or papilloedema or life-threatening symptoms such as new-onset confusion, chest pain, signs of heart failure, or acute kidney injury. Referral is also recommended if a phaeochromocytoma is suspected. If none of these apply, urgent investigations for end-organ damage should be arranged. If target organ damage is identified, antihypertensive drug treatment may be started immediately. If no target organ damage is identified, clinic blood pressure measurement should be repeated within 7 days.

      ABPM should involve at least 2 measurements per hour during the person’s usual waking hours, with the average value of at least 14 measurements used. If ABPM is not tolerated or declined, HBPM should be offered. For HBPM, two consecutive measurements need to be taken for each blood pressure recording, at least 1 minute apart and with the person seated. Blood pressure should be recorded twice daily, ideally in the morning and evening, for at least 4 days, ideally for 7 days. The measurements taken on the first day should be discarded, and the average value of all the remaining measurements used.

      Interpreting the results, ABPM/HBPM above 135/85 mmHg (stage 1 hypertension) should be

    • This question is part of the following fields:

      • Cardiovascular Health
      0
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  • Question 5 - A patient who started taking simvastatin half a year ago is experiencing muscle...

    Incorrect

    • A patient who started taking simvastatin half a year ago is experiencing muscle aches all over. What is not considered a risk factor for myopathy caused by statins?

      Your Answer:

      Correct Answer: Large fall in LDL-cholesterol

      Explanation:

      Statins are drugs that inhibit the action of HMG-CoA reductase, which is the enzyme responsible for cholesterol synthesis in the liver. However, they can cause adverse effects such as myopathy, liver impairment, and an increased risk of intracerebral hemorrhage in patients with a history of stroke. Statins should not be taken during pregnancy or in combination with macrolides. NICE recommends statins for patients with established cardiovascular disease, a 10-year cardiovascular risk of 10% or higher, type 2 diabetes mellitus, or type 1 diabetes mellitus with certain criteria. It is recommended to take statins at night, especially simvastatin, which has a shorter half-life than other statins. NICE recommends atorvastatin 20 mg for primary prevention and atorvastatin 80 mg for secondary prevention.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 6 - A 7-year-old girl has coarctation of the aorta. She was diagnosed six weeks...

    Incorrect

    • A 7-year-old girl has coarctation of the aorta. She was diagnosed six weeks ago. She needs to have a dental filling.

      Which one of the following is correct?

      Your Answer:

      Correct Answer: Antibiotic prophylaxis is not necessary

      Explanation:

      NICE Guidance on Antibiotic Prophylaxis for High-Risk Patients

      NICE has released new guidance regarding the use of antibiotic prophylaxis for high-risk patients. The guidance acknowledges that patients with pre-existing cardiac lesions are at risk of developing bacterial endocarditis (IE). However, NICE has concluded that clinical and cost-effectiveness evidence supports the recommendation that at-risk patients undergoing interventional procedures should no longer be given antibiotic prophylaxis against IE.

      It is important to note that antibiotic therapy is still necessary to treat active or potential infections. The current antibiotic prophylaxis regimens may even result in a net loss of life. Therefore, it is crucial to identify patient groups who may be most at risk of developing bacterial endocarditis so that prompt investigation and treatment can be undertaken. However, offering antibiotic prophylaxis for these patients during dental procedures is not considered effective. This new guidance marks a paradigm shift from current accepted practice.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 7 - The following patients all attend for a medication review in your afternoon clinic....

    Incorrect

    • The following patients all attend for a medication review in your afternoon clinic. They all have atrial fibrillation (AF) and are taking multiple medications.

      Which patient should discontinue anticoagulation?

      Your Answer:

      Correct Answer: An 80-year-old man who has undergone left atrial appendage closure, surgically preventing clots from entering the bloodstream

      Explanation:

      Even after undergoing catheter ablation for atrial fibrillation, patients must continue taking anticoagulants for an extended period based on their CHA2DS2-VASc score.

      Atrial fibrillation (AF) is a heart condition that requires prompt management. The management of AF depends on the patient’s haemodynamic stability and the duration of the AF. For haemodynamically unstable patients, electrical cardioversion is recommended. For haemodynamically stable patients, rate control is the first-line treatment strategy, except in certain cases. Medications such as beta-blockers, calcium channel blockers, and digoxin are commonly used to control the heart rate. Rhythm control is another treatment option that involves the use of medications such as beta-blockers, dronedarone, and amiodarone. Catheter ablation is recommended for patients who have not responded to or wish to avoid antiarrhythmic medication. The procedure involves the use of radiofrequency or cryotherapy to ablate the faulty electrical pathways that cause AF. Anticoagulation is necessary before and during the procedure to reduce the risk of stroke. The success rate of catheter ablation varies, with around 50% of patients experiencing an early recurrence of AF within three months. However, after three years, around 55% of patients who have undergone a single procedure remain in sinus rhythm.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 8 - A 70-year-old man with a medical history of chronic heart failure due to...

    Incorrect

    • A 70-year-old man with a medical history of chronic heart failure due to ischaemic cardiomyopathy is being evaluated. He was released from the hospital two weeks ago after experiencing a heart attack. An echocardiogram conducted during his hospitalization revealed a left ventricular ejection fraction of 40%, but no valve abnormalities were detected.

