1: A 52-year-old man is diagnosed with hypertension after ambulatory blood pressure monitoring confirms an average blood pressure of 152/96 mmHg. He has no significant medical history, normal renal function and is not of Black African or African-Caribbean family origin. Which ONE of the following is the most appropriate first-line treatment?
A. Amlodipine
B. Bisoprolol
C. Doxazosin
D. Ramipril
E. Indapamide
2: A 74-year-old woman presents to the emergency department with sudden-onset palpitations. An ECG confirms atrial fibrillation with a ventricular rate of 145 beats/minute. She is haemodynamically stable. What is the primary purpose of calculating her CHA₂DS₂-VASc score?
A. To determine the need for rate-control therapy
B. To assess bleeding risk
C. To estimate stroke risk and guide anticoagulation
D. To diagnose heart failure
E. To determine the need for electrical cardioversion
3: A patient is started on ramipril for hypertension. Which blood tests should routinely be checked within the first few weeks after initiation?
A. Liver function tests
B. Potassium and renal function
C. HbA1c
D. Thyroid function tests
E. Full blood count
4: A 67-year-old man with stable angina asks when he should use his glyceryl trinitrate (GTN) spray. Which ONE of the following is the most appropriate advice?
A. Use it every morning.
B. Use it after meals.
C. Use it immediately before exercise or at the onset of chest pain.
D. Replace regular anti-anginal treatment with GTN.
E. Use only if systolic blood pressure is above 140 mmHg.
5: A 71-year-old woman with heart failure reports increasing breathlessness when lying flat and worsening ankle swelling. Which finding is MOST suggestive of worsening heart failure?
A. Dry mouth
B. Orthopnoea with peripheral oedema
C. Constipation
D. Tinnitus
E. Blurred vision
6: A patient attends the anticoagulation clinic for routine monitoring while taking warfarin. What is the purpose of measuring the INR?
A. Assess kidney function
B. Ensure anticoagulation remains within the therapeutic range
C. Detect myocardial infarction
D. Assess liver function
E. Diagnose atrial fibrillation
7: A patient develops swollen ankles three weeks after starting treatment for hypertension. Which medicine is the MOST likely cause?
A. Ramipril
B. Amlodipine
C. Losartan
D. Bendroflumethiazide
E. Bisoprolol
8: A 64-year-old patient develops a persistent dry cough shortly after starting treatment for hypertension. Which medicine is MOST likely responsible?
A. Losartan
B. Indapamide
C. Ramipril
D. Amlodipine
E. Doxazosin
9: A 69-year-old man has heart failure with reduced ejection fraction. Which medicine has been shown to improve survival?
A. Omeprazole
B. Ramipril
C. Amlodipine
D. Digoxin
E. Glyceryl trinitrate spray
10: A 60-year-old man who smokes 20 cigarettes per day asks which lifestyle change would have the greatest impact on reducing his cardiovascular risk.
Which ONE of the following is the best advice?
A. Reduce caffeine intake.
B. Take a multivitamin.
C. Stop smoking.
D. Avoid dairy products.
E. Increase salt intake.
11: A 76-year-old man with a history of myocardial infarction is prescribed aspirin 75 mg once daily. What is the primary purpose of long-term aspirin therapy in this patient?
A. Reduce blood pressure
B. Prevent recurrent cardiovascular events
C. Improve cholesterol levels
D. Treat heart failure
E. Prevent atrial fibrillation
12: A 65-year-old woman is started on atorvastatin 80 mg following an acute coronary syndrome. What is the main therapeutic goal of initiating high-intensity statin therapy?
A. Lower blood glucose
B. Reduce LDL cholesterol and future cardiovascular risk
C. Prevent hypertension
D. Reduce heart rate
E. Improve renal function
13: A patient with hypertension is taking ramipril. At review, their blood pressure remains above target despite treatment at the maximum tolerated dose. According to the stepwise approach to hypertension management, which medicine is the most appropriate addition for a 70-year-old patient?
A. Amlodipine
B. Doxazosin
C. Spironolactone
D. Bisoprolol
E. Furosemide
14: A 73-year-old man presents with sudden central chest pain lasting over 45 minutes. The pain radiates to his left arm and is associated with sweating and nausea. Which diagnosis should be considered FIRST?
A. Stable angina
B. Gastro-oesophageal reflux disease
C. Acute coronary syndrome
D. Costochondritis
E. Panic attack
15: A patient taking furosemide for chronic heart failure attends for routine monitoring. Which electrolyte disturbance is most commonly associated with loop diuretics?
