Cardiology

Question 1

Who should be assessed for CV Risk?

Answer 1

Age>40, borderline hypertension, CKD, T2DM, FH of CVD, severe psoriasis, RA, mental health, SLE, migraines+aura, erectile drugs.

Question 2

Who should be assumed high risk and should not get scored?

Answer 2

T1DM, CVD, >85y, familial hyperlipidaemia.

Question 3

What goes into Q-Risk calculation?

Answer 3

age, gender, BMI, ethnicity, postcode, smoking status, PMH, FH, BP, TC:HDL.

Question 4

How do you manage QRISK <10%?

Answer 4

lifestyle advice, review other comorbidities and treatment. Repeat in 5 years.

Question 5

How do you manage QRISK >10%?

Answer 5

lifestyle advice + atorvastatin 20 mg

Question 6

Treatment for T1DM w/out established CVD?

Answer 6

Offer atorvastatin 20mg if over 40y/o, DM for >10y, nephropathy or other CVD risk factors. Consider for everyone else.

Question 7

Treatment for T1DM with CVD?

Answer 7

Offer atorvastatin 80mg

Question 8

Managing >85y/o?

Answer 8

consider risk benefit

Question 9

Mgt of familial hyperlipidaemia?

Answer 9

specialist care

Question 10

CKD 3-5 or (ACR) >3 mgt?

Answer 10

atorvastatin 20mg

Question 11

established CVD mgt?

Answer 11

atorvastatin 80mg

Question 12

When do you initiate antihypertensive treatment?

Answer 12

EITHER stage 1 hypertension and end organ damage/CVD risk >20% OR Stage 2/Severe HT.

Question 13

Step 1 Antihypertensive treatment for someone aged <55 years?

Answer 13

ACE inhibitor

Question 14

Step 1 Antihypertensive treatment for someone aged >55 years or Black?

Answer 14

CCB (give thiazide diuretic like indapamide instead if HF)

Question 15

Step 2 anti-hypertensive treatment?

Answer 15

ACE-I + CCB

Question 16

Step 3 anti-hypertensive treatment?

Answer 16

ACE-I+CCB+Indapamide

Question 17

Precaution with adding diuretic in step 2 anti-hypertensive treatment?

Answer 17

if they use beta blockers could increase risk of diabetes.

Question 18

Step 4 anti-hypertensive treatment?

Answer 18

step 3 plus low dose spironolactone (if K<45) or alpha blocker or beta blocker.

Question 19

When would you consider a beta blocker in young people?

Answer 19

can’t use ACE-i, non menopausal women and increased sympathetic drive.

Question 20

When do you refer for ambulatory BP Monitory?

Answer 20

if BP >140/90 at clinic

Question 21

Investigations for end organ damage in people with suspected hypertension?

Answer 21

Urine (haematuria and ACR)
ECG
Fundoscopy
Bloods (gluc, U&Es, eGFR, cholesterol)

Question 22

When do you do investigations for end organ damage?

Answer 22

If BP >140/90 at clinic

Question 23

Normal ABPM reading and management?

Answer 23

<135/85. Monitor every 5 years (if above 60 then yearly monitoring)

Question 24

Stage 1 Hypertension values?

Answer 24

> 140/90 (ABPM >135/85)

Question 25

Stage 2 Hypertension values?

Answer 25

>160/100 (ABPM >150/95)

Question 26

Severe hypertension values?

Answer 26

>180/110

Question 27

How would you manage a S1 HT patient aged <40 years with no evidence of organ damage, CV/renal disease or diabetes?

Answer 27

Seek specialist help for secondary causes of hypertension

Question 28

What would make you offer anti hypertensive drug treatment to a patient under the age of 80 with S1 HT?

Answer 28

``` if they have: target organ damage CVD Renal disease Diabetes QRISK >20% ```

Question 29

Management for S2 HT?

Answer 29

offer anti-hypertensive drug treatment

Question 30

Management for severe hypertension?

Answer 30

consider starting anti hypertensive therapy immediately.

Question 31

When do you refer severe hypertension to specialist care?

Answer 31

if they have: accelerated HT (>180/110) + retinopathy Suspected phaechromocytoma

Question 32

Guideline for alcohol intake?

Answer 32

14 units per week with no more than 3 units per session.

Question 33

Secondary causes of hypertension?

Answer 33

OSA, hyperthyroid, hypothyroid, conn's, cushing's, phaeochromocytoma, RAS, CKD. DRUGS: NSAIDS, Illegal drugs, caffeine, OCP

Question 34

What would be first line for a patient with hypertension and diabetes and why?

Answer 34

ACE-I because it's cardio and renal protective

Question 35

1st line treatment for patient with HT and CKD?

Answer 35

ACE-I (cardio and renal protective)

Question 36

1st line treatment for a pt. with HT and HF

Answer 36

ACE-I (cardio and renal protective)

Question 37

1st line treatment for a pt. with hypertension and coronary artery disease?

Answer 37

beta blockers to reduce cardiac load

Question 38

1st line treatment for a pt. with HT and AF

Answer 38

CCB and beta blocker for rate control

Question 39

1st line treatment for a pt. with HT and BPH?

Answer 39

doxasozin

Question 40

1st line treatment for a pt. with HT and Raynaud's disease?

Answer 40

CCB for vasodilation