      Despite his current regimen of furosemide, ramipril, carvedilol, aspirin, and simvastatin, he continues to experience shortness of breath with minimal exertion, such as walking 30 meters. On examination, his chest is clear, and there is minimal peripheral edema. What is the most appropriate next step in managing his condition?

      Your Answer:

      Correct Answer: Add an aldosterone antagonist

      Explanation:

      The 2010 NICE guidelines have been revised to recommend the use of both angiotensin-2 receptor blockers and hydralazine in combination with a nitrate as second-line treatments for heart failure, in addition to aldosterone antagonists. However, considering the patient’s recent myocardial infarction, the most appropriate option would be an aldosterone antagonist, as per the NICE guidelines. For further information, please refer to the guidelines.

      Chronic heart failure can be managed through drug therapy, as outlined in the updated guidelines issued by NICE in 2018. While loop diuretics are useful in managing fluid overload, they do not reduce mortality in the long term. The first-line treatment for all patients is an ACE-inhibitor and a beta-blocker, with clinical judgement used to determine which one to start first. Aldosterone antagonists are the standard second-line treatment, but both ACE inhibitors and aldosterone antagonists can cause hyperkalaemia, so potassium levels should be monitored. SGLT-2 inhibitors are increasingly being used to manage heart failure with a reduced ejection fraction, as they reduce glucose reabsorption and increase urinary glucose excretion. Third-line treatment options include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin, and cardiac resynchronisation therapy. Other treatments include annual influenza and one-off pneumococcal vaccines.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 9 - A 55-year-old woman who has previously had breast cancer visits her nearby GP...

    Incorrect

    • A 55-year-old woman who has previously had breast cancer visits her nearby GP clinic complaining of swelling in her left calf for the past two days. Which scoring system should be utilized to evaluate her likelihood of having a deep vein thrombosis (DVT)?

      Your Answer:

      Correct Answer: Wells score

      Explanation:

      Deep vein thrombosis (DVT) is a serious condition that requires prompt diagnosis and management. The National Institute for Health and Care Excellence (NICE) updated their guidelines in 2020, recommending the use of direct oral anticoagulants (DOACs) as first-line treatment for most people with VTE, including as interim anticoagulants before a definite diagnosis is made. They also recommend the use of DOACs in patients with active cancer, as opposed to low-molecular weight heparin as was previously recommended. Routine cancer screening is no longer recommended following a VTE diagnosis.

      If a patient is suspected of having a DVT, a two-level DVT Wells score should be performed to assess the likelihood of the condition. If a DVT is ‘likely’ (2 points or more), a proximal leg vein ultrasound scan should be carried out within 4 hours. If the result is positive, then a diagnosis of DVT is made and anticoagulant treatment should start. If the result is negative, a D-dimer test should be arranged. If a proximal leg vein ultrasound scan cannot be carried out within 4 hours, a D-dimer test should be performed and interim therapeutic anticoagulation administered whilst waiting for the proximal leg vein ultrasound scan (which should be performed within 24 hours).

      The cornerstone of VTE management is anticoagulant therapy. The big change in the 2020 guidelines was the increased use of DOACs. Apixaban or rivaroxaban (both DOACs) should be offered first-line following the diagnosis of a DVT. Instead of using low-molecular weight heparin (LMWH) until the diagnosis is confirmed, NICE now advocate using a DOAC once a diagnosis is suspected, with this continued if the diagnosis is confirmed. If neither apixaban or rivaroxaban are suitable, then either LMWH followed by dabigatran or edoxaban OR LMWH followed by a vitamin K antagonist (VKA, i.e. warfarin) can be used.

      All patients should have anticoagulation for at least 3 months. Continuing anticoagulation after this period is partly determined by whether the VTE was provoked or unprovoked. If the VTE was provoked, the treatment is typically stopped after the initial 3 months (3 to 6 months for people with active cancer). If the VTE was

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 10 - A 68-year-old man with a history of myocardial infarction is experiencing respiratory distress...

    Incorrect

    • A 68-year-old man with a history of myocardial infarction is experiencing respiratory distress during your emergency home visit. He is sweating, pale, and tachypnoeic with severe chest pain. His heart rate is 140 bpm and blood pressure is 110/60 mmHg. You hear fine crackles in the lower parts of both lungs and determine that he requires immediate hospitalization.
      What is the best initial management option to administer while waiting for hospital transfer for this patient?

      Your Answer:

      Correct Answer: IV furosemide

      Explanation:

      Management of Acute Left-Ventricular Failure: Initial Treatment Options

      Acute left-ventricular failure (LVF) with pulmonary oedema can be caused by various factors such as ischaemic heart disease, acute arrhythmias, and valvular heart disease. The initial management of this condition involves the use of intravenous (IV) diuretics, such as furosemide. However, other treatment options should be avoided or used with caution.

      Initial Treatment Options for Acute Left-Ventricular Failure with Pulmonary Oedema

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 11 - Which of the following statements about warfarin is accurate? ...

    Incorrect

    • Which of the following statements about warfarin is accurate?