A. Hyperkalaemia
B. Hypercalcaemia
C. Hypokalaemia
D. Hypermagnesaemia
E. Hyperphosphataemia
16: A patient prescribed rivaroxaban asks what they should do if they experience prolonged bleeding after cutting themselves while shaving. Which advice is MOST appropriate?
A. Stop taking rivaroxaban immediately.
B. Continue taking rivaroxaban and seek urgent medical advice if the bleeding does not stop or is severe.
C. Double the next dose.
D. Take aspirin to help the blood clot.
E. Miss all remaining doses for the week.
17: A 62-year-old man with heart failure is started on bisoprolol. What is the most appropriate way to initiate treatment?
A. Start at the maximum dose immediately.
B. Start at a low dose and increase gradually if tolerated.
C. Only start if the resting heart rate exceeds 120 beats/minute.
D. Use only during episodes of worsening symptoms.
E. Stop the ACE inhibitor before starting bisoprolol.
18: A patient with atrial fibrillation is started on apixaban. Which statement regarding routine monitoring is correct?
A. INR monitoring is required every month.
B. Routine coagulation monitoring is not required, but renal function should be monitored periodically.
C. Weekly liver function tests are required.
D. Daily platelet counts should be performed.
E. Blood pressure monitoring replaces renal monitoring.
19: A patient prescribed simvastatin reports new-onset muscle pain affecting both thighs. What is the MOST appropriate action?
A. Reassure the patient that this is expected and continue treatment.
B. Recommend an NSAID without further assessment.
C. Assess for possible statin-associated muscle symptoms, including checking creatine kinase if clinically indicated.
D. Double the statin dose.
E. Stop all cardiovascular medicines permanently.
20: A patient with stable heart failure asks why they have been advised to weigh themselves regularly at home. What is the main reason for this advice?
A. To monitor cholesterol levels.
B. To detect early fluid retention and worsening heart failure.
C. To calculate medicine doses every day.
D. To assess blood pressure control.
E. To monitor kidney function.
21: A 68-year-old man with atrial fibrillation has been taking warfarin for several years. He asks why his friend, who also has atrial fibrillation, does not need regular INR blood tests. Which ONE of the following best explains this difference?
A. Warfarin is less effective than direct oral anticoagulants.
B. Direct oral anticoagulants have a predictable anticoagulant effect and do not require routine INR monitoring.
C. INR monitoring is only required in patients over 75 years of age.
D. INR monitoring is only required during the first month of warfarin treatment.
E. Direct oral anticoagulants require weekly clotting tests instead of INR monitoring.
22: A 70-year-old woman with chronic heart failure reports increasing shortness of breath, swollen ankles and a weight gain of 3 kg over the last five days despite taking her medicines as prescribed. Which ONE of the following is the most appropriate action?
A. Reassure the patient that this is expected.
B. Advise the patient to stop all heart failure medicines.
C. Arrange urgent clinical review for possible worsening heart failure.
D. Recommend an over-the-counter cough medicine.
E. Advise the patient to increase her fluid intake.
23: A 63-year-old man attends his GP for a medication review. His blood pressure remains above target despite treatment with ramipril and amlodipine at optimal doses. His serum potassium is 4.2 mmol/L and renal function is normal. Which ONE of the following is the most appropriate next step in antihypertensive therapy?
A. Add indapamide.
B. Stop ramipril.
C. Replace amlodipine with verapamil.
D. Add spironolactone immediately.
E. Add glyceryl trinitrate.
24: A 59-year-old man presents to the emergency department with severe central chest pain that began one hour ago. An ECG demonstrates ST-segment elevation in the anterior leads. Which ONE of the following is the most appropriate immediate management?
A. Begin oral antibiotics.
B. Refer for urgent reperfusion therapy.
C. Arrange an outpatient exercise tolerance test.
D. Prescribe a proton pump inhibitor.
E. Discharge with glyceryl trinitrate spray.
25: A patient taking atorvastatin asks whether they should stop treatment because their cholesterol result is now within the target range. Which ONE of the following is the most appropriate response?
A. Stop treatment immediately.
B. Reduce the dose by half.
C. Continue treatment unless advised otherwise, as statins reduce ongoing cardiovascular risk.
D. Only take the statin when eating fatty foods.
E. Take the statin every other week.
26: A 72-year-old woman is admitted with atrial fibrillation. She becomes hypotensive, develops chest pain and loses consciousness briefly. Which ONE of the following is the most appropriate management?
