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CFINALS REVISION SESSION who are we? what we do? disclaimer: Theknowledge and expertise.hored by medical students and junior doctors to the best of their Cardiology Respiratory Gastroenterology Stroke Haematology Renal Endocrine Paediatrics ENT + General Surgery Musculoskeletal Ophthalmology online medical school finals Infections revision series & many more!easy medium hardkeep up to date with all our teaching sessionsHouse rules go on mute questions in chat be respectfulROUND: 1A 65-year-old male patient with a history of What is the purpose of using the CHA₂DS₂-VASc score in assessing this hypertension and diabetes mellitus presents to the patient with atrial fibrillation before clinic with newly diagnosed atrial fibrillation. starting anticoagulation therapy? To determine the patient's risk A of developing heart failure When deciding the patient’s management, the GP To predict the likelihood of B atrial fibrillation recurrence adopts the use of the CHA₂DS₂-VASc score. C To assess the patient's risk of hemorrhagic stroke To evaluate the patient's risk of D developing thromboembolic events, such as stroke What is the purpose of using the CHA₂DS₂-VASc score in assessing this patient with atrial fibrillation before starting anticoagulation therapy? To determine the patient's risk A of developing heart failure To predict the likelihood of B atrial fibrillation recurrence C To assess the patient's risk of hemorrhagic stroke To evaluate the patient's risk of developing thromboembolic D events, such as strokeMrs. Johnson, 55 has presented to her GP with SOB, reportedly worse on exertion as well as night What baseline blood test will best time, usually requiring 3 pillows to sleep. She feels a support the likely diagnosis? tightness in her chest and has also noticed her ankles are more swollen. A Troponin levels B Creatinine clearance C C - reactive protein levels Brain natriuretic levels DWhat baseline investigations should be ordered for Mrs Johnson? Troponin levels A Creatinine clearance B C C - reactive protein levels D Brain natriuretic levels Which medication should be used first line for this patient? A 53 year old African-Caribbean man presents to the GP for a follow-up appointment after having a A Ramipiril clinic blood pressure reading of 160/102 and ambulatory blood pressure monitoring readings B Indapamide with an average of 162/102. C Amlodipine Nil PMH D CandesartanWhich medication should be used first line for this patient? A Ramipril B Indapamide Amlodipine C D CandesartanWhich of the following medications is most likely to cause hyponatremia? A Ramipril Bendroflumethiazide B C Bisoprolol D AmlodipineDrugs commonly associated with hyponatraemia: Ramipril A Bendroflumethiazide B C Bisoprolol Amlodipine D What is the next add on medication to improve outcomes for this patient? A 63 year old presents with shortness of breath and chest pain. An echo was performed where her A Atenolol ejection fraction was 33%. She was immediately B Ramipril started on IV furosemide and her symptoms were reduced. She has a PMH: Asthma, Depression, C Candesartan Migraines. D Bendroflumethiazide What is the next add on medication to improve outcomes for this patient? Atenolol A Ramipril B Candesartan C Bendroflumethiazide She has a PMH of asthma hence a beta-blocker would be contraindicated D What is the most likely diagnosis? An 82 y/o patient is admitted to hospital after feeling faint, having palpitations and experiencing A Mitral valve stenosis syncope. The consultant in the acute medicine ward B Aortic valve regurgitation notes that the patient has a murmur. He described to the medical student that the patient has an C Aortic valve stenosis ejection systolic murmur around the upper right D Pulmonary valve stenosis sternal border. What is your most likely diagnosis ? A Mitral valve stenosis B Mitral valve regurgitation C Aortic valve stenosis D Pulmonary valve stenosisROUND: 2 Which of the following interventions is recommended as the first-line treatment A 65-year-old male patient with a history of for a peri-arrest rhythm characterized by bradycardia? coronary artery disease presents to the emergency department with dizziness, weakness, A Administer IV adenosine and a heart rate of 40 beats per minute. The B Initiate synchronized cardioversion patient's blood pressure is 90/60 mmHg, and an Administer IV atropine C ECG reveals sinus bradycardia. D Perform chest compressions Which