      Your Answer:

      Correct Answer: Warfarin can be used when breastfeeding

      Explanation:

      Understanding Warfarin: Mechanism of Action, Indications, Monitoring, Factors, and Side-Effects

      Warfarin is an oral anticoagulant that has been widely used for many years to manage venous thromboembolism and reduce stroke risk in patients with atrial fibrillation. However, it has been largely replaced by direct oral anticoagulants (DOACs) due to their ease of use and lack of need for monitoring. Warfarin works by inhibiting epoxide reductase, which prevents the reduction of vitamin K to its active hydroquinone form. This, in turn, affects the carboxylation of clotting factor II, VII, IX, and X, as well as protein C.

      Warfarin is indicated for patients with mechanical heart valves, with the target INR depending on the valve type and location. Mitral valves generally require a higher INR than aortic valves. It is also used as a second-line treatment after DOACs for venous thromboembolism and atrial fibrillation, with target INRs of 2.5 and 3.5 for recurrent cases. Patients taking warfarin are monitored using the INR, which may take several days to achieve a stable level. Loading regimens and computer software are often used to adjust the dose.

      Factors that may potentiate warfarin include liver disease, P450 enzyme inhibitors, cranberry juice, drugs that displace warfarin from plasma albumin, and NSAIDs that inhibit platelet function. Warfarin may cause side-effects such as haemorrhage, teratogenic effects, skin necrosis, temporary procoagulant state, thrombosis, and purple toes.

      In summary, understanding the mechanism of action, indications, monitoring, factors, and side-effects of warfarin is crucial for its safe and effective use in patients. While it has been largely replaced by DOACs, warfarin remains an important treatment option for certain patients.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 12 - A 50-year-old man comes to see you to ask about travel to India...

    Incorrect

    • A 50-year-old man comes to see you to ask about travel to India to visit his relatives. He has been discharged recently from the local district general hospital after suffering an inferior myocardial infarction. He had an exercise test prior to discharge and has made a good recovery. He looks well wants to return to his family home to Mumbai to recuperate.

      According to the UK Civil Aviation Authority, what is the minimum time after an uncomplicated MI that he would be OK to fly home?

      Your Answer:

      Correct Answer: 7 days

      Explanation:

      Travel Restrictions After Myocardial Infarction

      After experiencing a myocardial infarction (MI), also known as a heart attack, patients may wonder when it is safe to travel by air. The minimum time for flying after an uncomplicated MI is generally accepted to be seven days, although some authorities suggest waiting up to three weeks. It is important to note that this question specifically asks for the minimum time after an uncomplicated MI that would be safe for air travel.

      Consensus national guidance in the UK, including advice from the Civil Aviation Authority and British Airways, supports the seven-day minimum for uncomplicated MI. Patients who have had a complicated MI should wait four to six weeks before flying. Patients with severe angina may require oxygen during the flight and should pre-book a supply with the airline. Patients who have undergone coronary artery bypass graft (CABG) or suffered a stroke should not travel for ten days. Decompensated heart failure or uncontrolled hypertension are contraindications to flying.

      In summary, patients who have experienced an uncomplicated MI may fly after seven days without requiring an exercise test. It is important to follow national guidance and consult with a healthcare provider before making any travel plans after a heart attack.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 13 - You assess a 63-year-old man who has recently been released from a hospital...

    Incorrect

    • You assess a 63-year-old man who has recently been released from a hospital in Hungary after experiencing a heart attack. He presents a copy of an echocardiogram report indicating that his left ventricular ejection fraction is 38%. During the examination, you note that his pulse is regular at 78 beats per minute, his blood pressure is 124/72 mmHg, and his chest is clear. He is currently taking aspirin, simvastatin, and lisinopril. What would be the most appropriate course of action regarding his medication?

      Your Answer:

      Correct Answer: Add bisoprolol

      Explanation:

      The use of carvedilol and bisoprolol has been proven to decrease mortality in stable heart failure patients, while there is no evidence to support the use of other beta-blockers. NICE guidelines suggest that all individuals with heart failure should be prescribed both an ACE-inhibitor and a beta-blocker.

      Chronic heart failure can be managed through drug therapy, as outlined in the updated guidelines issued by NICE in 2018. While loop diuretics are useful in managing fluid overload, they do not reduce mortality in the long term. The first-line treatment for all patients is an ACE-inhibitor and a beta-blocker, with clinical judgement used to determine which one to start first. Aldosterone antagonists are the standard second-line treatment, but both ACE inhibitors and aldosterone antagonists can cause hyperkalaemia, so potassium levels should be monitored. SGLT-2 inhibitors are increasingly being used to manage heart failure with a reduced ejection fraction, as they reduce glucose reabsorption and increase urinary glucose excretion. Third-line treatment options include ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin, and cardiac resynchronisation therapy. Other treatments include annual influenza and one-off pneumococcal vaccines.

    • This question is part of the following fields:

      • Cardiovascular Health
      0
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  • Question 14 - A study investigated the effectiveness of a new statin therapy in preventing ischaemic...

    Incorrect

    • A study investigated the effectiveness of a new statin therapy in preventing ischaemic heart disease in a diabetic population aged 60 and above. Over a five year period, 1000 patients were randomly assigned to receive the new therapy and 1000 were given a placebo. The results showed that there were 150 myocardial infarcts (MI) in the placebo group and 100 in the group treated with the new statin. What is the number needed to treat to prevent one MI in this population?

