amk teach 21/05/2022

Question 1

BP of 152/89 then 149/88 what is the most appropriate management plan for this man

Answer 1

APBM

Question 2

before 4th hypertensive drug what should you do

Answer 2

confirm BP
Assess fro postural hypotension
discuss adherence

Question 3

4th drug for hypertension is what

Answer 3

low potassium - spironolactone

high potassium - alpha blocker

Question 4

when noe to use ACIE

Answer 4

breastfeeding or pregnancy, aortic stenosis , high potassium has they can cause hyperkaleai

Question 5

CCB used in hypertension what are they

Answer 5

dihydropyridines - amlodipine , nifedipine and felodipine

Question 6

caution for when not to use thiazides

Answer 6

high calcium , low potassium and low sodium and Addison’s

Question 7

in diabetics what sj0uld ou avoid

Answer 7

thiazides and beta blockers - ACEi first - same for CKD regardless of age

under 40 - underlying cause?

Question 8

walking up hill harder and chest becomes tight and pain goes away with rest - first line investigation considering most likely diagnosis

Answer 8

CT coronary angiogram

stable angina - chest tightness

Question 9

is diagnosed with stable angian - on aspire, atorvastatin and sublingual glycerol trinatre what else should be given

Answer 9

should also give bisoprolol

Question 10

what advice should be given to patients taking GTN fro angina for when to call an ambo

Answer 10

if pain is experienced, take one puff GTN. if pain docent settle in 5 minutes take another puff

Question 11

stable angina

Answer 11

constriction pain in chest, neck arm and or jaw
brought on by physical or emotional strain
relieved by rest of GTN within minutes

Question 12

unstable angian - ACS pain on rest over 20 minutes
nospeciifC ST and T wave normal trop non
often presents as worsening

Answer 12

prinzmental angina associated with recreational drug use, episodes of pain , midnight early morning - young patient

Question 13

stable angina gold standard

Answer 13

CT coronary angiogram - what next - cardiac MRI , stress echo, perfusion

Question 14

managing stable angina

Answer 14

conservative
first line is 75mg aspirin , 20mg atorvostatin, sublingual GTN and betablcoker/rate limiting CCB
second line - as above and BB and non rate limiting CCB - need to be careful of blockage though

third line - if drugs max dose fails refer to specialist - PCI ( stent) or CABG

Question 15

peripheral arterial disease - acutely 6Ps

embolus and thrombotic - doppler ultrasound

Answer 15

chronic peripheral arterial disease 
intermittent claudication 
pale and cold legs 
hair los
arterial ulcers - distal small and painful 
poor wound healing 
weak or absent peripheral pulses 

acute brachial pulse index

Question 16

peripheral arterial disease - acutely 6Ps

embolus and thrombotic - doppler ultrasound

Answer 16

chronic peripheral arterial disease 
intermittent claudication 
pale and cold legs 
hair los
arterial ulcers - distal small and painful 
poor wound healing 
weak or absent peripheral pulses 

acute brachial pulse index

1. supervised exercise +smoking cessation

Question 17

successful angioplasty when can you drive

if it wasn’t successful when can you drive

Answer 17

1 week

4 week

Question 18

acute management of stem

Answer 18

300mg aspirin

if able to perform PCI in 2 Horus - PCI if not firbinolyssi

Question 19

NS~TMEI or unstable angian management

Answer 19

300mg aspirin
haemodynampically stable
yes - grace score fondaparinuz - high then PCI if low clopidogrel or ticragelor
no - immediate PCI and unfractioned heparin

Question 20

all patients post MI need

Answer 20

ACEi 
BB
80mg stain 
75mg aspirin 
ticragelor 
echo 24-48hr 
refer to cardiac rehab