Testet iskemi dhe hipert..doc

7/26/2019 Testet iskemi dhe hipert..doc

1/17

1. In the management of hypertension

True False Confidence

drug therapy is usually initiated when the bloodpressure is 140/8 mm!g

thia"ide diuretic drugs #such as bendroflumethia"ide$are contra%indicated in patients with diabetes mellitus

renal function should be monitored prior to initiatingangiotensin%con&erting en"yme #'C($ inhibitors #suchas enalapril$

first dose hypotension is pronounced with angiotensin%con&erting en"yme #'C($ inhibitors #such as enalapril$

beta bloc)ers #such as atenolol$ are theantihypertensi&es of choice in patients with concurrentasthma

thia"ide diuretics #such as bendroflumethia"ide$ may

become less effecti&e in moderate renal impairmentdihydropyridine calcium channel antagonists #such asnifedipine$ are associated with causing oedema

beta bloc)ers #such as atenolol$ can precipitate heartfailure

#*4 mar)s+ negati&e mar)ing$

Key:Correct answer

,artially correct answer

Incorrect answerEmboldenedwords shown in brac)ets represent the correctresponse for each -uestion #not the users answer$.

,rint esults

1. In the management of hypertension

Correct

'nswerour

'nswer

False nanswereddrug therapy is usually initiated when the bloodpressure is 140/8 mm!g

This is not warrant treatment. Treatment levelsare >160/>100mmHg in otherwise healthyindividuals. But >160/>90mmHg when there isincreased cardiovascular risk / end organdamage

False nanswered thia"ide diuretic drugs #such as
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2/17

bendroflumethia"ide$ are contra%indicated inpatients with diabetes mellitus

Although they are diaetogenic! they are nowrecognised as having a role in the managemento" hy#ertension in #atients with $%.

True nansweredrenal function should be monitored prior toinitiating angiotensin%con&erting en"yme #'C($inhibitors #such as enalapril$

This is im#ortant and should e "ollowed u#during treatment to monitor "or renal damage.

True nansweredfirst dose hypotension is pronounced withangiotensin%con&erting en"yme #'C($ inhibitors#such as enalapril$

A reason why they are initially taken on retiring toed.

False nanswered

beta bloc)ers #such as atenolol$ are the

antihypertensi&es of choice in patients withconcurrent asthma

They are contra&indicated in asthma/'()$.

True nansweredthia"ide diuretics #such as bendroflumethia"ide$may become less effecti&e in moderate renalimpairment

They re*uire renal e+cretion to act.

True nanswereddihydropyridine calcium channel antagonists#such as nifedipine$ are associated with causingoedema

Through arteriolar dilatation.

True nanswered beta bloc)ers #such as atenolol$ can precipitateheart failure

But they do have a role in the management o"stale 'H,.

2. 0 out of 24

1. In patients with ischaemic heart disease

True False Confidence

beta bloc)ers #such as atenolol$ are first line therapy forthe pre&ention of attac)s of stable angina

the anticoagulant warfarin is usually prescribed topre&ent coronary thrombosis

only patients with hypercholestolaemia should recei&estatins #such as sim&astatin$


3/17

angiotensin%con&erting en"yme #'C($ inhibitors #suchas ramipril$ are contra%indicated

the calcium channel antagonist &erapamil is used incombination with beta bloc)ers #such as atenolol$ forcontrol of refractory angina

#1 mar)s+ negati&e mar)ing$

Key:Correct answer

,artially correct answer

Incorrect answerEmboldenedwords shown in brac)ets represent the correctresponse for each -uestion #not the users answer$.

,rint esults

1. In patients with ischaemic heart disease

Correct

'nswerour

'nswer

True nansweredbeta bloc)ers #such as atenolol$ are first linetherapy for the pre&ention of attac)s of stableangina

As long as they are not contra&indicated

False nansweredthe anticoagulant warfarin is usually prescribed topre&ent coronary thrombosis

Anti#latelet drugs -such as low doseas#irin/clo#idogrel are used. ar"arin is lesse""ective in arterial thromosis.

False nansweredonly patients with hypercholestolaemia shouldrecei&e statins #such as sim&astatin$

tatins are o" ene"it in #atients with increasedcardiovascular risk! irres#ective o" cholesterollevels.

False nansweredangiotensin%con&erting en"yme #'C($ inhibitors#such as ramipril$ are contra%indicated

H() trial estalished A' inhiitors asreducing mortality in #atients with 2H$.

False nansweredthe calcium channel antagonist &erapamil is usedin combination with beta bloc)ers #such asatenolol$ for control of refractory angina

erious interaction. 3era#amil should not e corescried with eta lockers as oth arenegative ino#tro#es and could #reci#itateasystole.