      Your Answer:

      Correct Answer: 10

      Explanation:

      Understanding the Number Needed to Treat (NNT)

      When evaluating the efficacy of a treatment, it’s important to look beyond statistical significance and consider the practical impact on patients. The Number Needed to Treat (NNT) is a statistical figure that provides valuable information about the effectiveness of a treatment. For example, if 1000 patients are treated with a new statin for five years and 50 MIs are prevented, the NNT to prevent one MI is 20 (1000/50). This means that by treating just 20 patients, one MI can be prevented over a five-year period.

      The NNT can also be used to calculate cost economic data by factoring in the cost of the drug against the costs of treating and rehabilitating a patient with an MI. By understanding the NNT, healthcare professionals can make informed decisions about the most effective and cost-efficient treatments for their patients.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 15 - Which of the following is the least acknowledged side effect of sildenafil? ...

    Incorrect

    • Which of the following is the least acknowledged side effect of sildenafil?

      Your Answer:

      Correct Answer: Abnormal liver function tests

      Explanation:

      Phosphodiesterase type V inhibitors are medications used to treat erectile dysfunction and pulmonary hypertension. They work by increasing cGMP, which leads to relaxation of smooth muscles in blood vessels supplying the corpus cavernosum. The most well-known PDE5 inhibitor is sildenafil, also known as Viagra, which is taken about an hour before sexual activity. Other examples include tadalafil (Cialis) and vardenafil (Levitra), which have longer-lasting effects and can be taken regularly. However, these medications have contraindications, such as not being safe for patients taking nitrates or those with hypotension. They can also cause side effects such as visual disturbances, blue discolouration, and headaches. It is important to consult with a healthcare provider before taking PDE5 inhibitors.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 16 - A 55-year-old woman has started to experience episodes of pallor in the distal...

    Incorrect

    • A 55-year-old woman has started to experience episodes of pallor in the distal parts of the middle three digits of her hands. A feeling of pain and numbness and cyanosis follows this. Finally, the digits become red and feel warm. This first occurred around six months ago.
      Which of the following features is most suggestive that these symptoms occur secondary to an underlying disorder, rather than occurring in isolation?

      Your Answer:

      Correct Answer: Her age

      Explanation:

      Characteristics of Primary Raynaud’s Phenomenon

      Primary Raynaud’s phenomenon is a condition characterized by recurrent vasospasm of the fingers and toes, typically triggered by stress or cold exposure. Here are some key characteristics that can help distinguish primary Raynaud’s phenomenon from secondary disease:

      Age of onset: Symptoms that develop before age 30 are more likely to be primary Raynaud’s phenomenon, while later onset may suggest an underlying autoimmune disorder.

      Gender: Primary Raynaud’s phenomenon is more common in females than males.

      Digital ulceration: Absence of digital ulceration is more likely to indicate primary Raynaud’s phenomenon, while secondary disease is associated with more severe symptoms.

      Antinuclear antibody: The presence of an antinuclear antibody may suggest an underlying condition, while its absence is more associated with primary Raynaud’s phenomenon.

      Symmetry: Symmetrical involvement of digits is more indicative of primary Raynaud’s phenomenon and the absence of an underlying disorder.

      By considering these characteristics, healthcare providers can better diagnose and manage patients with primary Raynaud’s phenomenon.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 17 - An 80-year-old woman presents with a leg ulcer above the right medial malleolus....

    Incorrect

    • An 80-year-old woman presents with a leg ulcer above the right medial malleolus. Compression bandaging is being considered as a treatment option. Without diabetes, what is the minimum ankle-brachial pressure index (ABPI) recommended by SIGN guidelines to ensure the safety of compression bandaging?

      Your Answer:

      Correct Answer: 0.8

      Explanation:

      It is safe to use compression therapy for patients with leg ulcers who have an ABPI of 0.8 or higher.

      Ankle-Brachial Pressure Index for Evaluating Peripheral Arterial Disease

      The ankle-brachial pressure index (ABPI) is a diagnostic tool used to evaluate peripheral arterial disease (PAD). It measures the ratio of systolic blood pressure in the lower leg to that in the arms. A lower blood pressure in the legs, resulting in an ABPI of less than 1, is an indicator of PAD. This test is particularly useful in evaluating patients with suspected PAD, such as a male smoker who presents with intermittent claudication.

      In addition, it is important to determine the ABPI in patients with leg ulcers. Compression bandaging is often used to treat venous ulcers, but it can be harmful in patients with PAD as it further restricts blood supply to the foot. Therefore, ABPIs should always be measured in patients with leg ulcers to determine if compression bandaging is appropriate.

      The interpretation of ABPI values is as follows: a value greater than 1.2 may indicate calcified, stiff arteries, which can be seen in advanced age or PAD. A value between 1.0 and 1.2 is considered normal, while a value between 0.9 and 1.0 is acceptable. A value less than 0.9 is likely indicative of PAD, and values less than 0.5 indicate severe disease that requires urgent referral. The ABPI is a reliable test, with values less than 0.90 having a sensitivity of 90% and a specificity of 98% for PAD. Compression bandaging is generally considered acceptable if the ABPI is greater than or equal to 0.8.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 18 - What is the only true statement about high blood pressure from the given...