A. Start oral bisoprolol and review in 48 hours.
B. Urgent electrical cardioversion.
C. Arrange outpatient anticoagulation.
D. Begin atorvastatin therapy.
E. Start aspirin only.
27: A 65-year-old patient taking furosemide for heart failure reports feeling dizzy when standing up quickly. Which ONE of the following is the most likely explanation?
A. Hyperthyroidism.
B. Postural hypotension.
C. Hyperglycaemia.
D. Acute liver failure.
E. Iron deficiency.
28: A patient with stable angina experiences chest pain while walking uphill. They use one dose of glyceryl trinitrate spray, but the pain persists after five minutes. Which ONE of the following is the most appropriate advice?
A. Continue walking to improve circulation.
B. Use another dose if appropriate and seek emergency medical assistance if pain persists.
C. Wait until the following day before seeking advice.
D. Take an ibuprofen tablet.
E. Skip their next anti-anginal medicine.
29: A patient receiving ramipril develops swelling of the lips and tongue shortly after taking their morning dose. Which ONE of the following is the most appropriate action?
A. Continue treatment and monitor symptoms.
B. Arrange routine GP review next month.
C. Stop ramipril and seek emergency medical attention immediately.
D. Reduce the ramipril dose by half.
E. Take an antihistamine and continue ramipril.
30: A 66-year-old man with hypertension asks which lifestyle change is most likely to reduce his blood pressure alongside medication. Which ONE of the following is the best recommendation?
A. Increase dietary salt intake.
B. Reduce physical activity.
C. Maintain a healthy weight, exercise regularly and reduce salt intake.
D. Drink more sugary drinks.
E. Avoid all fruit and vegetables.
31: A 64-year-old man presents to his GP with exertional chest discomfort that resolves within a few minutes of resting. The pain has occurred several times over the past three months and has not changed in frequency or severity. Which ONE of the following is the most likely diagnosis?
A. Acute coronary syndrome
B. Stable angina
C. Pericarditis
D. Pulmonary embolism
E. Aortic dissection
32: A 79-year-old woman with atrial fibrillation is started on apixaban. Her estimated creatinine clearance falls significantly six months later. Which ONE of the following is the most appropriate reason for monitoring her renal function?
A. To assess whether anticoagulation is still required.
B. To determine whether the apixaban dose remains appropriate.
C. To decide whether aspirin should be started.
D. To monitor liver enzyme activity.
E. To calculate her cholesterol level.
33: A 60-year-old man with hypertension is prescribed indapamide. Which ONE of the following blood tests should be monitored after treatment is initiated?
A. Calcium and thyroid function
B. Electrolytes and renal function
C. Troponin
D. Vitamin B12
E. Ferritin
34: A patient who recently had a myocardial infarction asks why they have been prescribed bisoprolol. Which ONE of the following is the most appropriate explanation?
A. It dissolves existing blood clots.
B. It reduces myocardial workload and lowers the risk of future cardiovascular events.
C. It lowers cholesterol production.
D. It prevents all episodes of chest pain.
E. It replaces the need for antiplatelet therapy.
35: A 75-year-old man presents with sudden tearing chest pain radiating to his back. He is pale, clammy and hypotensive. Which ONE of the following conditions should be suspected?
A. Stable angina
B. Gastro-oesophageal reflux disease
C. Aortic dissection
D. Costochondritis
E. Community-acquired pneumonia
36: A patient with heart failure is started on dapagliflozin. Which ONE of the following best describes the primary reason for prescribing this medicine?
A. It is only used if the patient has type 2 diabetes.
B. It improves heart failure outcomes, including reducing hospitalisation and cardiovascular death.
C. It is prescribed solely to lower cholesterol.
D. It replaces ACE inhibitor therapy.
E. It is only used for resistant hypertension.
37: A patient receiving warfarin telephones the anticoagulation clinic after forgetting to attend their scheduled INR appointment. Which ONE of the following is the most appropriate advice?
A. Stop taking warfarin until the next appointment.
B. Arrange another INR test as soon as possible and continue taking warfarin unless advised otherwise.
C. Double the next dose of warfarin.
D. Switch to aspirin until the INR is checked.
E. Miss the next three doses.
38: A 58-year-old woman is prescribed ticagrelor following an acute coronary syndrome. Which ONE of the following counselling points is MOST appropriate?
