Exam Qs Flashcards
(8 cards)
For each of the statements below, select the single most appropriate medication from the list. Each option may be used once, more than once, or not at all.
A 50-year-old man with hypertension and a QRISK3 of 15% started Atorvastatin 20 mg three months ago. His baseline LDL was 4.2 mmol/L. What is the most appropriate next step?
Question 100 Answer
A.
Atorvastatin 20 mg once daily
B.
Atorvastatin 80 mg once daily
C.
Bempedoic acid 180 mg once daily
D.
Discontinue treatment
E.
Ezetimibe 10 mg once daily
F.
Inclisiran SC injection
G.
PCSK9 inhibitor (e.g., Alirocumab)
H.
Repeat lipid profile in 3 months
Lipid levels should be reassessed 3 months after starting a statin.
Target: LDL reduction of ≥40%.
If target is not met, consider dose adjustment or adherence review.
A 58-year-old man with heterozygous familial hypercholesterolaemia (FH) has been taking Atorvastatin 80 mg and Ezetimibe 10 mg for the past 6 months. His LDL remains above 3.5 mmol/L, despite good adherence to treatment. What is the most appropriate next step?
Question 101 Answer
A.
Atorvastatin 20 mg once daily
B.
Atorvastatin 80 mg once daily
C.
Bempedoic acid 180 mg once daily
D.
Discontinue treatment
E.
Ezetimibe 10 mg once daily
F.
Inclisiran SC injection
G.
PCSK9 inhibitor (e.g., Alirocumab)
H.
Repeat lipid profile in 3 months
The National Institute for Health and Care Excellence (NICE) technology appraisal guidance recommends inclisiran as an option for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia as an adjunct to diet in adults only if [NICE, 2021b]:
There is a history of acute coronary syndrome (such as myocardial infarction or unstable angina needing hospitalization), coronary or other arterial revascularization procedures, coronary heart disease, ischaemic stroke, or peripheral arterial disease, and LDL cholesterol concentrations are persistently 2.6 mmol/L or more, despite maximum tolerated lipid-lowering treatment (that is, maximum tolerated statins with or without other lipid-lowering treatments or other lipid-lowering treatments when statins are not tolerated or are contraindicated).
Inclisiran is recommended only in research for treating primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia in adults who have no history of cardiovascular events. This research is in the form of a clinical trial currently in development.
It is a small interfering RNA therapy that inhibits PCSK9 synthesis, leading to increased LDL receptor activity and greater LDL clearance.
Inclisiran is given by subcutaneous injection. The recommended dosage is initially 284 mg for 1 dose, then 284 mg after 3 months for 1 dose, then 284 mg every 6 months.
https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/management/primary-prevention-of-cvd/
https://cks.nice.org.uk/topics/lipid-modification-cvd-prevention/prescribing-information/inclisiran/
Exam Framework: CVS
The correct answer is: Inclisiran SC injection
A 65-year-old woman with a history of stable angina and a QRISK3 score of 25% has been unable to tolerate multiple statins due to severe myalgia. She has been taking Ezetimibe 10 mg once daily for the past 3 months, but her LDL cholesterol remains high at 4.2 mmol/L. What is the most appropriate next step?
Question 102 Answer
A.
Atorvastatin 20 mg once daily
B.
Atorvastatin 80 mg once daily
C.
Bempedoic acid 180 mg once daily
D.
Discontinue treatment
E.
Ezetimibe 10 mg once daily
F.
Inclisiran SC injection
G.
PCSK9 inhibitor (e.g., Alirocumab)
H.
Repeat lipid profile in 3 months
Bempedoic acid is recommended for patients who cannot tolerate statins and have an inadequate response to ezetimibe alone.
It works by inhibiting ATP citrate lyase, reducing cholesterol synthesis in the liver.
Can be used as monotherapy or in combination with ezetimibe.
A 68-year-old male patient has been diagnosed with non-valvular atrial fibrillation (AF). He has no history of stroke or transient ischemic attacks (TIA), and he does not have significant renal or hepatic impairment. His CHA2DS2-VASc score is 3, and his HAS-BLED score is 2, indicating a moderate risk of stroke and a moderate risk of bleeding. The patient expresses a preference for a once-daily medication.
Which of the following medications is most appropriate for stroke prevention in this patient?