    Incorrect

    • What is the only true statement about high blood pressure from the given list?

      Your Answer:

      Correct Answer: Treatment of hypertension reduces the risk of coronary heart disease by approximately 20%.

      Explanation:

      Understanding Hypertension: Prevalence, Types, and Treatment

      Hypertension, or high blood pressure, is a common condition that affects both men and women, with its prevalence increasing with age. Essential hypertension, which has no identifiable cause, is the most common type of hypertension, affecting 95% of hypertensive patients. However, indications for further evaluation include resistant hypertension and early, late, or rapid onset of high blood pressure.

      Reducing blood pressure by an average of 12/6 mm Hg can significantly reduce the risk of stroke and coronary heart disease. Salt restriction, alcohol reduction, smoking cessation, aerobic exercise, and weight loss can also help reduce blood pressure by 3-5 mmHg, comparable to some drug treatments.

      In severe cases, hypertension can lead to target organ damage, resulting in a hypertensive emergency. Malignant hypertension, which is diagnosed when papilloedema is present, can cause symptoms such as severe headache, visual disturbance, dyspnoea, chest pain, nausea, and neurological deficit.

      Understanding hypertension and its types is crucial in managing and treating this condition. By implementing lifestyle changes and seeking medical attention when necessary, individuals can reduce their risk of hypertension-related complications.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 19 - Which of the following is the least acknowledged in individuals who are prescribed...

    Incorrect

    • Which of the following is the least acknowledged in individuals who are prescribed amiodarone medication?

      Your Answer:

      Correct Answer: Gynaecomastia

      Explanation:

      Gynaecomastia can be caused by drugs such as spironolactone, which is the most frequent cause, as well as cimetidine and digoxin.

      Adverse Effects and Drug Interactions of Amiodarone

      Amiodarone is a medication used to treat irregular heartbeats. However, its use can lead to several adverse effects. One of the most common adverse effects is thyroid dysfunction, which can manifest as either hypothyroidism or hyperthyroidism. Other adverse effects include corneal deposits, pulmonary fibrosis or pneumonitis, liver fibrosis or hepatitis, peripheral neuropathy, myopathy, photosensitivity, a slate-grey appearance, thrombophlebitis, injection site reactions, bradycardia, and lengthening of the QT interval.

      It is also important to note that amiodarone can interact with other medications. For example, it can decrease the metabolism of warfarin, leading to an increased INR. Additionally, it can increase digoxin levels. Therefore, it is crucial to monitor patients closely for adverse effects and drug interactions when using amiodarone. Proper management and monitoring can help minimize the risks associated with this medication.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 20 - A 50-year-old woman, who has a history of atrial fibrillation and is receiving...

    Incorrect

    • A 50-year-old woman, who has a history of atrial fibrillation and is receiving warfarin and digoxin, tells you that she has been feeling low lately and has been self medicating with St John's wort which she bought from a health store.

      Which of the following interactions can be anticipated between St John's Wort and her current medication?

      Your Answer:

      Correct Answer: INR is likely to be reduced

      Explanation:

      St John’s Wort and Medication Interactions

      St John’s wort is a popular natural remedy for depressive symptoms. However, it is important to note that it is a liver enzyme inducer, which can lead to interactions with other medications. For example, St John’s wort may reduce the efficacy of warfarin, a blood thinner, requiring an increased dose to maintain the desired level of anticoagulation. It may also reduce the efficacy of digoxin, a medication used to treat heart failure. Therefore, it is important to discuss the use of St John’s wort with a healthcare provider before taking it in combination with other medications. By doing so, potential interactions can be identified and managed appropriately.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 21 - A 67-year-old patient is being evaluated post-hospitalization for chest pain and has been...

    Incorrect

    • A 67-year-old patient is being evaluated post-hospitalization for chest pain and has been prescribed standard release isosorbide mononitrate (ISMN) for ongoing angina. The medication instructions indicate taking it twice daily, but with an 8-hour interval between doses. What is the rationale behind this uneven dosing schedule?

      Your Answer:

      Correct Answer: Prevent nitrate tolerance

      Explanation:

      To prevent nitrate tolerance, it is recommended to use asymmetric dosing regimens for standard-release ISMN when taken regularly for angina relief. This involves taking the medication twice daily, with an 8-hour gap in between to create a nitrate-free period. It is important to note that nitrates only provide relief for angina symptoms and do not improve cardiovascular outcomes. While asymmetric dosing doesn’t affect the efficacy of nitrates, it can prevent tolerance from developing. However, patients should still be aware of potential adverse effects such as dizziness and headaches, which can occur even with asymmetric dosing. Proper counseling on these side effects can help prevent falls and discomfort.