of the following interventions is recommended as the first-line treatment for a peri-arrest rhythm characterized by bradycardia? A Administer IV adenosine B Initiate synchronized cardioversion C Administer IV atropine Perform chest compressions D Which of the following is the most appropriate management strategy for A 65-year-old patient presents to the emergency this patient's condition? department with minor epistaxis (nosebleed). He has A Administer vitamin K subcutaneously at a dose of 1 to 2.5 mg. a PMH of AF for which he takes warfarin. B Withhold Warfarin, Administer 1-3mg of IV Vitamin K Laboratory tests reveal an international Hold warfarin therapy and C monitor INR closely without intervention. normalized ratio (INR) of 7.2. D Give PO Vitamin K 1-5mg Which of the following is the most appropriate management strategy for this patient's condition? Administer vitamin K subcutaneously A at a dose of 1 to 2.5 mg. Withhold Warfarin, Administer 1-3mg B of IV Vitamin K, Hold warfarin therapy and C monitor INR closely without intervention. D Give PO Vitamin K 1-5mgA 55 year old man has had 3 days of sharp central chest pain that radiates to the back and is worse on lying flat. Observations: temp 37.8C, HR 96 bpm, BP 112/72, RR 18 breaths per minute and oxygen sats 98% breathing air. He has normal heart sounds. Brachial pulses can be felt in both arms and are synchronous. What is the most likely diagnosis? Investigations: Haemoglobin 152 g/L (130–175) White cell count 10.6 × 109/L (3.8–10.0) Platelets 390 × 109/L (150–400) Neutrophils 7.5 × 109/L (2.0–7.5) A Acute pericarditis D dimers 0.5 mg/L (<0.5) Troponin T 1 μg/L (<0.01) CRP 50 mg/L (<5) B Acute coronary syndrome An ECG was carried out and is shown below: Aortic dissection C D Musculoskeletal chest pain What is the most likely diagnosis? Acute pericarditis A Acute coronary syndrome B Aortic dissection C Musculoskeletal chest pain Acute pericarditis common ECG findings: widespread ST elevation DA 58 year old man presented to A&E with chest pain and breathlessness which started 2 hours ago. PMH: Hypertension, AF. Which medication should also be given DH: Ramipril, atenolol and apixaban. SH: smoker along with the aspirin? Investigations: Haemoglobin 160 g/L (130–175) White cell count 10.6 × 109/L (3.8–10.0) A Rivaroxaban Platelets 380 × 109/L (150–400) Neutrophils 7.4 × 109/L (2.0–7.5) B Prasugrel D dimers 0.4 mg/L (<0.5) Troponin T 35 ng/L (<0.01) An ECG was carried out which has confirmed a C Ticagrelor STEMI. D Clopidogrel This patient is deemed suitable for PCI and has already been started on aspirin. Which medication should also be given along with the aspirin? A Rivaroxaban B Prasugrel C Ticagrelor As they are already taking apixaban - offer clopidogrel with aspirin for those Clopidogrel undergoing primary PCI if taking an oral anticogulant (give prasugrel with D apsirin if not already taking oral anticoagulant)A 56 year old patient recently underwent a valve replacement What investigation would best support surgery, and was admitted to the ward for his postoperative the most likely diagnosis? recovery. On the 7th day the patient developed myalgia and fatigue. Patients' vitals are given below. There was also a new A ECG onset murmur heard in the apex. B Blood pressure monitoring DH: Ramipril, Simvastatin, Aspirin. C Chest X-Ray Temp - 38.5, HR - 90, BP 145/93 D Blood Cultures What investigation would be most useful considering the likely diagnosis? A ECG B Blood pressure monitoring C Chest X-ray BMJ best practice: Blood cultures DWhile receiving her blood work-up the Nurse informed the patient that her blood work up is abnormal. She decided to come to the GP surgery to review her blood reports. She is currently on three anti-hypertensive medications involving amlodipine 20mg, ramipril 30mg and bendroflumethiazide. Her blood results are Which is the first line management for given below. Her BP is 144/72, HR is 78 and O2 sats is 96%. Her ECG is given this patient? below. Na = 137 A IV Insulin dextrose K = 6.7 infusion Urea = 6.0 Cr = 68 B IV Calcium Gluconate Glucose = 5.7 C Repeat blood tests in 24 hours Stop D bendroflumethiazideWhich is the first line management for this patient ? IV Insulin dextrose infusion A B IV Calcium gluconate C Repeat blood tests in 24 hours D Stop bendroflumethiazideround threeA 72-year-old male patient presents to the emergency department with complaints of epigastric pain and nausea. His medical history includes atrial fibrillation, for