A. Stop taking ticagrelor if minor bruising occurs without informing a healthcare professional.
B. Report any signs of significant or prolonged bleeding promptly.
C. Avoid taking the medicine with food.
D. Take the medicine only when chest pain occurs.
E. Do not take aspirin alongside ticagrelor under any circumstances.
39: A patient with chronic heart failure asks why an echocardiogram was requested during their assessment. Which ONE of the following is the primary purpose of this investigation?
A. Measure serum potassium.
B. Assess cardiac structure and ventricular function.
C. Detect myocardial infarction using blood markers.
D. Measure cholesterol concentration.
E. Assess kidney function.
40: A 62-year-old woman presents with crushing central chest pain lasting over 30 minutes. She appears pale and sweaty. While waiting for the ambulance, which ONE of the following is the MOST appropriate immediate advice?
A. Drive herself to the emergency department.
B. Rest, call emergency services and chew 300 mg aspirin if not contraindicated and available.
C. Take ibuprofen and monitor symptoms overnight.
D. Wait until the pain has lasted two hours before seeking help.
E. Drink plenty of water and continue normal activities.
41: A 72-year-old man with chronic heart failure is prescribed spironolactone in addition to ramipril and bisoprolol. Which ONE of the following adverse effects requires regular biochemical monitoring?
A. Hyperglycaemia
B. Hyperkalaemia
C. Hypocalcaemia
D. Hyperuricaemia
E. Iron deficiency
42: A 69-year-old woman presents with palpitations and dizziness. Her ECG demonstrates a narrow-complex tachycardia at 180 beats/minute. She is haemodynamically stable. Initial vagal manoeuvres are unsuccessful. Which ONE of the following is the most appropriate next treatment?
A. Adenosine
B. Atorvastatin
C. Digoxin
D. Ramipril
E. Verapamil MR
43: A 57-year-old man who had a myocardial infarction 12 months ago asks why he should continue taking atorvastatin despite feeling well. Which ONE of the following is the best explanation?
A. It cures coronary artery disease.
B. It reduces the long-term risk of future cardiovascular events.
C. It prevents all episodes of angina.
D. It lowers blood pressure.
E. It replaces the need for a healthy lifestyle.
44: A 75-year-old patient taking warfarin is prescribed trimethoprim for a urinary tract infection. Which ONE of the following is the most appropriate concern?
A. Trimethoprim has no clinically significant interaction with warfarin.
B. Trimethoprim may increase the anticoagulant effect of warfarin, increasing bleeding risk.
C. Warfarin reduces the effectiveness of trimethoprim.
D. INR monitoring is no longer required while taking trimethoprim.
E. The combination commonly causes severe hypertension.
45: A 66-year-old man with hypertension asks how he can improve the accuracy of his home blood pressure readings. Which ONE of the following pieces of advice is MOST appropriate?
A. Measure blood pressure immediately after exercise.
B. Take one reading only and record the highest result.
C. Rest quietly for five minutes before taking the measurement.
D. Measure blood pressure only when experiencing symptoms.
E. Cross your legs during the measurement.
46: A 73-year-old woman presents with increasing breathlessness over the past week. On examination, she has bilateral basal crackles and pitting oedema to both ankles. Which ONE of the following findings is MOST consistent with fluid overload secondary to heart failure?
A. Raised jugular venous pressure
B. Pinpoint pupils
C. Hyperactive bowel sounds
D. Hepatosplenomegaly due to infection
E. Bilateral middle-ear effusions
47: A patient taking ramipril reports developing a persistent dry cough that has become troublesome. His blood pressure is well controlled and renal function is normal. Which ONE of the following is the most appropriate management?
A. Continue ramipril without review.
B. Switch to an angiotensin II receptor blocker if clinically appropriate.
C. Add a cough suppressant and continue ramipril indefinitely.
D. Stop all antihypertensive therapy.
E. Replace ramipril with aspirin.
48: A 68-year-old woman with heart failure asks why she receives an influenza vaccination every year. Which ONE of the following is the best explanation?
A. Influenza vaccination lowers cholesterol.
B. Influenza infection may worsen heart failure and increase the risk of complications.
C. Influenza vaccination replaces heart failure medicines during winter.
D. Influenza vaccination prevents hypertension.
E. Influenza vaccination removes the need for pneumococcal vaccination.
49: A 71-year-old man with stable angina is prescribed a beta-blocker. Which ONE of the following is the primary therapeutic effect of this medicine in angina?