      Angina pectoris can be managed through lifestyle changes, medication, percutaneous coronary intervention, and surgery. In 2011, NICE released guidelines for the management of stable angina. Medication is an important aspect of treatment, and all patients should receive aspirin and a statin unless there are contraindications. Sublingual glyceryl trinitrate can be used to abort angina attacks. NICE recommends using either a beta-blocker or a calcium channel blocker as first-line treatment, depending on the patient’s comorbidities, contraindications, and preferences. If a calcium channel blocker is used as monotherapy, a rate-limiting one such as verapamil or diltiazem should be used. If used in combination with a beta-blocker, a longer-acting dihydropyridine calcium channel blocker like amlodipine or modified-release nifedipine should be used. Beta-blockers should not be prescribed concurrently with verapamil due to the risk of complete heart block. If initial treatment is ineffective, medication should be increased to the maximum tolerated dose. If a patient is still symptomatic after monotherapy with a beta-blocker, a calcium channel blocker can be added, and vice versa. If a patient cannot tolerate the addition of a calcium channel blocker or a beta-blocker, long-acting nitrate, ivabradine, nicorandil, or ranolazine can be considered. If a patient is taking both a beta-blocker and a calcium-channel blocker, a third drug should only be added while awaiting assessment for PCI or CABG.

      Nitrate tolerance is a common issue for patients who take nitrates, leading to reduced efficacy. NICE advises patients who take standard-release isosorbide mononitrate to use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimize the development of nitrate tolerance. However, this effect is not seen in patients who take once-daily modified-release isosorbide mononitrate.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 22 - An 80 year old male underwent an ECG due to palpitations and was...

    Incorrect

    • An 80 year old male underwent an ECG due to palpitations and was found to have AF with a heart rate of 76 bpm. Upon further evaluation, you determine that he has permanent AF and a history of hypertension. If there are no contraindications, what would be the most suitable initial step to take at this point?

      Your Answer:

      Correct Answer: Direct oral anticoagulant

      Explanation:

      According to the patient’s CHADSVASC2 score, which is 4, they have a high risk of stroke due to factors such as congestive cardiac failure, hypertension, age over 75, and being female. As per NICE guidelines, all patients with a CHADSVASC score of 2 or more should be offered anticoagulation, while taking into account their bleeding risk using the ORBIT score. Direct oral anticoagulants are now preferred over warfarin as the first-line treatment. For men with a score of 1, anticoagulation should be considered. Beta-blockers or a rate-limiting calcium channel blocker should be offered first-line for rate control, while digoxin should only be used for sedentary patients.

      Atrial fibrillation (AF) is a condition that requires careful management, including the use of anticoagulation therapy. The latest guidelines from NICE recommend assessing the need for anticoagulation in all patients with a history of AF, regardless of whether they are currently experiencing symptoms. The CHA2DS2-VASc scoring system is used to determine the most appropriate anticoagulation strategy, with a score of 2 or more indicating the need for anticoagulation. However, it is important to ensure a transthoracic echocardiogram has been done to exclude valvular heart disease, which is an absolute indication for anticoagulation.

      When considering anticoagulation therapy, doctors must also assess the patient’s bleeding risk. NICE recommends using the ORBIT scoring system to formalize this risk assessment, taking into account factors such as haemoglobin levels, age, bleeding history, renal impairment, and treatment with antiplatelet agents. While there are no formal rules on how to act on the ORBIT score, individual patient factors should be considered. The risk of bleeding increases with a higher ORBIT score, with a score of 4-7 indicating a high risk of bleeding.

      For many years, warfarin was the anticoagulant of choice for AF. However, the development of direct oral anticoagulants (DOACs) has changed this. DOACs have the advantage of not requiring regular blood tests to check the INR and are now recommended as the first-line anticoagulant for patients with AF. The recommended DOACs for reducing stroke risk in AF are apixaban, dabigatran, edoxaban, and rivaroxaban. Warfarin is now used second-line, in patients where a DOAC is contraindicated or not tolerated. Aspirin is not recommended for reducing stroke risk in patients with AF.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 23 - A 50-year-old woman has been diagnosed with an unprovoked proximal deep vein thrombosis....

    Incorrect

    • A 50-year-old woman has been diagnosed with an unprovoked proximal deep vein thrombosis. What are the available treatment options for this condition?

      Your Answer:

      Correct Answer: Warfarin or Rivaroxaban or Dabigatran or Apixaban

      Explanation:

      Direct oral anticoagulants (DOACs) are medications used to prevent stroke in non-valvular atrial fibrillation (AF), as well as for the prevention and treatment of venous thromboembolism (VTE). To be prescribed DOACs for stroke prevention, patients must have certain risk factors, such as a prior stroke or transient ischaemic attack, age 75 or older, hypertension, diabetes mellitus, or heart failure. There are four DOACs available, each with a different mechanism of action and method of excretion. Dabigatran is a direct thrombin inhibitor, while rivaroxaban, apixaban, and edoxaban are direct factor Xa inhibitors. The majority of DOACs are excreted either through the kidneys or the liver, with the exception of apixaban and edoxaban, which are excreted through the feces. Reversal agents are available for dabigatran and rivaroxaban, but not for apixaban or edoxaban.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 24 - A 48-year-old man presents to the hypertension clinic with a recent diagnosis of...

    Incorrect

    • A 48-year-old man presents to the hypertension clinic with a recent diagnosis of high blood pressure. He has been on ramipril for three months, but despite titration up to 10 mg od, his blood pressure remains elevated at 156/92 mmHg.

      What would be the most suitable course of action for further management?

      Your Answer:

      Correct Answer: Add amlodipine OR indapamide

      Explanation:

      To improve control of hypertension in patients who are already taking an ACE inhibitor or an angiotensin receptor blocker, the 2019 NICE guidelines recommend adding either a calcium channel blocker (such as amlodipine) or a thiazide-like diuretic (such as indapamide). This is a change from previous guidelines, which only recommended adding a calcium channel blocker in this situation.

      Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of calcium channel blockers or thiazide-like diuretics in addition to ACE inhibitors or angiotensin receptor blockers.

      Lifestyle changes are also important in managing hypertension. Patients should aim for a low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruits and vegetables, exercise more, and lose weight.

      Treatment for hypertension depends on the patient’s blood pressure classification. For stage 1 hypertension with ABPM/HBPM readings of 135/85 mmHg or higher, treatment is recommended for patients under 80 years old with target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For stage 2 hypertension with ABPM/HBPM readings of 150/95 mmHg or higher, drug treatment is recommended regardless of age.

      The first-line treatment for patients under 55 years old or with a background of type 2 diabetes mellitus is an ACE inhibitor or angiotensin receptor blocker. Calcium channel blockers are recommended for patients over 55 years old or of black African or African-Caribbean origin. If a patient is already taking an ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or thiazide-like diuretic can be added.

      If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, NICE recommends seeking expert advice or adding a fourth drug. Blood pressure targets vary depending on age, with a target of 140/90 mmHg for patients under 80 years old and 150/90 mmHg for patients over 80 years old. Direct renin inhibitors, such as Aliskiren, may be used in patients who are intolerant of other antihypertensive drugs, but their role is currently limited.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 25 - A 45-year-old man is brought to the Emergency Department following a fall. He...

    Incorrect

    • A 45-year-old man is brought to the Emergency Department following a fall. He recalled rushing for the train before feeling dizzy. His father recently died suddenly because of a heart problem. On examination, he has a ‘jerky’ pulse, a thrusting apex beat with double impulse and a late ejection systolic murmur which diminishes on squatting.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Hypertrophic cardiomyopathy

      Explanation:

      Hypertrophic cardiomyopathy is a genetic heart condition that is the leading cause of sudden cardiac death in young people. It is characterized by an enlarged left ventricle, which can cause obstruction of blood flow. A jerky pulse and an intensifying systolic murmur during activities that decrease blood volume in the left ventricle are common examination findings. Aortic stenosis, Brugada syndrome, mitral regurgitation, and mitral valve prolapse are other heart conditions that have different symptoms and examination findings.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 26 - You start a patient on atorvastatin after their cholesterol was found to be...

    Incorrect

    • You start a patient on atorvastatin after their cholesterol was found to be raised in the context of a QRISK of 15%. You repeat the blood tests 6 months after starting treatment.

      Which of the following blood results does NICE recommend using to determine the next course of action?

      Your Answer:

      Correct Answer: Non-HDL cholesterol

      Explanation:

      Monitoring Statin Treatment for Primary Prevention

      Following the initiation of statin treatment for primary prevention, it is recommended to have a repeat blood test after 3 months. The non-HDL cholesterol level should be interpreted to guide the next steps in management. The goal of treatment is to reduce non-HDL levels by 40% of the patient’s baseline. If adherence, timing of the dose, and lifestyle measures are in place, an increase in dose may be necessary.

      It is not routine to investigate creatine kinase in this context, but it would be helpful to investigate unexplained muscle symptoms. Liver function tests are not an option, but NICE advises testing these 3 months and 12 months following statin initiation. If stable, no further monitoring for LFTs is required after this.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 27 - A 58-year-old man comes to his GP complaining of headaches and blurred vision...

    Incorrect

    • A 58-year-old man comes to his GP complaining of headaches and blurred vision that have been present for two days. He has been taking amlodipine 5 mg, which was prescribed at the same clinic two weeks ago. During the examination, his blood pressure is measured at 190/115 mmHg. Although his cardiovascular examination is unremarkable, retinal hemorrhages are observed during fundoscopy, but no papilledema is present. What is the best course of action for this patient?

      Your Answer:

      Correct Answer: Refer for urgent specialist care on the same day

      Explanation:

      NICE Guidelines for Referral to Specialist Care for Hypertension

      According to NICE guidelines, patients with accelerated hypertension or suspected phaeochromocytoma should be referred to specialist care on the same day. Accelerated hypertension is defined as having a blood pressure usually higher than 180/120 mmHg with signs of papilloedema and/or retinal haemorrhage. Suspected phaeochromocytoma is characterized by labile or postural hypotension, headache, palpitations, pallor, and diaphoresis.

      It is important to note that if a patient presents with a blood pressure higher than 180/120 mmHg, it is crucial to examine their fundi and check for the presence or absence of papilloedema or retinal haemorrhages. Additionally, healthcare professionals should consider the need for specialist investigations in patients with signs and symptoms suggesting a secondary cause of hypertension. By following these guidelines, healthcare professionals can ensure that patients receive appropriate and timely care for their hypertension.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 28 - A 45-year-old male with type 2 diabetes is struggling to manage his hypertension....