4/17

2. 0 out of 15

1. Mr HT (aged 52) visited his GP for a routine medical check and

his blood pressure was measured as !5"## mmHg in thesitting position$ %urther &uestioning and e'amination

revealed

eight ##kg

Height *+#m

Marital status single%H father died aged 5, -ears old (.heart trouble/)0 mother died

+5 -ears old (ca colon)0 sister (a1w) and brother (t-pe 2

diabetes)$

PMH occasional asthma

rug histor- salbutamol 2## 3g p$r$n$4ocial histor- e'*smoker (2# pack -ears) and admits to 5 units

of alcohol a week$

2hat ad&ice may be appropriate to this patient

es 3o 'bstain

!is blood pressure is normal for a man of his age

!e should loose weight as he is obese

!e now re-uires drugs to control his blood pressure

!is alcohol consumption should protect his cardio&ascularsystem

#4 mar)s+ negati&e mar)ing$

*. ne month later he &isits the 5, and his blood pressure is now 160/10*mm!g andthe results of his blood test from the last &isit are detailed7

Biochemistry and haematology

Variable Value ormal range

Haemoglobin 15 g/dL [13-18g/dL]

White blood cells 6x109/L [4-11x109/L]

latelets !00x109/L [150-400x109/L]"odi#m 140 mmol/L [135-145 mmol/L]

otassi#m 4$0 mmol/L [3$5-5 mmol/L]

%&ea 5 mmol/L [!$5-6$' mmol/L]

(l#cose )&andom* 6$! mmol/L [+11$1mmol/L]

lasma c&eatinine 100 mol/L [+150 mol/L]

,otal choleste&ol '$5 mmol/L [+5$! mmol/L]


5/17

HL 1$0 mmol/L [.0$9 mmol/L]

,&iglce&ides !$0 mmol/L [0$6 1$' mmol/L]

!i"er function test


'lbumin 40 g/L [36-4' g/L]ilibin 10 mol/L [3-1' mol/L]

2lanine

aminot&anse&ase30 i#/L [3-35 i#/L]

2sa&tatet&ansaminase

30 i#/L [3-35 i#/L]

2laline hoshatase 100 i#/L [40-1!5 i#/L]

(l#taml

t&anse&ase )((,*!00 i#/L [+'0 i#/L]

n the basis of the abo&e which one of the following best describes the patients

problems7

#1 mar)$

9. ,he aboe tests excl#de 7hich o the ollo7ing

True False 'bstain

Conns syndrome

:eft &entricular hypertrophy

,olycythaemia

enal artery stenosis

'ddisons disease

# mar)s+ negati&e mar)ing$

4. Which one o the ollo7ing additional combination o tests is mosta&o&iate

#1 mar)$

. :stimate the atient;s &is o deeloing co&ona& hea&t disease oe& the

next 10 ea&s


6/17


7/17


>. 2hich of the following monitoring is appropriate during this treatmentA

es 3o 'bstain

enal functionBlood glucose

:i&er function

(C5

,lasma lipids


10. 2 month late& he isits his ( and his blood &ess#&e is no7

160/95mmHg

Which one)s* o the ollo7ing is a next logical ste

es 3o 'bstain

Increase the dose of bendroflumethia"ide tomg.

'dd atenolol #0mg$.

3o action.

'dd pra"osin #00mcg t.d.s.$

'dd ramipril #1.*mg$


11. In addition to the abo&e+ sim&astatin #*0 mg+ o.n.$ is added to the prescription.

Concerning this addition which of the following are trueA

True False 'bstain

im&astatin is pro&en reduce the ris) of ischaemic heartdisease.

im&astatin is only of benefit in patients with cholesterol le&els?.*mmol/:

im&astatin is best used to manage hypertriglyceridaemia

im&astatin is an acyl Co en"yme ' inhibitor

im&astatin is associated with muscle myopathy


1*. 2hich of the following counselling points are rele&ant to a patient ta)ingsim&astatinA


8/17

es 3o 'bstain

It should be ta)en at night

The patient should report immediately any une@pected musclepains

It may cause weight gain,atients should e@pect to suffer from headaches+ nausea andgastrointestinal disturbances

It is important to continue with recommended dietary andlifestyle changes


19. It is now decided to manage the patient with the 'C( inhibitor ramipril alone.

2hich of the following may pose a problem

es 3o 'bstain

First dose hypotension

' dry cough.

!ypo)alaemia

Deterioration of renal function

Eyocardial depression


14. 2 ea& late& he isits his ( and comlains o chest ains on exe&tion and

an exe&cise test &eeals ",-segment de&ession on the :


9/17

#10 mar)s+ all options items mar)ed with negati&e mar)ing$

Key:Correct answer

,artially correct answerIncorrect answer

Emboldenedwords shown in brac)ets represent the correctresponse for each -uestion #not the users answer$.

