Here is the first of two questions on oedema. A bit like that scene in the Harry Potter book where the muggle expands and floats off (hence the balloons). There are two to choose from and here is one of them … good luck!
Reviewed by: awaiting review
A 77 year old female patient presents to her GP with a swollen and red forearm. The limb is hot, tender and there is a notable puncture wound. The red region is poorly demarcated and covers about two palms. Her medical history is notable for allergy to warfarin, atorvastatin and penicillin. She has controlled atrial fibrillation, GORD and diverticulosis.
Given the best matched differential, which is the most appropriate first line therapy?
Stem 1 of 10
An 82 year-old man presents with difficulty in breathing after walking up a flight of stairs in town today. He is “terribly” wheezing and complains of fatigue. This he puts down to lack of sleep because “I keep waking up gasping for breath! Its so scary!”. On examination his peripheries are cold, SBP95, apex is felt closer to the anterior axillary fold than midclavicular. His BMI is 21.
Which of the below descriptions best define the anterior axillary fold?
Contains a muscle innervated by the dorsal scapular n
Contains a muscle innervated by the latissimus dorsi n
Contains a muscle innervated by the long thoracic n
Contains a muscle innervated by the medial pectoral n
Contains a muscle innervated by the phrenic n
Stem 2 of 10How is ejection fraction calculated?
CO x HR
EDV / SV
HR x SV
SV / EDV
SV / SVR
Stem 3 of 10To classify this patient as systolic heart failure, which ejection fraction is most appropriate?
Stem 4 of 10Calculate his New York Classification of Heart Failure
Stem 5 of 10According to NICE, what is/are the first line investigation(s) in this patient?
Stem 6 of 10As per the previous question, labs are requested. They are positive. What is the next best step for this patient?
Stem 7 of 10Which of the following would you least expect on chest X-ray in this patient?
57% cardiothoracic ratio
Diversion of blood to apices
Septal/Kerley B lines
Stem 8 of 10Which of the following best describes the lab test BNP?
Increased VQ ratio is unlikely to cause BNP elevation
BNP is one of the most sensitive biomarkers of heart failure
BNP decreases glomerular filtration rate
Sudden cardiac arrest risk is proportional to pro-BNP in serum
The release of BNP is related to increased preload
Stem 9 of 10The patient is started on medication. Of the choices below, select the two that are true.
A contraindication for digoxin is atrial fibrillation
Hydralazine can be paired with ISMN for second line therapy
If patient is still symptomatic after ACEi and BB, consider thiazide
Beta blockers do not improve mortality
Ramipril improves symptoms and mortality
Stem 10 of 10Which three of the following medications should be avoided in this patient?
Carbonic anhydrase inhibitors
Class four anti-arrhythmics
NaCl early DCT antagonists
Oxyntic cell direct inhibitors
Selective COX2 inhibitors