GP

Question 1

AF:

rate control should be first line in all people except…? (4)

Answer 1

Whose AF has a reversible cause
Who have heart failure thought to be primarily due to AF
Who have new onset AF
For whom a rhythm control strategy is more suitable based on clinical judgement (patients with PAF)

Question 2

AF:
what are the heart rate goals if non-symptomatic? (1)
what if symptomatic? (1)

Answer 2

no benefit of strict rate control over more lenient HR control —>
- <110 bpm

if symptomatic:
- strict control: resting <80bmp, moderate exercise <110 bpm

Question 3

AF:
you review a patient you commenced on AF drugs after 1-2 weeks. They are still symptomatic. What do you do in consultation?

Answer 3

reassess symptoms, check rate/ rhythm and discuss medication – side effects, compliance. Care package for patients with AF should include education & information about the following:

causes, effects and complications of AF

symptoms of stroke & measures to prevent it

anticoagulation – practical advice

support networks

who to contact for advice

Question 4

H. Pylori:
types of test? (6)
which tests for eradication? (1)
how do urea breath tests work? (1)
when can't they be done? (2)
how does rapid urease test work? (1)

Answer 4

• urea breath test
• rapid urease test
• serum antibody
• culture of gastric biopsy
• gastric biopsy
• stool antigen test
• urea breath test
• patients consumer carbon isotope 13 enriched urea
• urea broken down by H pylori urease
• after 30 mins exhale into glass tube
• mass spectrometry analysis calculates the amount of 13C CO2
• can’t be done within 2 weeks of antisecretory (PPI)
• cant be done within 4 weeks of antibacterial
• biopsy sample mixed with urea and pH indicator; change colour if H pylori urease activity