Management of Chronic Conditions

Question 1

What is the first line treatment for hypertension in under 55s?

Answer 1

ACEi (e.g. lisinopril) or ARB (e.g. losartan), unless Black, in which case CCB (e.g. amlodipine)

Question 2

What is the first line treatment for hypertension in T2DM?

Answer 2

ACEi (e.g. lisinopril) or ARB (e.g. losartan)

Question 3

What is the first line treatment for hypertension in >55s?

Answer 3

CCB (e.g. amlodipine)

Question 4

State the components of the CHA2DS2-VASc score

Answer 4

Congestive or left HF, hypertension, age 75+ (2pts), diabetes mellitus, stroke/TIA (2pts), vascular disease, age 65-74, sex female

Question 5

State the components of the HAS-BLED score

Answer 5

Hypertension, abnormal renal or liver function (Cr >200 or known dialysis/transplant, bilirubin 2x normal, other LFTs 3x normal), stroke, bleeding tendency, labile INR, elderly >65

Question 6

State the criteria for rhythm control in AF

Answer 6

<48h of onset, young, symptomatic

Question 7

Name the drugs used for chemical cardioversion in AF

Answer 7

Flecanide (if no structural heart disease), amiodarone (if structural heart disease)

Question 8

Describe the first line management of stable angina pectoris

Answer 8

GTN spray as required, secondary prevention (aspirin, statin), anti-anginal (either beta blocker or CCB)

Question 9

Describe the first line management of asthma

Answer 9

Low dose ICS plus salbutamol as required

Question 10

Describe the second line management of asthma

Answer 10

Low dose ICS plus inhaled LABA plus salbutamol as required

Question 11

Describe the third line management of asthma

Answer 11

Medium dose ICS or low dose ICS plus LTRA, with or without LABA, plus salbutamol as required

Question 12

Describe the cardiovascular risk management required in T2DM

Answer 12

Aspirin 75mg od if any cardiovascular risk factors or over 50, atorvastatin 20mg od if any RFs or over 40

Question 13

Describe the first-line management for T2DM with HbA1c >48mmol/l on lifestyle therapy

Answer 13

Metformin. If metformin contraindicated, pioglitazone, a sulphonylurea (e.g. gliclazide), or a DPP-4i (e.g. sitagliptin)

Question 14

Describe the first line management for T2DM with HbA1c >58mmol/l

Answer 14

Metformin plus a DPP-4i (e.g. sitagliptin) or a sulphonylurea (e.g. gliclazide) or pioglitazone

Question 15

Describe the first line options for treating myoclonic seizures

Answer 15

Valproate or levetiracetam

Question 16

Describe the first line options for treating tonic seizures

Answer 16

Valproate or lamotrigine

Question 17

Describe the first line options for treating focal seizures (other than myoclonic and tonic seizures)

Answer 17

Carbamazepine or lamotrigine

Question 18

Describe the first line options for treating absence seizures

Answer 18

Ethosuximide or valproate

Question 19

Describe the first line options for treating generalised tonic-clonic seizures

Answer 19

Valproate or lamotrigine

Question 20

State the 3 drugs which can be used in mild to moderate Alzheimer’s disease

Answer 20

Donepezil, rivastigmine, galantamine

Question 21

State the one drug which can be used in moderate to severe Alzheimer’s disease

Answer 21

Memantine

Question 22

Name 2 stimulant laxatives

Answer 22

Senna, bisacodyl

Question 23

Name an osmotic laxative

Answer 23

Lactulose

Question 24

State the main side effects of lamotrigine

Answer 24

Rash, rarely Stevens-Johnson syndrome

Question 25

State the main side effects of carbamazepine

Answer 25

Rash, dysarthria, ataxia, nystagmus, hyponatraemia

Question 26

State the main side effects of phenytoin

Answer 26

Ataxia, peripheral neuropathy, gingival hypertrophy, hepatotoxicity

Question 27

State the main side effects of sodium valproate

Answer 27

Tremor, teratogenicity, weight gain

Question 28

State the main side effects of levetiracetam

Answer 28

Fatigue, mood disorders, agitation