CVS

Question 1

How to estimate CVS risk

Answer 1

QRISK2 score (online)

Question 2

At what QRISK score are statins started

Answer 2

10yr risk of 10%

Question 3

Medical mx of smoking cessation

Answer 3

Nicotine replacement therapy NRT
Bupropion
Varenicline
E-cigarettes

Question 4

Different forms of NRT

Answer 4

patch
gum
inhalors
lozenges
sprays

Question 5

Bupropion mech of action

Answer 5

affects addictive behaviour in brain

antidepressant

Question 6

Advise on Bupropion use

Answer 6

8 week course
stop smoking in 1-2 wks through the course
doubles the chance of quitting after 3 mo

Question 7

CI to bupropion

Answer 7

epilepsy
bipolar
eating disorder
breast feeding

Question 8

CI to NRT

Answer 8

None

Question 9

Varenicline mech of action

Answer 9

partial agonist of nicotine receptor

reduces cravings and rewarding effect of smoking

Question 10

Varenicline vs bupropion

Answer 10

v= more effective, but more SEs so prescribed less often

Question 11

E-cigs mech of action

Answer 11

deliver vaporised nicotine

Question 12

BP and age

Answer 12

BP increases with age

Question 13

How many times to measure BP in clinic if high first time

Answer 13

If HTN at 1st, repeat, if significantly lower, repeat again

BP= lowest of the last 2 measurements

Question 14

What to do if someone is hypertensive in clinic

Answer 14

Ambulatory BP monitoring (ABPM) 24HRS
or
Home BP monitoring (HBPM) over 7 days

Question 15

Whats involved in HBPM

Answer 15

7 days, twice daily measurements

BP= average of all readings

Question 16

Stages of HTN

Answer 16

Stage 1 : >140/90 or A/H BPM >135/85
Stage 2: >160/100 or A/H BPM > 150/95
Severe: clinic >180/110

Question 17

Lifestyle advice for HTN

Answer 17

stop smoking
increase exercise
reduce salt intake
moderate alcohol consumption

Question 18

When to medically rx HTN

Answer 18

If severe (even before A/H BPM) or stage 2 HTN
Stage1 HTN with high QRISK (>20%)

Question 19

HTN meds

Answer 19

CADB or ACDB (if <55)

1) If <55, ACEi or ARB. CCB if >55 or black
2) ACEi/ARB + CCB
3) ACEi/ARB + CCB + diuretic (Thiazides)
4) (resistant hypertension) Another diuretic (spironolactone) or β or α blockers

Question 20

example of thiazides used for HTN

Answer 20

Indapamide

Question 21

Which 2 drugs should be avoided together if poss in HTN?

Answer 21

B blockers and thiazides

impairs glucose tolerance and induces DM

Question 22

When to consider specialist advice on chol/TG levels

Answer 22

Tot chol
> 7.5 + FH premature CHD (<50yo) 
> 9 
TG 
> 10 
> 4.5 + tot chol>7.5

Question 23

Starting dose of statins for primary prevention of CVD

Answer 23

atorvastatin 20 mg

Question 24

SEs of statins

Answer 24

• GI upset (consider milder simvastatin)
• Myalgia, myopathy, rhabdomyolysis
• Liver function
• DM

Question 25

Which bloods need to be tested for statins and when

Answer 25

at start, 3 and 12 mo liver transaminases if >3 times normal, stop

Question 26

Diet advice for CVS risk

Answer 26

1. reduce sat fats and cholesterol 2. increase mono-unsat fat intake (eg olive oil) 3. use wholegrain varieties of starch 4. reduce sugar intake 5. eat 5 fruit/veg a day 6. eat 2 portions of fish, 1 oily fish /wk 7. eat 4 portions of unsalted nuts, seeds /wk 8. limit alcohol to 14 units/wk

Question 27

Exercise advice for CVS risk

Answer 27

Per wk: - 150min moderate aerobic or 75min high intensity - 2 days of muscle strengthening (all muscles each time)

Question 28

Secondary prevention post MI

Answer 28

- ACEi or ARB - 75 mg Aspirin + 12mo of clopidogrel (or anticoagulation + aspirin for AF) - BB 12mo (for life if L ventricular problem) - 80 mg atorvastatin

Question 29

Driving restriction post MI

Answer 29

4 wks or 6 (for bus/lorry drivers)

Question 30

BP measurement different devices

Answer 30

Aneroid (tends to under-read) Mercury (most accurate, but safety issues) Electronic

Question 31

How to select the correct cuff for bp

Answer 31

in adults: - a cuff's bladder length should be >2/3 of circumference of the arm - a cuff's bladder height should be >1/2 of circumference of the arm

Question 32

How does too big of a cuff affect readings

Answer 32

gives BP lower than it is

Question 33

How does too small of a cuff affect readings

Answer 33

gives BP higher than it is

Question 34

Which arm normally gives a higher BP

Answer 34

right (always use right to record BP)

Question 35

Normal variation in BP between 2 arms

Answer 35

10 mmHg

Question 36

Pulsus paradoxus

Answer 36

BP goes down on inspiration

Question 37

How much BP difference is normal between inspiration and expiration

Answer 37

5 mmHg | more than 10 pathological

Question 38

Causes of pathological pulsus paradoxus

Answer 38

cardiac tamponade constrictive pericarditis severe asthma emphysema