Question Easy:
A 45-year-old man presents to the GP with chest pain. He describes the pain as constricting and radiates to his left arm. What is the most likely diagnosis?
a) Gastroesophageal reflux disease (GERD)
b) Myocardial infarction (MI) ❤️
c) Pneumonia
d) Musculoskeletal pain
Question Medium:
A 65-year-old woman with a history of chronic obstructive pulmonary disease (COPD) comes to the clinic with increased breathlessness and a productive cough for the past three days. She has also noticed purulent sputum. Which of the following is the most appropriate initial management?
a) Start broad-spectrum antibiotics
b) Increase doses of bronchodilators and corticosteroids
c) Admit to hospital immediately for IV antibiotics
d) Prescribe antiviral medication
Question Hard:
A 32-year-old man presents with sudden-onset shortness of breath, pleuritic chest pain, and hemoptysis. He has a previous history of deep vein thrombosis (DVT). Which diagnostic test is most appropriate to confirm your suspected diagnosis?
a) Chest X-ray
b) Echocardiogram
c) D-dimer test
d) Computed tomography pulmonary angiography (CTPA) 📸
Explanations & Answers:
Question Easy Answer:
b) Myocardial infarction (MI) ❤️
Question Easy Explanation:
According to NICE guidelines, chest pain that radiates to the left arm and is described as constricting is highly suggestive of myocardial infarction. Immediate assessment and management per acute coronary syndrome protocol are necessary. Other conditions should be considered only after ruling out MI.
Question Medium Answer:
b) Increase doses of bronchodilators and corticosteroids
Question Medium Explanation:
As per NICE guidelines for managing acute exacerbations of COPD, increasing the doses of bronchodilators and corticosteroids is typically the initial management. Antibiotics may be considered if there are signs of bacterial infection, such as purulent sputum, but should be guided by local antimicrobial stewardship policies rather than broad-spectrum empirical use.
Question Hard Answer:
d) Computed tomography pulmonary angiography (CTPA) 📸
Question Hard Explanation:
For suspected pulmonary embolism (PE), as indicated by sudden-onset shortness of breath, pleuritic chest pain, and hemoptysis especially in a patient with a history of DVT, CTPA is the gold standard investigative modality recommended by NICE guidelines. Other tests such as D-dimer may be used for initial screening, but CTPA confirms the diagnosis.
Medical fact of the day:
Did you know? Chronic obstructive pulmonary disease (COPD) is primarily caused by smoking and is the second most common cause of emergency hospital admissions in the UK. Quitting smoking is the single most effective way to slow the progression of the disease.
Quote of the day:
“The best way to find yourself is to lose yourself in the service of others. Each patient you heal, and each smile you inspire, shapes the future of healthcare.”