Question 90 Answer
A.
Aspirin
B.
Apixaban
C.
Dabigatran
D.
Edoxaban
E.
Warfarin
Edoxaban - Edoxaban: A DOAC that can be taken once daily. It is an oral Factor Xa inhibitor that provides effective stroke prevention in non-valvular AF and aligns with the patient’s preference for a once-daily medication
Offer anticoagulation with a direct-acting oral anticoagulant (DOAC) first-line if a person has AF and a CHA2DS2-VASc score of 2 or above, and consider a DOAC for a man with AF and a CHA2DS2-VASc score of 1, taking into account the risk of bleeding.
Both dabigatran and apixiban would be twice daily so wouldn’t fit the patient’s preference.
A 68-year-old man with a history of hypertension and atrial fibrillation is brought to A&E by paramedics. His wife found him disoriented and confused at home. She reports he’s been increasingly anxious and depressed lately, and she discovered an empty pill bottle of his heart medication. He’s currently bradycardic and hypotensive.
In which of the following beta-blockers, is there an under-recognised risk of toxicity in overdose?
Question 50 Answer
A.
Atenolol
B.
Bisoprolol fumarate
C.
Celiprolol hydrochloride
D.
Propranolol hydrochloride
E.
Sotalol hydrochloride
There is an under-recognised risk of toxicity of propranolol in overdose.
A 49-year-old male patient presents to the emergency department with symptoms consistent with STEMI. After assessment, it is determined that the patient is not eligible for reperfusion therapy. The patient has low bleeding risk. The healthcare team is focusing on medical management to reduce the risk of complications. What is the most appropriate medical management for this patient?
Question 112 Answer
A.
Angiography
B.
Aspirin with clopidogrel
C.
Aspirin with prasugrel
D.
Aspirin with ticagrelor
E.
Clopidogrel
F.
Fibrinolysis
G.
Primary Percutaneous Coronary Intervention (PCI)
H.
Ticagrelor
ASPIRIN AND TICAGRELOR
In patients with STEMI who are not eligible for reperfusion therapy (i.e., they cannot undergo primary PCI or receive fibrinolysis), the goal is to provide effective medical management to prevent thrombus formation and minimize complications. The NICE guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and ticagrelor for these patients. Consider clopidogrel with aspirin, or aspirin alone, for high bleeding risk.
A 62-year-old patient with STEMI arrives at the emergency department, and the healthcare team is preparing for an imminent PCI. The patient is on edoxaban therapy due to a history of atrial fibrillation. Which of the following should be administered immediately to the patient as part of the early management?
Question 111 Answer
A.
Angiography
B.
Aspirin with clopidogrel
C.
Aspirin with prasugrel
D.
Aspirin with ticagrelor
E.
Clopidogrel
F.
Fibrinolysis
G.
Primary Percutaneous Coronary Intervention (PCI)
H.
Ticagrelor
ASPIRIN AND CLOP
NICE guidelines recommend that for patients with STEMI who are already on an oral anticoagulant (such as edoxaban), the management involves dual antiplatelet therapy (DAPT) using aspirin and clopidogrel.
Aspirin with prasugrel would be offered if not already taking an anticoagulant. For people aged 75 and over, think about whether risk of bleeding with prasugrel outweighs its effectiveness ; if so offer ticagrelor or clopidogrel as alternatives.
A patient presents with symptoms consistent with a ST-elevation myocardial infarction (STEMI) and is within 10 hours of symptom onset. The local hospital does not have PCI capability, and the patient cannot be transferred to a PCI centre. What is the most appropriate management for reperfusion therapy?
Question 110 Answer
A.
Angiography
B.
Aspirin with clopidogrel
C.
Aspirin with prasugrel
D.
Aspirin with ticagrelor
E.
Clopidogrel
F.
Fibrinolysis
G.
Primary Percutaneous Coronary Intervention (PCI)
H.
Ticagrelor
Fibrinolysis
According to NICE guidelines, fibrinolysis should be offered to patients with STEMI who present within 12 hours of symptom onset and are unable to access PCI within 120 minutes. Fibrinolysis is the preferred treatment when PCI cannot be performed in a timely manner. If the patient presents later than 12 hours, fibrinolysis is generally not recommended unless there is ongoing ischemia.