A. Increase myocardial oxygen demand.
B. Reduce heart rate and myocardial oxygen demand.
C. Dissolve coronary artery plaques.
D. Prevent platelet aggregation.
E. Increase cardiac contractility.
50: A 64-year-old woman with atrial fibrillation asks why she has been advised to take her anticoagulant every day, even when she feels completely well. Which ONE of the following is the best explanation?
A. The medicine treats symptoms of atrial fibrillation only.
B. The medicine lowers blood pressure.
C. Regular anticoagulation reduces the ongoing risk of stroke associated with atrial fibrillation.
D. Anticoagulants permanently cure atrial fibrillation.
E. The medicine prevents high cholesterol.
Cardiovascular Questions
Answers and Rationale
1. D – Ramipril
Adults under 55 years without Black African or African-Caribbean family origin are generally offered an ACE inhibitor first-line unless contraindicated.
2. C – Estimate stroke risk
CHA₂DS₂-VASc is used to determine whether anticoagulation should be offered to reduce stroke risk in atrial fibrillation.
3. B – Potassium and renal function
ACE inhibitors can increase potassium and affect renal function. Serum creatinine/eGFR and potassium should be checked after initiation and dose increases.
4. C – Use before exertion or when symptoms occur
GTN spray provides rapid symptom relief and may also be used prophylactically before activities known to precipitate angina.
5. B – Orthopnoea with peripheral oedema
These symptoms indicate worsening fluid overload and possible heart failure decompensation.
6. B – Therapeutic anticoagulation
INR monitoring ensures warfarin remains effective while minimising the risk of bleeding.
7. B – Amlodipine
Peripheral oedema is a common adverse effect of dihydropyridine calcium-channel blockers.
8. C – Ramipril
A persistent dry cough is a recognised adverse effect of ACE inhibitors due to increased bradykinin.
9. B – Ramipril
ACE inhibitors are one of the cornerstone disease-modifying therapies shown to reduce mortality in HFrEF.
10. C – Stop smoking
Smoking cessation provides one of the greatest reductions in cardiovascular morbidity and mortality.
11. B – Prevent recurrent cardiovascular events
Low-dose aspirin is used for secondary prevention by reducing the risk of future myocardial infarction, stroke and other cardiovascular events.
12. B – Reduce LDL cholesterol and future cardiovascular risk
High-intensity statins substantially lower LDL cholesterol and reduce the risk of recurrent cardiovascular events after acute coronary syndrome.
13. A – Amlodipine
For patients aged 55 years and over (or of Black African or African-Caribbean family origin), a calcium-channel blocker is the preferred addition or first-line option in the stepwise treatment of hypertension.
14. C – Acute coronary syndrome
Prolonged central chest pain with radiation, diaphoresis and nausea is highly suggestive of an acute coronary syndrome and requires urgent assessment.
15. C – Hypokalaemia
Loop diuretics increase urinary potassium excretion, making hypokalaemia a common adverse effect that requires monitoring.
16. B – Continue rivaroxaban and seek medical advice if bleeding is prolonged or severe
Minor bleeding may settle with pressure, but persistent or significant bleeding requires medical assessment. Patients should not stop anticoagulation without professional advice unless instructed in an emergency.
17. B – Start low and titrate slowly
Evidence-based beta-blockers should be initiated at a low dose and increased gradually to improve tolerability and reduce the risk of worsening heart failure.
18. B – No routine coagulation monitoring
Direct oral anticoagulants do not require routine INR monitoring, but renal function should be checked periodically to ensure appropriate dosing.
19. C – Assess for statin-associated muscle symptoms
Muscle pain may indicate statin-associated myopathy. Clinical assessment and creatine kinase measurement may be appropriate depending on symptom severity.
20. B – Detect early fluid retention
A sudden increase in body weight may indicate fluid accumulation and worsening heart failure, allowing treatment to be adjusted before symptoms become severe.
21. B – Direct oral anticoagulants have a predictable anticoagulant effect.
DOACs such as apixaban and rivaroxaban do not require routine INR monitoring because they have more predictable pharmacokinetics than warfarin.
22. C – Arrange urgent clinical review.
Rapid weight gain, worsening breathlessness and peripheral oedema suggest acute decompensation of heart failure and require prompt assessment.
23. A – Add indapamide.
If blood pressure remains uncontrolled despite an ACE inhibitor (or ARB) plus a calcium-channel blocker, a thiazide-like diuretic such as indapamide is an appropriate next step.
24. B – Refer for urgent reperfusion therapy.
ST-elevation myocardial infarction requires immediate reperfusion, usually by primary PCI where available.
