Chronic conditions

Question 1

HASBLED score

Answer 1

HTN
Abnormal LFTs or U&Es ( up to 2 points)
Stroke
Bleeding
Labile INRs
Elderly >65
Drugs and alcohol (up to 2 points) - antiplatelts, NSAIDs, 8 or more alcohol/week

Question 2

CHA2DS2VASc score and what points

Answer 2

CHD or LVEF <40%
HTN
AGE >75 - 2 points
DM
Stroke or TIA Hx - 2 points
Vascular disease
Age >65
Sex F 

If male then anticoagulate if 1 point
If female then need 2 points

Question 3

AF more common in males or females?

Answer 3

males

Question 4

initial episode of AF definition

Answer 4

AF>/=30s diagnosed by ECG

Question 5

paroxysmal AF

Answer 5

recurrent >/=2 episodes that terminate within 7 days (or <48hrs and terminated with cardioversion)

Question 6

persistant AF

Answer 6

continuous >7 days or AF >48hrs in which decision made to perform cardioversion

Question 7

long standing persistent AF

Answer 7

continuous AF of >12m

Question 8

permanent AF

Answer 8

joint decision by pt and clinician to cease further attempts to restore or maintain sinus ryhthm

Question 9

management of AF rate control

Answer 9

beta blocker or rate limiting CCB (eg diltiazem)

use digoxin in CHF

Question 10

what is a rate limiting CCB contraindicated in

Answer 10

HF

Question 11

definition of CKD

Answer 11

abnormality of kidney structure or function for >3 months that has implications for health

Question 12

how to diagnose CKD

Answer 12

2x GFR <60 at least 3 months apart

Question 13

definition of kidney failure

Answer 13

when GFR <15 or need for replacement

Question 14

2 most common causes of CKD

Answer 14

diabetic nephropathy

glomerulonephritis

Question 15

in a new finding of GFR <60 what do you do?

Answer 15

2nd sample within 2 weeks
3rd sample within 3 months

check ACR

Question 16

what is defined by rapid progression of CKD

Answer 16

drop in GFR by 25% and in new category in <1yr
OR
drop in GFR by 15 in <1yr

Question 17

definition of COPD in terms of spirometry

Answer 17

FEV1/FVC ratio <0.7

Question 18

CXR in COPD signs

Answer 18

• hyperinflation (>6 ant ribs, flat hemidiaphragms, floating heart sign)
• large central pulmonary arteries (pulmonary HTN)
• reduced peripheral vascular markings
• bullae

Question 19

what is the MRC dyspnoea scale used for

Answer 19

COPD

Question 20

what is the BODE index used for and what are the components?

Answer 20

COPD

BMI
Airflow Obstruction
Dyspnoea
Exercise capacity

Question 21

people who you should not use QRisk 2 for

Answer 21

>85yrs
T1DM
eGFR <60
prexisting CVD
familial hypercholesterolaemia

Question 22

when do you offer statin in T1DM

Answer 22

T1DM >40yrs, DM for >10yrs, established nephropathy or other CV risk factors

Question 23

bloods in statins

Answer 23

basline LFTs + 3m +12m
lipids at start and at 3m (40% reduction wanted)
renal function at start

ask if persistent muscle pain if yes measure serum CK

Question 24

interactions in statin

Answer 24

grapefruit

Question 25

stable angina

Answer 25

occurs predictably with physical exertion or emotional stress. lasts <10mins and is relieved within mins of rest as well as GTN spray

Question 26

unstable angina

Answer 26

new onset angina or abrupt deterioration in previously stable angina, often occuring at rest

Question 27

diagnosis of angina (3 features)

Answer 27

- constricting discomfort at front of chest or in neck, shoulders, jaw or arms - precipitated by physical exertion - relieved by rest or GTN within 5 mins

Question 28

angina management

Answer 28

``` GTN PRN beta blocker or CCB (both second line) consider 75mg aspirin consider ACEi if stable angina + DM statins Treat HTN ``` revascularisation - CABG or PCI

Question 29

DVLA angina rules

Answer 29

cars/motorbikes: dont need to tell DVLA. might need to stop driving if angina at rest or while driving lorries buses: must not drive and must notify DVLA

Question 30

stage 1 HTN

Answer 30

>140/90 clinic and ambulatory >130/85

Question 31

stage 2 HTN

Answer 31

>150/90 and ambulatory >150/95

Question 32

severe HTN

Answer 32

>180 systolic or >110 diastolic

Question 33

who to offer pharmacological HTN treatment

Answer 33

< 80 yrs with: - target organ damage, establised CVD, renal disease, DM, QRisk2>20% offer to everyone with stage 2 HTN

Question 34

what does beta blocker + thiazide incrrease risk of

Answer 34

DM