Question Easy:
A 65-year-old man comes to the GP with a 4-week history of increasing breathlessness and a productive cough. He smokes 20 cigarettes per day and has a 40-pack-year smoking history. On examination, there are signs of hyperinflation, and he has a prolonged expiratory phase with wheezing. What is the most likely diagnosis?
A) Asthma
B) COPD
C) Lung Cancer
D) Pulmonary Embolism
E) Tuberculosis
Explanations & Answers:
Question Easy Answer: B)
Question Easy Explanation: COPD, or Chronic Obstructive Pulmonary Disease, is characterized by prolonged expiratory phase, wheezing, and often a history of significant smoking. According to NICE guidelines, COPD is the most likely diagnosis in the above context.
Question Medium:
A 52-year-old woman presents to the emergency department with sudden onset of pleuritic chest pain and shortness of breath. She has a history of recent long-haul flight. On physical examination, her respiratory rate is 28 breaths per minute, and oxygen saturation is 88% on room air. What is the most appropriate next step in management?
A) Chest X-ray
B) D-dimer test
C) ECG
D) CT pulmonary angiography (CTPA)
E) Start empirical antibiotics
Explanations & Answers:
Question Medium Answer: D)
Question Medium Explanation: CT pulmonary angiography (CTPA) is the definitive test for confirming a diagnosis of pulmonary embolism, especially with a relevant history such as recent immobility due to long-haul flight. NICE and NHS guidelines recommend it for acute symptoms suggestive of pulmonary embolism.
Question Hard:
A 45-year-old man with a history of hypertension and diabetes presents with crushing substernal chest pain radiating to the left arm. On examination, he is diaphoretic and pale. His ECG shows ST elevation in leads II, III, and aVF. Which of the following is the most appropriate next step?
A) Administer aspirin and refer for coronary angiography
B) Order a chest X-ray
C) Prescribe beta-blockers and arrange a follow-up
D) Perform echocardiography
E) Start heparin and observe
Explanations & Answers:
Question Hard Answer: A)
Question Hard Explanation: The patient’s presentation is highly suggestive of an acute ST-elevation myocardial infarction (STEMI). Immediate administration of aspirin and referral for coronary angiography aligns with NICE and BNF guidelines for managing STEMI.
Medical fact of the day: According to the British Heart Foundation, heart and circulatory diseases cause more than a quarter (27%) of all deaths in the UK, approximately one death every three minutes.
Quote of the day: “Healing doesn’t mean the damage never existed. It means the damage no longer controls our lives. Keep pushing forward.”