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.

Staphylococcus aureus is the most common cause of acute infective endocarditis, particularly in IV drug users. The murmur described is tricuspid regurgitation (right-sided), which is characteristic of endocarditis in this patient group.

The patient has signs of severe aortic stenosis (syncope, slow-rising pulse, ESM radiating to carotids). Longstanding aortic stenosis leads to increased afterload and subsequent left ventricular hypertrophy (LVH).

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.

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.

According to the Resuscitation Council UK tachycardia algorithm, the first-line drug for stable narrow-complex SVT after failed vagal manoeuvres is adenosine (6mg, then 12mg, then 12mg). DC cardioversion is for hemodynamically unstable patients.

NICE recommends an ACE inhibitor and a beta-blocker as first-line treatment for all patients with heart failure with reduced ejection fraction (HFrEF). While furosemide treats symptoms of congestion, it does not improve mortality like beta-blockers do.

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.

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.

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.