Cardiovascular in GP

Question 1

What are the risk factors for CVD?

Answer 1

• High BP
• Diabetes
• Obesity
• Raised cholesterol
• Smoking
• Alcohol drinking exceeding guidelines
• Lack of physical activity
• Socioeconomic deprevation

Question 2

How much moderate or vigorous physical activity should a person get a week?

Answer 2

Moderate = 150 minutes (2.5hrs)

Vigorous = 75 minutes (1hr 15)

Question 3

After what age does the risk of stroke double after every decade?

Answer 3

55

Question 4

Risk of CVD is greater in men than both pre and post menopausal women. True or false?

Answer 4

False - it is higher than pre-menopausal women but the risk is similar once women pass the menopause

Question 5

What family history increases the risk of CVD?

Answer 5

A 1st degree male relative who had an MI before 55 or a female relative who had an MI before 65

Question 6

How often should those aged 40-74 have their CV risk assessed?

Answer 6

Every 5 years

Question 7

What categories of patients are not candidates for a CV risk assessment with QRISK?

Answer 7

• Type 1 diabetics
• > 85 years
• eGFR <60mL/min and/or albuminuria
• Pre-existing CVD
• Familial
  hypercholesterolaemia

Question 8

What are the UK alcohol guidelines

Answer 8

14 units max spread over at least 3 days

Question 9

Who should be considered for statin therapy for primary prevention?

Answer 9

• Patients with 10 year CV risk of ≥10%
• All patients with CKD
• All patients with type 1 diabetes who are over 40, have had diabetes for over 10 years or have other CV risk factors

Question 10

What is the BP treatment threshold for patients over 80?

Answer 10

150/90

Question 11

At what BP should treatment be started immediately without waiting for home or ambulatory BP monitoring

Answer 11

≥180/120

Question 12

At what BP and with what symptoms should patients be referred to hospital for a same-day specialist assessment?

Answer 12

≥180/120
\+
- Retinal haemorrhage /papilloedema 
- New confusion/chest pain/HF/AKI
- Symptoms of pheochromocytoma (headache/sweating/heart palpitations)

Question 13

What is the initial hypertension therapy for a patient with T2DM?

Answer 13

ACEi or ARB

Question 14

What are the BP targets for:

• Normal patients
• Patients over 80
• T2DM without CKD
• T2DM with CKD
• T1DM

Answer 14

• Normal = <140/90
• Over 80s = <150/90
• T2DM without CKD = <140/90
• T2DM with CKD = <130/80
• T1DM = 130/80

Question 15

What treatment should all patients who have had an acute MI get?

Answer 15

ACEi/ARD (indefinitely) 
\+ 
dual anti-platelet therapy eg clopidogrel + aspirin (12 months)
\+ 
aspirin (for life)
\+
beta blocker (12 months)
\+
statin eg atorvastatin 80mg

Question 16

What is the recommended daily salt intake?

Answer 16

<6g a day

Question 17

What is considered an unhealthy weight circumference in men and women?

Answer 17

Men = ≤ 94 cm
Women = ≤ 80cm

Question 18

Which 2 arteries are the most likely to be affected by PVD?

Answer 18

Femoral and popliteal

Question 19

What ABPI is considered to be abnormal (low)

Answer 19

≤0.9 - associated with 2 to 3 fold increase of total and CV death

Question 20

What class of medication should all patients with PAD be offered?

Answer 20

Statins

Question 21

What is the first line antiplatelet medication in PAD?

Answer 21

Clopidogrel