Question Easy:
A 60-year-old male presents to your clinic with chest pain that radiates to his left arm and jaw. He mentions the pain started after climbing stairs and subsided with rest. He has a history of hypertension and hyperlipidaemia. Which is the most likely diagnosis? ❤️
A) Myocardial infarction
B) Stable angina
C) Pulmonary embolism
D) Gastroesophageal reflux disease (GERD)
E) Costochondritis
Explanations & Answers:
Question Easy Answer:
B
Question Easy Explanation:
The symptoms described are classic for stable angina, which typically presents with chest pain of a crushing or squeezing nature that radiates to the left arm or jaw, especially occurring with exertion and relieved by rest. Myocardial infarction would usually present with more severe and prolonged pain not relieved by rest. Pulmonary embolism and GERD may present with chest pain but often have different characteristics and associated symptoms. 🌟
Question Medium:
A 45-year-old woman with a history of asthma presents with increased wheeziness, shortness of breath, and cough for the past 3 days. She has been using her salbutamol inhaler more frequently. On examination, her respiratory rate is 24/min, O2 saturation is 94% on air, and auscultation reveals widespread wheeze. What is the best immediate management step? 🩺
A) Increase salbutamol dose
B) Add inhaled corticosteroids
C) Perform spirometry
D) Prescribe oral prednisolone
E) Refer for immediate hospital admission
Explanations & Answers:
Question Medium Answer:
D
Question Medium Explanation:
The patient is experiencing an asthma exacerbation. According to NICE guidelines, the preferred first-line treatment for an acute asthma exacerbation includes administering oral corticosteroids (i.e., prednisolone) to control inflammation quickly. Increasing the salbutamol dose or adding inhaled corticosteroids might help but not as the immediate primary step. While spirometry is useful for diagnosis, it is not the immediate management. Hospital admission is reserved for severe cases where there is risk of respiratory failure. 🫁
Question Hard:
A 65-year-old male presents with severe dyspnoea, orthopnoea, and paroxysmal nocturnal dyspnoea. He has a history of ischemic heart disease and hypertension. On examination, you find a displaced apex beat, bilateral basal crackles, and elevated jugular venous pressure. What is the most appropriate next step in managing this patient? 🩻
A) Administer intravenous furosemide
B) Offer beta-blockers
C) Prescribe ACE inhibitors
D) Admit to intensive care unit
E) Suggest fluid restriction and monitor
Explanations & Answers:
Question Hard Answer:
A
Question Hard Explanation:
The clinical signs are consistent with acute decompensated heart failure, likely due to volume overload. According to NICE guidelines, immediate management includes administering intravenous diuretics (such as furosemide) to reduce the fluid overload. Beta-blockers and ACE inhibitors are important for long-term management but are not appropriate as an immediate next step in acute settings. ICU admission depends on the severity and response to initial treatment, while fluid restriction is used as a part of long-term management. 🫀
Medical fact of the day:
The UK has a significant prevalence of atrial fibrillation, affecting about 1.4 million people, posing a risk for stroke, heart failure, and reduced quality of life. Early detection and appropriate anticoagulation therapy are crucial. 🩺
Quote of the day:
“Every patient care moment is an opportunity to show compassion and make a lasting impact. Never forget the eternal value of your empathy and dedication.” 🌼