5.

Question 1

What ST depressions in anterior leads (V1-V4) can mean?

Answer 1

Either of:

• anterior ischaemia: stable/unstable angina
• posterior infarction: add leads V7-V9 posteriorly to confirm ST elevation

Question 2

Management of stable angina

Answer 2

• GTN spray as required (for symptomatic relief)
• Secondary prevention: consider aspirin, statin and CV risk modification
• one anti-anginal drug, either b-blocker or CCB
• if still symptomatic - increase doses
• if still symptomatic: add either of the above or long-acting nitrate (isosorbide mononitrate) or potassium channel activator (nicorandil)
• if still uncontrolled: PCI or CABG

Question 3

Contraindications for b-blocker

Answer 3

• hypotension
• bradycardia
• asthma
• acute HF

Question 4

Contraindications for CCB

Answer 4

• hypotension
• bradycardia
• peripheral oedema

Question 5

When to add aspirin in the management of diabetes?

Answer 5

Add 75mg Aspirin in diabetic patient if:

• over 50 years age in T2DM
• significant CV factor

Question 6

When to add atorvastatin in management of diabetes?

Answer 6

20 mg Atorvastatin if:

• significant CV risk factor
• >50 age in T2DM

Question 7

ACE-inhibitor and impact on renal system

Answer 7

ACE-inhibitor in:

• chronic setting: cardiovascular + renal protection
• acute setting: can worsen AKI

Question 8

What to do if ACR in a diabetic patient is >/3 mg/mmol?

Answer 8

add ACE-inhibitor

Question 9

1 st choice for Parkinson’s therapy?

Answer 9

Co- beneldopa or Co - Careldopa

(i.e. levodopa combined with peripheral dopa decarboxylase inhibitor: benserazide or carbidopa respectively)

Question 10

1st line therapy if a patient present with very mild Parkinson’s or concerned about a finite period of benefit from levodopa (2)

Answer 10

• dopamine agonist: ropinirole

OR

• monoamine oxidase (MAO) inhibitor: rasagiline

Question 11

First choice of anti-epileptic for myoclonic seizures

Answer 11

• Man: Valproate
• Female: Levetiracetam

Question 12

When epilepsy is diagnosed?

Answer 12

• two unprovoked seizures

Or

x1 unprovoked seizure and:

• >60% risk of recurrence in the next 10 years (abnormal MRI or EEG)

Question 13

Anti-epileptic treatment for tonic seizures

Answer 13

• Male: Valproate
• Female: Lamotrigine

Question 14

Treatment options for focal seizures

Answer 14

Carbamazepine or Lamotrigine

Question 15

Treatment options for absence seizures

Answer 15

ethosuximide or valproate

Question 16

Treatment options for generalised tonic-clonic seizures

Answer 16

• valproate for males
• lamotrigine for females

Question 17

Medical treatment for mild dementia

Answer 17

Acetylcholinesterase (AChE) inhibitors

3 licensed drugs (but all must be started only by a specialist):

• donepezil
• rivastigmine
• galantamine

Question 18

Medicine for moderate/severe dementia

Answer 18

NMDA antagonist

Memantine

Question 19

SEs of Lamotrigine

Answer 19

• rash
• Stevens-Johnson syndrome (rare)

Question 20

SEs of Carbamazepine

Answer 20

• rash
• dysarthria
• ataxia
• nystagmus
• low sodium