,rint esults

1# Mr HT (aged 52) visited his GP for a routine medical check

and his blood pressure was measured as !5"## mmHg inthe sitting position$ %urther &uestioning and e'amination

revealed

eight ##kg

Height *+#mMarital status single

%H father died aged 5, -ears old (.heart trouble/)0 mother

died +5 -ears old (ca colon)0 sister (a1w) and brother(t-pe 2 diabetes)$

PMH occasional asthma

rug histor- salbutamol 2## 3g p$r$n$

4ocial histor- e'*smoker (2# pack -ears) and admits to 5units of alcohol a week$

2hat ad&ice may be appropriate to this patient

Correct

'nswerour

'nswer

o nanswered !is blood pressure is normal for a man of his age

He is hy#ertensive

$es nanswered !e should loose weight as he is obese

eight reduction is im#ortant and may ringaout a reduction in lood #ressure

o nanswered!e now re-uires drugs to control his bloodpressure

4i"estyle changes should e used as the "irst

course o" action

o nanswered!is alcohol consumption should protect hiscardio&ascular system

He is a heavy drinker which is associated withincreasing lood #ressure

0 out of 4


10/17

*. ne month later he &isits the 5, and his blood pressure is now160/10*mm!g and the results of his blood test from the last &isit aredetailed7

Biochemistry and haematology


Haemoglobin 15 g/dL [13-18g/dL]

White blood cells 6x109/L [4-11x109/L]

latelets !00x109/L [150-400x109/L]

"odi#m 140 mmol/L [135-145 mmol/L]

otassi#m 4$0 mmol/L [3$5-5 mmol/L]

%&ea 5 mmol/L [!$5-6$' mmol/L]

(l#cose )&andom* 6$! mmol/L [+11$1mmol/L]

lasma c&eatinine 100 mol/L [+150 mol/L],otal choleste&ol '$5 mmol/L [+5$! mmol/L]

HL 1$0 mmol/L [.0$9 mmol/L]

,&iglce&ides !$0 mmol/L [0$6 1$' mmol/L]

!i"er function test


'lbumin 40 g/L [36-4' g/L]

ilibin 10 mol/L [3-1' mol/L]

2lanine

aminot&anse&ase30 i#/L [3-35 i#/L]

2sa&tatet&ansaminase

30 i#/L [3-35 i#/L]

2laline hoshatase 100 i#/L [40-1!5 i#/L]

(l#taml

t&anse&ase )((,*!00 i#/L [+'0 i#/L]

n the basis of the abo&e which one of the following best describes the

patients problems7

enal impairment+ diabetes+ hypercholesterolaemia

enal impairment+ cholestasis+ polycythaemia

E"idence of alcohol abuse% hy&ercholesterolaemia% mild


11/17

hy&ertriglyceridaemia

(&idence of acute li&er damage+ hypercholesterolaemia+hypertriglyceridaemia

aundice+ e&idence of alcohol abuse+ hypercholesterolaemia

There is evidence o" alcohol ause! hy#ercholesterolaemia as shown yincreased 55Ts and cholesterol res#ectively. His hy#ertriglyceridaemia isvery mild. There is no evidence o" renal im#airment or diaetes as creatinineand glucose are in the normal range. There is no cholestasis as the iliruinand alkaline #hos#hatase are normal. Haematocrit is normal There is noevidence o" acute liver damage or hy#ertriglyceridaemia as the aminotrans"erases and iliruin are normal! and T5s are normal. o evidence o"

7aundice as the iliruin is normal

0 out of 1

9. ,he aboe tests excl#de 7hich o the ollo7ing

Correct

'nswerour

'nswer

True nanswered Conns syndrome

o evidence o" a retention or 8 loss

False nanswered :eft &entricular hypertrophy

This can not e assessed "rom iochemistry

True nanswered ,olycythaemia

H is within range

False nanswered enal artery stenosis

This can not e assessed "rom iochemistry

True nanswered'ddisons disease

o evidence o" a loss or 8 retention. 2t is alsoassociated with hy#otension.

4. 0 out of 5

. Which one o the ollo7ing additional combination o tests is most

a&o&iate

1* lead (C5+ e@ercise tolerance test+ retinal e@amination

Thyroid function+ e@ercise tolerance test


12/17

5lucose tolerance test+ echocardiogram

12 lead E'(% retinal e)amination

(chocardiogram+ thyroid function

1 lead '5! retinal e+amination: ;es! these will identi"y le"t ventricularhy#ertro#hy and any damage to the eye. An e+ercise tolerance test is notre*uired as this is used to identi"y angina which is not sus#ected at themoment. 5lucose tolerance test not reuired as no anormal random glucoseresult and echocardiogram not relevant to hy#ertension unless 'H, issus#ected.

0 out of 1

=. :stimate the atient;s &is o deeloing co&ona& hea&t diseaseoe& the next 10 ea&s

;1

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Testet iskemi dhe hipert..doc