Question Bank

For patients of Black African or African Caribbean family origin of any age, or patients over 55 who are not of Black African/Caribbean origin, the first-line treatment for hypertension is a Calcium Channel Blocker (CCB) such as amlodipine.

NICE NG185 recommends primary PCI as the preferred reperfusion strategy for STEMI when it can be delivered within 120 minutes of the time at which fibrinolysis could have been given (i.e. door-to-balloon time). With the PCI centre only 60 minutes away, this criterion is met and primary PCI is strongly preferred over fibrinolysis. If the expected door-to-balloon time exceeds 120 minutes — for example due to transfer delays — fibrinolysis should be offered immediately instead, followed by angiography within 3–24 hours. Aspirin 300 mg and anticoagulation should be given to all STEMI patients regardless of reperfusion strategy.

His CHA₂DS₂-VASc score is 4: Age ≥75 scores 2 points; Hypertension (BP 135/82 mmHg qualifies as hypertension or treated hypertension) scores 1 point; Type 2 Diabetes scores 1 point. For male patients with a score of 2 or more, anticoagulation with a DOAC (such as apixaban) is recommended by NICE and the 2020 ESC AF guidelines. Aspirin is no longer recommended for stroke prevention in AF. Warfarin with a target INR of 3.5 is not indicated; standard INR target for AF is 2.0–3.0, and DOACs are preferred over warfarin for non-valvular AF.

For peripheral arterial disease (PAD), NICE recommends clopidogrel 75mg daily as the first-line antiplatelet agent for the prevention of cardiovascular events. Aspirin is used for coronary artery disease secondary prevention.

Hypertrophic Cardiomyopathy (HCM) is the most common cause of sudden cardiac death in young athletes. It is typically inherited in an autosomal dominant fashion, usually due to mutations in genes encoding sarcomere proteins (e.g., MYH7 or MYBPC3).

NICE guidelines recommend either a beta-blocker (e.g., atenolol/bisoprolol) or a calcium channel blocker (e.g., diltiazem/verapamil) as first-line treatment for stable angina. Long-acting nitrates and others are reserved for second-line or combination therapy.

The clinical presentation and ECG findings are classic for acute pericarditis. First-line treatment is high-dose NSAIDs (like ibuprofen) combined with colchicine to reduce symptoms and the risk of recurrence.

The classic ECG findings (short PR interval and delta wave) describe Wolff-Parkinson-White (WPW) syndrome, which is caused by the presence of an accessory conduction pathway known as the Bundle of Kent, bypassing the AV node.

A pan-systolic murmur at the apex radiating to the axilla indicates mitral regurgitation. Chronic mitral regurgitation leads to volume overload of the left atrium and left ventricle, causing left atrial enlargement.

In shockable rhythms (VF/Pulseless VT), Resus Council UK guidelines recommend 1mg adrenaline and 300mg amiodarone after the 3rd shock. For non-shockable rhythms, adrenaline is given immediately.