PRACTICE QUESTIONS Flashcards
A 60 year old male patient with a history of HF presents to clinic with worsening shortness of breath and increased ankle swelling over 3 months. He currently takes ramipril, bisoprolol, eplerenone and furosemide 20mg OD. His recent echo shows an ejection fraction of 35%. Which is the most appropriate next medication to add in?
Ivabradine (HCN blocker)
A 60 year old male presents to A&E complaining of fluttering in his chest for about a week and this morning woke feeling dizzy, unwell and short of breath. His pulse is irregularly irregular and CRT= 4 seconds. There are bibasal crackles on inspiration. ECG shows absent p waves and narrow QRS complexes. Obs show:
- HR 230bpm
- BP 80/44
- RR 28 Sats 93% OA
- T 37.1
Given the likely diagnosis, what is the next best step in management?
Synchronized DC cardioversion
A 74 year old woman is diagnosed with paroxysmal atrial fibrillation. What is the minimum CHA2DS2VASC score indicated for anticoagulation consideration?
2
A 70 year old female has a 4/52 history of fever and malaise. PMH: COPD and CCF. Observations:
- HR 80bpm
- BP 145/90
- T 38.2
- RR 18
- Loud ejection systolic murmur at sternal angle, radiates to the neck.
- Echo shows 4mm vegetation on leaflet of aortic valve.
Which additional finding is necessary to confirm the patient’s diagnosis?
Single positive blood culture for Coxiella burnetti
A patient is brought in by ambulance due to acute shortness of breath. They describe this as being relieved by sitting up and associated with worsening bilateral leg swelling. On examination:
HR 90
BP 120/70
RR 35
Sats 90% on RA improve to 98% on 15L
JVP raised to 4cm.
Chest – bibasal crepitations
Legs – bilateral pitting oedema extending to the sacrum
What should you prescribe and why?
Diuretic for pulmonary oedema
