74 year old male with known hypertension is sent to you for a review by the practice nurse who has noted high BP on multiple readings. Other PMH include gout and long term smoker. His BP today is 168/105. Recent total cholesterol is 3.8 and HBA1c was 5.4%. You also note his Q-risk for CVD as 23%. Current medication is Amlodipine 10mg OD, Allopurinol 300mg OD. What should be done with his medication: a)Start indapamide b)Start Ramipril c)Start indapamide + statin d)Start Ramipril + Statin e)Start Statin alone

Patient agrees to start Ramipril 2.5mg OD and simvastatin 40mg OD. What blood test will be needed with regards to his statin: a) LFT baseline then at 3 months and at 12months. Needs yearly LFTs therafter. b) Don’t worry about it. c) CK and LFTs followed by LFTs and CK at 3 months and 12months. No further test if NAD. d)LFTs at 6months and 12 months. Then yearly LFTs thereafter e) LFTs at three months. No further test if NAD.

Patient comes back with generalised muscle pains. CK is checked and is 3 times the normal limit. His symptoms have now settled but what do you do next? a)Stop simvastatin b)Change to 20mg OD simvastatin and continue. c)Change to Atorvastatin d)Change to pravastatin e)Don’t worry about it.

46 year old female with rheumatoid arthritis stable on methotrexate for the last 18months. She has been discharged to your care and are in charge of monitoring her blood test. What needs to be done: a)FBC/UEs/LFTs 3monthly b)FBC/LFTs 6monthly c)LFTs 3 monthly d)FBC/UE/folate 6monthly e)Don’t worry about it

76 year old patient with heart failure and atrial fibrillation. Other PMH include peripheral vascular disease and hypertension. Currently on Warfarin, Digoxin 250mcg OD, Ramipril 5mg OD and Furosemide 40mg OD. Patients rate control has been an issue. He is well in himself. You have done a Digoxin level which is therapeutic and other blood tests including thyroid function are normal. What medication should be added? a)Amiodarone b)Bisoprolol c)Verapamil d)Increase digoxin e)Don’t worry about it

Patient has agreed to commence amiodarone after warning him about possible side effects. What investigations are needed prior to treatment and for continued monitoring? At baseline: a)TFT’s, LFT’s and U/E’s b)FBC, U/E’s, LFT’s and lipid profile c)Chest X-Ray, LFT’s, TFT’s and U/E’s d)Chest X-Ray, FBC, LFT’s and lipid profile

And then… a)TFT’s and LFT’s 6 monthly b)TFT’s and U/E’s 6 monthly c)FBC and TFT’s 12 monthly d)U/E’s and TFT’s 4 monthly

26 year old pregnant female presented with hyperactivity, euphoria, rapid speech and grandiose delusions. Not currently on any medication but has PMH of bipolar. What is the most appropriate medication for this patient? a)Lithium b)Sodium valporate c)Olanzapine d)Lamotragine e)Clonazapam

Olanzapine has been commenced. What investigations are needed at baseline? a)FBC, TFT’s, weight, ECG, U/E’s and LFT’s. b) U/E’s, LFT’s, FBC, lipids, fasting glucose, prolactin, weight, BP and ECG. c) BP, weight, random glucose, lipids and FBC. d) ECG, BP, fasting glucose, FBC, prolactin and U/E’s.