which he Which of the following ECG findings is has been taking digoxin for the past year. Upon most consistent with digoxin toxicity in this patient? examination, the patient's vital signs are stable, but a baseline electrocardiogram (ECG) is shown below. A Shortened QT interval B Prolonged PR interval C Down-sloping ST segment D Bidirectional ventricular tachycardia Which of the following ECG findings is most consistent with digoxin toxicity in this patient? A Shortened QT interval B Prolonged PR interval C Down-sloping ST segment D Bidirectional ventricular tachycardia As per the NICE guidelines, what is the A 62-year-old male patient with a known most appropriate management strategy for this patient? abdominal aneurysm presents to the emergency department with complaints of severe headache Immediate surgical intervention for A Endovascular coiling or stenting to and blurred vision. treat the aneurysm Observation and monitoring with B regular imaging studies 3 monthly Imaging studies reveal an aneurysm measuring 2 week referral to Vascular 5.6cm, compared to 4.5cm 6 months previously. C Surgery for elective endovascular repair (EVAR) or open Recommending lifestyle modifications D and regular exercise to manage the aneurysm. As per the NICE guidelines, what is the most appropriate management strategy for this patient? Immediate surgical intervention for A Endovascular coiling or stenting to treat the aneurysm Observation and monitoring with B regular imaging studies 3 monthly 2 week referral to Vascular Surgery for elective endovascular C repair (EVAR) or open Recommending lifestyle modifications D and regular exercise to manage the aneurysm. Which investigation is most appropriate for this patient? A 62 year old man presents with sudden onset ‘tearing’ chest pain which radiates to the back. He has a PMH of hypertension. He has weak brachial A Chest x-ray and femoral pulses. Observations: Sats 98%, Temp 37.1C, BP: 92/60, ECG HR 122 B C Transoesophageal echocardiography D CT angiography CAP Which investigation is most appropriate for this patient? A Chest x-ray ECG Investigations: B CT angiography is gold standard BUT... TOE is more suitable when the patient is unstable as can be too unstable to take a scanner (this patient’s vital signs show that he is unstable) C Transoesophageal echocardiography CXR: can also be performed, possible findings include a widened mediastinum ECG D CT angiography CAPA 59 year old man presents with central chest pain which radiates into his left arm. On examination he Given this clinical picture, which coronary is clammy to touch artery is likely to be occluded? Observations: Apyrexial, RR 16, No 02 req, BP 150/76, HR 40 A Right coronary artery The FY1 performs an ECG to rule out an MI. Left anterior descending B artery Left circumflex C artery Right marginal D arteryGiven this clinical picture, which coronary artery is likely to be occluded? Right coronary artery A Left anterior descending B artery C Left circumflex artery D Right marginal arteryA 78 year old man is currently being assessed by the stroke team. Upon assessing him you notice he is very short of breath having a respiratory rate of 33 What is the most likely diagnosis? breaths per minute. A chest X-Ray was taken and it demonstrated to have a straight left heart border. ECG given below. A Aortic regurgitation B Mitral valve stenosis C Mitral valve regurgitation D Aortic stenosis What is the most likely diagnosis? Mitral stenosis impedes left ventricular filling, this leads to increase in left atrial pressure, which will lead to left atrial hypertrophy. Hence the CXR shows straight left heart border. A Aortic regurgitation Moreover, this leads to blood returning back to the B Mitral valve stenosis lungs increasing pulmonary congestion leading to the dyspnoea. C Mitral valve prolapse D Aortic stenosisA 27 year old man was admitted to hospital after suddenly falling unconscious at a party with his friends. The doctor carried out an ECG, which is given below. Which of the following options is the most appropriate form of management? His vitals are: BP 88/65 HR - 122 bpm A IV Amiodarone RR -23 B IV fluids C Synchronised Cardioversion D DefibrillationWhich of the following options is the most appropriate form of management? IV Amiodarone A B IV fluids C Synchronised Cardioversion D Defibrillation Thank you very much for listening! Note: Certificates will be received once feedback is completednext session Respiratory 28th February