**Question Easy:**
A 60-year-old man presents with breathlessness, chest pain, and palpitations. On examination, his pulse is irregularly irregular, and an ECG shows absent P waves. What is the most likely diagnosis? 💓
A) Atrial fibrillation
B) Ventricular tachycardia
C) Third-degree heart block
D) Sinus bradycardia
E) Atrial flutter
**Question Easy Answer:**
A) Atrial fibrillation
**Question Easy Explanation:**
The most likely diagnosis is atrial fibrillation (AF). AF presents with an ‘irregularly irregular’ pulse and the absence of P waves on the ECG. It’s essential to manage AF due to the increased risk of stroke, often with anticoagulation therapy. Refer to NICE guidelines for a detailed management plan.
**Question Medium:**
A 72-year-old woman with a history of hypertension and diabetes presents with exertional dyspnoea and ankle swelling. On examination, she has bilateral basal crepitations and raised JVP. What is the first-line investigation? 🌡️
A) Chest X-ray
B) ECG
C) Serum natriuretic peptides (BNP or NT-proBNP)
D) Echocardiogram
E) Spirometry
**Question Medium Answer:**
C) Serum natriuretic peptides (BNP or NT-proBNP)
**Question Medium Explanation:**
In suspected heart failure, NICE guidelines recommend performing a measurement of serum natriuretic peptides such as BNP or NT-proBNP as the initial diagnostic test. Elevated levels suggest heart failure and necessitate further investigation usually by echocardiography.
**Question Hard:**
A 45-year-old male presents with sudden onset pleuritic chest pain and hemoptysis. He recently underwent knee surgery. Vital signs show tachycardia and hypoxia. Which diagnostic modality is most appropriate to confirm the diagnosis? 🩺
A) D-dimer
B) Chest X-ray
C) ECG
D) CT pulmonary angiography (CTPA)
E) Ventilation-perfusion (V/Q) scan
**Question Hard Answer:**
D) CT pulmonary angiography (CTPA)
**Question Hard Explanation:**
The clinical presentation suggests a pulmonary embolism (PE). NICE guidelines and the BTS recommend CT pulmonary angiography (CTPA) as the gold standard for diagnosing PE, particularly given the acute presentation and risk factors like recent surgery.
**Medical fact of the day:**
Pulmonary embolism accounts for approximately 15% of all in-hospital deaths in the UK. Rapid diagnosis and treatment are crucial to improve patient outcomes. (Source: NHS and NICE guidelines)
**Quote of the day:**
“Every heartbeat you help save today, makes a life beat stronger tomorrow. Keep pushing forward!”