Core Topics

Question 1

In UK practice, the advice to initiate cardiovascular preventative treatment is based on

Answer 1

 an elevated QRISK2 score
 a particularly “high” risk factor (e.g. very high blood pressure)
 the presence of certain other risk factors (e.g. diabetes)
 target organ damage (e.g. hypertensive retinopathy)

Question 2

Patient information

Offering Statins percentage threshold

Answer 2

In 2014, NICE lowered the threshold for offering statins to a 10-year risk of 10%.

Question 3

Patient information

Quitting Smoking

Answer 3

Nicotine Replacement Therapy
(patches / gum / spray)
Bupropion
Varenicline
E cigarretes

Question 4

Patient Information
If clinic BP is ≥140/90 mmHg
What should you tell the patient

Answer 4

ambulatory BP monitoring (ABPM) should be offered to confirm the diagnosis
of hypertension (at least 14 measurements over waking hours). 

Home BP monitoring (HBPM) can be used as an alternative (ideally twice daily pairs of measurements for 7 days). ABPM/HBPM is taken as the average of
all readings.

Question 5

Diagnosis

NICE definition stage 1 hypertension

Answer 5

Clinic BP is ≥140/90 mmHg and subsequent ABPM daytime average or HBPM
average ≥135/85 mmHg

Question 6

Diagnosis

NICE definition stage 2 hypertension

Answer 6

Clinic BP ≥160/100 mmHg and subsequent ABPM daytime average or HBPM
average ≥150/95 mmHg

Question 7

Diagnosis

NICE definition of severe hypertension:

Answer 7

Clinic BP ≥180/110 mmHg

Question 8

Management

Step 1 Drug Treatment of hypertension if patient < 55

Answer 8

ACEi (PRILS)
  Ramipril	
 Captopril	
 Cilazapril	
 Enalapril	 
 Fosinopril	 
 Imidapril	 
 Lisinopril	
 Moexipril	
 Perindopril	 
 Quinapril	
 Trandolapril

Question 9

Management

Step 1 Drug Treatment of hypertension if patient > 55 or black

Answer 9

Calcium Channel blocker
Amlodipine 	 
Diltiazem 	 
Verapamil 
Felodopine 	
Isradipine 	
Lacidipine 	
Lercanidipine 	
Nicardipine 	
Nifedipine 	
Nisoldipine

Question 10

Management

Step 2 Drug Treatment for hypertension

Answer 10

ACE inhibitor + calcium channel blocker

Question 11

Management

Step 1 Drug Treatment of hypertension if patient < 55 but cannot tolerate ACEi

Answer 11

Angiotensin II receptor blocker (ARTAN)
Candesartan	
Eprosartan 	
Irbesartan 	
Losartan 	
Olmesartan 	
Telmisartan 	
Valsartan

Question 12

Management
Step 3 Drug Treatment of hypertension
ACE inhibitor + calcium channel blocker + thiazide (indapamide)

Step 4 Drug Treatment of hypertension
ACE inhibitor + calcium channel blocker + thiazide (indapamide)
+ alpha blocker / beta blocker / thiazide

Risk of prescribing beta-blocker and thiazide?

Answer 12

impair glucose tolerance

induce diabetes

Question 13

Investigation

Investigations to assess cholesterol levels if they are suspected to be high

Answer 13

take a serum blood sample for a full lipid profile,
including total cholesterol,
HDL cholesterol,
non-HDL cholesterol and triglycerides

Question 14

Management

What level of cholesterol should you consider treatment

Answer 14

Total cholesterol >9.0 mmol/l irrespective of family history

Total cholesterol >7.5 mmol/l and family history of premature coronary disease (i.e. <50 years)

Question 15

Management

What level of triglycerides should you consider treatment

Answer 15

Triglycerides >10 mmol/l (exclude secondary causes)

Triglycerides >4.5 mmol/l and total cholesterol >7.5 mmol/l

Question 16

Management

The first-line recommended primary prevention drug treatment statin (HMG-CoA reductase inhibitors)

Answer 16

atorvastatin 20mg

Question 17

Management

Common side effects of statin (HMG-CoA reductase inhibitors)

Answer 17

Gastrointestinal upset is common with statins

Question 18

Management

Levels of which liver enzyme need to be checked before starting a statin

Answer 18

NICE advice checking liver transaminases before and at 3 and 12 months
after treatment.

Question 19

Management

Drugs that should be prescribed post-MI

Answer 19

Low-dose (75mg) aspirin

Statins – NICE recommend atorvastatin 80mg daily as first-line treatment

Question 20

Management
Post MI the DVLA publishes clear guidelines on when it is safe to drive
How long should a patient wait

Answer 20

Patients should not drive for at least 4 weeks

post-MI

Question 21

Causes of acute breathlessness

Answer 21

10 PM
 Pulmonary constriction e.g. Asthma,
 Pneumonia including acute aspiration
 Pulmonary embolus (PE)
 Pneumothorax
 Pump failure e.g. LVF
 Psychogenic e.g. hyperventilation of panic attack / acute anxiety
 Peanut or other foreign body inhalation
 Pericardial tamponade
 Peak seekers - high altitude
 Poisons e.g. inhalations of noxious gases / chemicals
 Metabolic e.g. diabetic ketoacidosis

Question 22

Causes of chronic breathlessness

Answer 22

CPD MAN
 Cardiac e.g. LVF, mitral valve disease
 Pulmonary e.g. COPD, chronic asthma, pulmonary hypertension, pulmonary fibrosis, chronic
aspiration, pulmonary infiltrates from sarcoidosis or malignancy, pneumoconiosis, multiple PEs
 Drugs e.g. B-blockers, amiodarone, drugs affecting the immune response, local radiotherapy,
recreational drugs
 Musculoskeletal / habitus e.g. severe kyphoscoliosis, ankylosing spondylitis, obesity
 Anaemia
 Neuromuscular e.g. Motor Neurone Disease (MND), Myasthenia gravis (MG)