cardio

Question 1

Which ONE of the following lipid measurements is most useful, in association with DNA testing, to identify patients who have FH?

Answer 1

Low density lipoprotein cholesterol (LDL-C)

Question 2

ABPI measurements and interpretation

Answer 2

Less than 0.5 — suggests chronic limb-threatening ischaemia.
Refer the person urgently for specialist vascular assessment.
0.9 or less — suggests the presence of peripheral arterial disease.
Between 0.91 and 0.99 — peripheral arterial disease may be present.
Between 1.0 and 1.4 — is considered normal.
Greater than 1.4 — may suggest the presence of arterial calcification, such as in some people with diabetes, rheumatoid arthritis, systemic vasculitis, atherosclerotic disease, and advanced chronic renal failure.

Question 3

BP threshold with signs of end organ needing same day specialist referral

Answer 3

180/120

Question 4

step for third line management of htn

Answer 4

low dose spironolactone if K <=4.5, or alpha or beta blocker if K >4.5

Question 5

CHADSVASC

Answer 5

Congestive heart failure or left ventricular dysfunction
Hypertension
Age ≥75 **
Diabetes
Stroke or TIA **
Vascular disease (prior MI, peripheral artery disease, aortic plaque)
Age 65-74
Sex category (female)

Question 6

HTN treatment for patients with T2Dm irrespective of age or ethnicity

Answer 6

ACE or ARB

Question 7

HTN treatment , preferred for black people - second line

Answer 7

ARB over ACE

Question 8

HTN management- age, and ethnicity, t2dm

Answer 8

T2Dm - always ACe or arb regardless if age or race
Afro or black - always ccb regardless of age
55 or over - CCB
Less than 55 - ACE/ARB
T2DM - ACE or (ARB preferred for blacks)

Question 9

should be a core element of cardiac rehabilitation programmes, and there is increasing recognition that it reduces morbidity as well as mortality in men and women of all ages with previous MI, revascularisation or angina

Answer 9

Exercise-only rehabilitation

Question 10

Standard NICE guidelines for management of HTN apply to patients with ACR of

Answer 10

30mg/mmol or less

Question 11

fainting whilst shaving

Answer 11

Carotid sinus syndrome - usually due to head rotation

Question 12

MOST common clinical feature of familial hypercholesterolaemia

Answer 12

Tendon xanthomata

Question 13

common cause of renal artery stenosis on younger patients diagnosed with HTN

Answer 13

fibromuscular dysplasia

Question 14

QRISK3 is underestimated on patients with

Answer 14

skin and joint involvement

Question 15

Stages of HTN based on ABPM

Answer 15

135/85-149/94 - Stage 1
above 150/95 - Stage 2

Question 16

DAPT for MI up to how long

Answer 16

12 months

Question 17

Target of <140/90 BP on patients with (x3)

Answer 17

less than 80 with T2DM, T1DM ACR <70, CKD ACR <70

Question 18

classical diagnostic triad of sub-acute bacterial endocarditis

Answer 18

persistent fever, embolic events and new or changing murmurs

Question 19

anti-anginals to be avoided for patients with HCM

Answer 19

nitrates (ISMN)

Question 20

AF rate control, preferred

Answer 20

beta blocker or rate limiting CCB (diltiazem or verapamil)

Question 21

when to offer digoxin for patients with non pAF

Answer 21

person does no or little physical activity, other rate limiting drugs are ruled out due to comorbidities

Question 22

medication to prevent CVD risk for patients with PAD

Answer 22

clopidogrel

Question 23

ABPI threshold for use of compression banfage for PAD

Answer 23

0.8-1.3

Question 24

off work for uncomplicated MI doing heavy job

Answer 24

12 weeks

Question 25

uncomplicated MI, when to fly

Answer 25

7-10 days

Question 26

PCI after MI, when to drive

Answer 26

1 week

Question 27

likely cause of falsely elevated BNP (x4)

Answer 27

AF, CKD, COPD, T2DM

Question 28

time limit for thrombolysis for stroke

Answer 28

4.5 hours

Question 29

MOST appropriate first-line drug to control the heart rate in atrial fibrillation (AF)

Answer 29

Bisoprolol

Question 30

referral based on BNP (for echo)

Answer 30

400-2000 - refer within 6 weeks more than 2000 - refer within 2 weeks

Question 31

Patients with rest pain are at significant risk with approximately what % dying within a year and what% requiring a major lower limb amputation.