    Incorrect

    • A 45-year-old male with type 2 diabetes is struggling to manage his hypertension. Despite being on atenolol, amlodipine, and ramipril, his blood pressure consistently reads above 170/100 mmHg. During examination, he was found to have grade II hypertensive retinopathy. His test results show sodium levels at 144 mmol/L (137-144), potassium at 3.1 mmol/L (3.5-4.9), urea at 5.5 mmol/L (2.5-7.5), creatinine at 100 mol/L (60-110), glucose at 7.9 mmol/L (3.0-6.0), and HbA1c at 53 mmol/mol (20-46) or 7% (3.8-6.4). Additionally, his ECG revealed left ventricular hypertrophy. What potential diagnosis should be considered as a cause of his resistant hypertension?

      Your Answer:

      Correct Answer: Renal artery stenosis

      Explanation:

      Diagnosis of Primary Hyperaldosteronism

      This patient is experiencing resistant hypertension and has a low potassium concentration despite being on an angiotensin-converting enzyme inhibitor (ACEi), which should have increased their potassium levels. These symptoms are highly suggestive of primary hyperaldosteronism, which can be caused by either an adrenal adenoma (Conn syndrome) or bilateral adrenal hyperplasia.

      To diagnose primary hyperaldosteronism, doctors typically look for an elevated aldosterone:renin ratio, which is usually above 1000. This condition can be challenging to diagnose, but it is essential to do so as it can lead to severe complications if left untreated. By identifying the underlying cause of the patient’s symptoms, doctors can develop an effective treatment plan to manage their hypertension and potassium levels.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 29 - A 55-year-old man has been diagnosed with stage one hypertension without any signs...

    Incorrect

    • A 55-year-old man has been diagnosed with stage one hypertension without any signs of end-organ damage. As a first step, he is recommended to make lifestyle changes instead of taking medication.

      What are the most suitable lifestyle modifications to suggest?

      Your Answer:

      Correct Answer: A diet containing less than 6g of salt per day

      Explanation:

      For patients with hypertension, it is recommended to follow a low salt diet and aim for less than 6g/day, ideally 3g/day. Consuming a diet high in processed red meats may increase cardiovascular risk and blood pressure, although this is a topic of ongoing research and public opinion varies. While tea may contain a similar amount of caffeine as coffee, it is unlikely to reduce overall caffeine intake. The current exercise recommendation for hypertension is 30 minutes of moderate-intensity exercise, 5 days a week. It is recommended to limit alcohol intake in hypertension, and consuming 2 glasses of red wine, 5 days a week would exceed the recommended limits.

      Hypertension, or high blood pressure, is a common condition that can lead to serious health problems if left untreated. The National Institute for Health and Care Excellence (NICE) has published updated guidelines for the management of hypertension in 2019. Some of the key changes include lowering the threshold for treating stage 1 hypertension in patients under 80 years old, allowing the use of angiotensin receptor blockers instead of ACE inhibitors, and recommending the use of calcium channel blockers or thiazide-like diuretics in addition to ACE inhibitors or angiotensin receptor blockers.

      Lifestyle changes are also important in managing hypertension. Patients should aim for a low salt diet, reduce caffeine intake, stop smoking, drink less alcohol, eat a balanced diet rich in fruits and vegetables, exercise more, and lose weight.

      Treatment for hypertension depends on the patient’s blood pressure classification. For stage 1 hypertension with ABPM/HBPM readings of 135/85 mmHg or higher, treatment is recommended for patients under 80 years old with target organ damage, established cardiovascular disease, renal disease, diabetes, or a 10-year cardiovascular risk equivalent to 10% or greater. For stage 2 hypertension with ABPM/HBPM readings of 150/95 mmHg or higher, drug treatment is recommended regardless of age.

      The first-line treatment for patients under 55 years old or with a background of type 2 diabetes mellitus is an ACE inhibitor or angiotensin receptor blocker. Calcium channel blockers are recommended for patients over 55 years old or of black African or African-Caribbean origin. If a patient is already taking an ACE inhibitor or angiotensin receptor blocker, a calcium channel blocker or thiazide-like diuretic can be added.

      If blood pressure remains uncontrolled with the optimal or maximum tolerated doses of four drugs, NICE recommends seeking expert advice or adding a fourth drug. Blood pressure targets vary depending on age, with a target of 140/90 mmHg for patients under 80 years old and 150/90 mmHg for patients over 80 years old. Direct renin inhibitors, such as Aliskiren, may be used in patients who are intolerant of other antihypertensive drugs, but their role is currently limited.

    • This question is part of the following fields:

      • Cardiovascular Health
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  • Question 30 - A 39-year-old man presents with gingival hypertrophy.

    Which of his cardiac medications is likely...

    Incorrect

    • A 39-year-old man presents with gingival hypertrophy.

      Which of his cardiac medications is likely to be responsible?

      Your Answer:

      Correct Answer: Atenolol

      Explanation:

      Gingival Hypertrophy and Medications

      Gingival hypertrophy, or an overgrowth of gum tissue, can be caused by certain medications. Calcium channel blockers, such as amlodipine, as well as drugs like phenytoin and cyclosporin, have been associated with this side effect. It is important for patients taking these medications to maintain good oral hygiene and regularly visit their dentist to monitor any changes in their gum tissue. If gingival hypertrophy does occur, treatment options may include scaling and root planing, gingivectomy, or medication adjustments. Awareness of this potential side effect can help patients and healthcare providers make informed decisions about medication management.

    • This question is part of the following fields:

      • Cardiovascular Health
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SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiovascular Health (1/2) 50%
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