Question Bank

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.

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.

Stanford Type B dissections (descending aorta) are usually managed medically with aggressive blood pressure control (e.g., IV labetalol). Type A dissections (ascending aorta) require urgent surgery.

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.

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.

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.

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 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 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.

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.

His CHA2DS2-VASc score is 3 (Age >=75 = 2 points, Diabetes = 1 point). Anticoagulation (DOAC like apixaban) is indicated for men with a score of 1 or more, and recommended for a score of 2 or more; aspirin is no longer used for stroke prevention in AF.

NICE guidelines recommend primary PCI for STEMI if it can be delivered within 120 minutes of the time when fibrinolysis could have been given. Since the PCI centre is only 60 minutes away, it is the preferred reperfusion strategy over fibrinolysis.

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.

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).

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).