Answer 31

25%, 33%

Question 32

The National Institute for Health and Care Excellence (NICE) guideline recommends that the following groups of people with these conditions should be assumed to be at high risk and do NOT require risk assessment with a scoring system (3x)

Answer 32

Patients with type 1 diabetes who: are aged more than 40 years have had diabetes for more than 10 years or have established nephropathy have other CVD risk factors. Patients with chronic kidney disease stage 3 or beyond. Patients with familial hypercholesterolaemia.

Question 33

recent MI with PCI, increasing chest pain and fevers. Pain improves on sitting forward

Answer 33

Dressler’s syndrome

Question 34

Wells score system should not be applied to

Answer 34

females who are pregnant or within the puerperal period (six weeks post gestation)

Question 35

beta-blocker licensed in the uk for heart failure (3x)

Answer 35

Bisoprolol, carvedilol and nebivolol

Question 36

suffered a deep venous thrombosis to her right leg a year ago comes to see you with ongoing swelling, hyperpigmentation, dermatitis and lipodermatosclerosis

Answer 36

Post-thrombotic syndrome

Question 37

which ONE of the direct oral anticoagulants (DOACs) can dialysis be used to reduce the plasma levels, in cases of overdose or accidental ingestion

Answer 37

Dabigatran

Question 38

antihypertensive drug to cause gynaecomastia

Answer 38

Spironolactone, ramipril (ace)

Question 39

Which of the following lipid profile results is part of the Simon Broome diagnostic criteria for identifying individuals with familial hypercholesterolaemia

Answer 39

TC > 7.5 mmol/l and LDL-C > 4.9 mmol/l

Question 40

people with CKD and diabetes, or those with an albumin:creatinine ratio (ACR) of 70 mg/mmol or more, the target blood pressure should be

Answer 40

below 130/80 mmHg

Question 41

people with CKD the target is to keep the blood pressure

Answer 41

below 140/90 mmHg

Question 42

co-morbid hypertension and/or angina in patients with heart failure - medication should be avoided

Answer 42

verapamil, diltiazem or short-acting dihydropyridine agents

Question 43

When using home blood pressure readings to confirm a diagnosis of hypertension, which is the SINGLE MOST appropriate advice about the recommended number of recordings?

Answer 43

Twice daily for seven days

Question 44

if gtn not tolerated for angina, give?

Answer 44

nifedipine

Question 45

thiazide-like diuretic as third line for htn

Answer 45

indapamide or chlortalidone

Question 46

wgen to check renal function after starting ace inhibitor

Answer 46

1-2 weeks

Question 47

diuretic for gut oedema

Answer 47

bumetanide

Question 48

MOST common clinical feature of familial hypercholesterolaemia

Answer 48

Tendon xanthomata

Question 49

pansystolic murmur heard at apex radiates to axilla

Answer 49

mitral regurgitation

Question 50

which ccb to use with beta blocker for angina

Answer 50

dihydro - amolodipine, dipines (diltiazem - nondihydro - use if betablocker contraindicated)

Question 51

hould be considered for the treatment of intermittent claudication when supervised exercise has not led to satisfactory improvement and the patient prefers not to be referred for consideration of angioplasty or bypass surgery

Answer 51

Naftidrofuryl oxalate

Question 52

What is the target total cholesterol level for primary prevention of cardiovascular disease?

Answer 52

No target level but aim for 40% reduction

Question 53

What is the SINGLE MOST important primary objective for GPs optimising patients with atrial fibrillation for surgery?

Answer 53

Rate control

Question 54

no heavy activity for how many weeks after uncomplicated mi

Answer 54

12 weeks

Question 55

Which single additional clinical sign is the SINGLE MOST predictive of chronic heart failure?

Answer 55

Elevated jugular venous pressure

Question 56

recommended for the prevention of occlusive vascular events in patients with peripheral arterial disease

Answer 56

clopidogrel