QuestionSBA
QuestionChoice
This patient has atrial fibrillation and a CHA₂DS₂-VASc of 5. (Age=2, TIA=2, treated hypertension = 1. 2+2+1=5.) Anticoagulation should therefore be initiated. Direct oral anticoagulants such as apixaban are the first-line medications used.
50096
a
Start Apixaban 5mg Oral
QuestionChoice
This patient has atrial fibrillation (AF). Warfarin was historically first line for anticoagulation in patients with AF although DOACs are now preferred as they have a lower bleeding risk and do not require regular monitoring.
50098
c
Start Warfarin 5mg OD Oral and book follow-up in INR clinic
QuestionChoice
This patient has atrial fibrillation (AF) . Flecainide is a treatment option in paroxysmal atrial fibrillation as a ‘pill in pocket’ initiated by. This would not be appropriate here as it is a specialist treatment, this patient has a normal heart rate and there is no suggestion that their AF is paroxysmal.
50100
e
Start Flecainide 50mg OD Oral
QuestionChoice
This patient has atrial fibrillation (AF). Although clopidogrel is used in the management of patients after a TIA, where patients have AF, anticoagulation with DOACs is more appropriate than antiplatelet treatment as they have a greater risk of clot formation.
50099
d
Start Clopidogrel 75mg OD Oral
QuestionChoice
This would be correct if the patient was presenting with unstable AF causing haemodynamic compromise. However, all of this patient's vital signs are stable.
50097
b
Start DC Cardioversion
QuestionComment
I thought you wait 2 weeks after a stroke to start a DOAC?
39641
QuestionComment
Yes for stroke but this question is for TIA
39900
User
subscriber
Acute Ketone
User
subscriber
Zygomatic Hallux
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3599
Anticoagulation in a new diagnosis of Atrial Fibrillation
Topic
9
Internal Medicine
10067
Case Presentation: A 76-year-old man is admitted to the stroke ward following a TIA. **PH** TIA, Hyperlipidaemia, Gout **DH** Atorvastatin 20mg oral OD, Ramipril 5mg oral OD, Allopurinol 100mg oral OD. NKDA



**On examination**

* Irregularly irregular radial pulse and central pulse.
* HS S1+S2
* Chest clear on auscultation.
* BP 130/80, HR 88, Temperature 37.1°C, O2 98% on room air

**Investigations**

 - ECG: Irregularly irregular rhythm, no p waves
 - Transthoracic echocardiogram: normal
 - CT head normal
 - FBC,U&Es, LFTs and clotting studies are all NAD.

Question: Select the most appropriate initial management at this stage, given the results of the investigations.
a