25. C – Continue treatment.
Statins are used for long-term cardiovascular risk reduction. Cholesterol reaching target is an indication that treatment is working, not that it should be stopped.
26. B – Urgent electrical cardioversion.
Patients with atrial fibrillation who are haemodynamically unstable require immediate synchronised electrical cardioversion.
27. B – Postural hypotension.
Loop diuretics can contribute to volume depletion and orthostatic hypotension, particularly in older adults.
28. B – Use another dose and seek emergency help if pain persists.
Persistent chest pain despite GTN may indicate an acute coronary syndrome and warrants urgent medical assessment.
29. C – Stop ramipril and seek emergency care.
Angioedema is a rare but potentially life-threatening adverse effect of ACE inhibitors and requires immediate discontinuation and emergency assessment.
30. C – Healthy weight, exercise and salt reduction.
Lifestyle interventions such as weight loss, regular physical activity and dietary salt reduction complement antihypertensive therapy and improve cardiovascular outcomes.
31. B – Stable angina
Chest pain that is predictably triggered by exertion and relieved by rest is characteristic of stable angina.
32. B – Determine whether the apixaban dose remains appropriate
Renal function should be monitored periodically because reduced kidney function may require dose adjustment or influence the choice of anticoagulant.
33. B – Electrolytes and renal function
Thiazide-like diuretics can affect sodium, potassium and renal function, so these should be monitored after initiation and during treatment.
34. B – Reduces myocardial workload and future cardiovascular events
Beta-blockers reduce heart rate and myocardial oxygen demand and improve outcomes after myocardial infarction in appropriate patients.
35. C – Aortic dissection
Sudden tearing chest pain radiating to the back with haemodynamic instability is a classic presentation of aortic dissection and requires immediate emergency management.
36. B – Improves heart failure outcomes
SGLT2 inhibitors such as dapagliflozin improve outcomes in heart failure with reduced ejection fraction regardless of whether the patient has diabetes.
37. B – Arrange an INR as soon as possible
Patients should continue warfarin unless advised otherwise and have INR monitoring rearranged promptly to maintain safe anticoagulation.
38. B – Report significant bleeding
Patients taking ticagrelor should be counselled about bleeding risk and advised to seek medical advice if bleeding is severe, prolonged or unusual.
39. B – Assess cardiac structure and ventricular function
Echocardiography is the key investigation for assessing ventricular function, valvular disease and confirming heart failure.
40. B – Rest, call emergency services and chew aspirin if appropriate
Suspected acute coronary syndrome requires immediate emergency assessment. If aspirin is not contraindicated, a 300 mg dose should be chewed while awaiting emergency medical assistance.
41. B – Hyperkalaemia
Spironolactone is a potassium-sparing diuretic. When used with ACE inhibitors or ARBs, it can significantly increase serum potassium. Potassium and renal function should be monitored regularly.
42. A – Adenosine
In a haemodynamically stable patient with a regular narrow-complex supraventricular tachycardia that does not respond to vagal manoeuvres, adenosine is the recommended first-line pharmacological treatment.
43. B – Reduces future cardiovascular events
High-intensity statins provide long-term secondary prevention by reducing the risk of myocardial infarction, stroke and cardiovascular death.
44. B – Increased anticoagulant effect
Trimethoprim can potentiate the effects of warfarin, increasing the risk of bleeding. Patients require closer INR monitoring and may need warfarin dose adjustment.
45. C – Rest for five minutes
Patients should be seated comfortably, rest for at least five minutes, avoid caffeine, smoking and exercise beforehand, and use a correctly sized cuff to improve measurement accuracy.
46. A – Raised jugular venous pressure
Raised JVP is a classic sign of systemic venous congestion and fluid overload in heart failure, alongside peripheral oedema and pulmonary crackles.
47. B – Switch to an ARB
A persistent ACE inhibitor-induced cough can often be managed by switching to an angiotensin II receptor blocker, which has a much lower incidence of cough.
48. B – Prevent heart failure deterioration
Respiratory infections, including influenza, can precipitate decompensated heart failure. Annual influenza vaccination is recommended to reduce this risk.
49. B – Reduce heart rate and myocardial oxygen demand
Beta-blockers improve angina symptoms by reducing heart rate and myocardial contractility, thereby lowering myocardial oxygen demand during exertion.
50. C – Reduce stroke risk
Patients with atrial fibrillation remain at risk of thromboembolism even if they are asymptomatic. Taking anticoagulants consistently is essential to reduce the risk of stroke.