Cardiovascular1. A 52-year-old man attends after a well-man check. Pulse is regular. Two seated clinic readings average 148/94 mmHg. He has no target-organ damage, diabetes or known cardiovascular disease. What is the most appropriate next step?A. Offer ambulatory blood pressure monitoring (or home monitoring if ABPM is unsuitable)B. Start ramipril 2.5 mg daily today without further readingsC. Reassure and recall only at his next NHS Health Check in 5 yearsD. Start amlodipine 5 mg today because the clinic reading is already diagnosticCheck
Cardiovascular2. A 59-year-old woman develops crushing central chest pain at rest, with sweating, lasting 25 minutes. She is still in pain in the surgery. An ECG machine is warming up. Oxygen saturations are 97% on air. What is the most appropriate immediate action?A. Draw a troponin in the treatment room and wait for the resultB. Give glyceryl trinitrate then review her in 48 hours if the pain easesC. Call 999 and give aspirin 300 mg unless it is contraindicatedD. Give oral morphine and observe for 30 minutes before deciding on transferCheck
Cardiovascular3. A 64-year-old man reports 8 weeks of mild exertional breathlessness. Examination is unremarkable. Chest X-ray is normal. NT-proBNP is 310 ng/L. What is the most appropriate interpretation?A. Refer for echocardiography within 2 weeks for suspected heart failureB. Refer for specialist heart-failure assessment within 6 weeksC. Start bisoprolol and ramipril today for presumed HFrEFD. Heart failure is unlikely; look for other causes of breathlessnessCheck
Cardiovascular4. A 46-year-old White British woman has confirmed stage 2 hypertension on ABPM. She does not have type 2 diabetes. She is not of Black African or African-Caribbean family origin. What is the most appropriate step 1 antihypertensive class?A. A dihydropyridine calcium-channel blockerB. A thiazide-like diuretic as first choice in everyone under 55C. An ACE inhibitor (or an ARB if an ACE inhibitor is not tolerated)D. Atenolol as first-line therapy for essential hypertension at this ageCheck
Cardiovascular5. A 63-year-old man with a mechanical mitral valve develops ECG-confirmed atrial fibrillation. He is already on warfarin with a recent INR of 2.8. eGFR is 70 mL/min/1.73 m². What is the most appropriate anticoagulation plan? Select TWO correct statements.Select all that apply.A. Most appropriate: WarfarinB. The following is not the most appropriate next step: Stop warfarin and start apixabanC. Most appropriate: Switch to rivaroxaban because DOACs are first line in AFD. Most appropriate: Stop all anticoagulation and use aspirin 75 mg onlyCheck
Cardiovascular6. A 55-year-old man has suspected ACS. Pulse oximetry is 97% on air. He is not breathless at rest between pain waves. What is the most appropriate oxygen plan while awaiting the ambulance? Select TWO correct statements.Select all that apply.A. Most appropriate: Do not give routine oxygenB. The following is not the most appropriate next step: 15 litres per minute via a non-rebreathe mask for all ACSC. Most appropriate: 2 litres per minute via nasal cannulae in every chest-pain presentationD. Most appropriate: Withhold the ambulance until saturations fall below 94%Check
Cardiovascular7. A 71-year-old woman has new persistent atrial fibrillation with a resting ventricular rate of 118 per minute. She is breathless on stairs but has no signs of heart failure. She is normally active. What is the most appropriate first-line rate-control medicine?A. Long-term amiodaroneB. BisoprololC. SotalolD. Digoxin monotherapyCheck
Cardiovascular8. A 49-year-old man ran to the surgery. A single automated reading is 168/98 mmHg. He is asymptomatic. Repeat seated readings after rest are 128/78 mmHg and 126/76 mmHg. Pulse is regular. What is the most appropriate action?A. Do not diagnose hypertension or start drugs on the isolated high readingB. Start amlodipine 5 mg today because one reading exceeded 160 mmHgC. Refer the same day as accelerated hypertensionD. Issue ramipril and arrange only telephone follow-up in 3 monthsCheck
Cardiovascular9. A 53-year-old man has repeated clinic readings around 156/94 mmHg. Daytime ABPM average is 128/76 mmHg. He has no target-organ damage. What is the most appropriate management of his blood pressure?A. Do not start lifelong antihypertensives; give healthy-living advice and follow upB. Start ramipril because clinic readings are stage 1C. Start amlodipine to treat the clinic numbersD. Treat to a clinic target of 140/90 mmHg despite the normal ABPMCheck
Cardiovascular10. A 78-year-old woman with atrial fibrillation and a CHA2DS2-VASc score of 4 is being counselled about a DOAC. You need a bleeding-risk score to support shared decisions. Which tool does NICE prefer?A. HAS-BLED as the preferred NICE bleeding toolB. ATRIAC. ORBITD. CHA2DS2-VASc, because a high stroke score implies a high bleed scoreCheck