Question Easy:
A 65-year-old man comes into the GP surgery complaining of breathlessness and a persistent productive cough worsened over the past year. He admits to smoking 20 cigarettes daily for the last 40 years. On examination, his lung auscultation reveals wheezing and crackles. What is the most likely diagnosis? 🚬
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Pneumonia
D) Tuberculosis
E) Pulmonary Embolism
Question Medium:
A 58-year-old woman is admitted to the emergency department with chest pain that radiates to her left arm. She is sweaty and nauseated. It started suddenly an hour ago while she was gardening. Her past medical history includes type 2 diabetes and hypertension. Which investigation would confirm the diagnosis of myocardial infarction? 🏥
A) Chest X-ray
B) Full blood count
C) Serum troponin levels
D) D-dimer
E) Oxygen saturation
Question Hard:
A 72-year-old man with a history of atrial fibrillation is scheduled for elective hip replacement surgery. He is currently on warfarin. What is the best approach to manage anticoagulation therapy before surgery to reduce the risk of perioperative bleeding? 📋
A) Continue warfarin and monitor INR closely
B) Stop warfarin 5 days pre-surgery and start heparin bridge therapy
C) Stop warfarin 1 day pre-surgery without any bridging
D) Switch to a direct oral anticoagulant 3 days pre-surgery
E) Stop warfarin 2 weeks pre-surgery and restart immediately post-operatively
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The patient’s history of smoking and symptoms suggest Chronic Obstructive Pulmonary Disease (COPD). The presence of wheezing and crackles on examination aligns with this condition. According to NICE guidelines, smoking is a major risk factor for COPD, characterised by progressive breathlessness and chronic cough.
Question Medium Answer: C
Question Medium Explanation: Serum troponin levels are specific markers for myocardial damage. In the context of chest pain and risk factors like diabetes and hypertension, elevated troponin levels would confirm a myocardial infarction. NICE guidelines recommend measuring troponin levels when an acute coronary syndrome is suspected.
Question Hard Answer: B
Question Hard Explanation: According to the British Society for Haematology and NICE guidelines, patients on warfarin who are at high risk of perioperative thrombosis should have warfarin stopped approximately 5 days before surgery. Bridging with heparin (usually low-molecular-weight heparin) is recommended to mitigate the risk of thromboembolism in high-risk patients, such as those with atrial fibrillation undergoing significant surgery.
Medical fact of the day: Did you know that the human lung covers a total surface area of over 70 square meters when spread out flat? That’s approximately the size of a tennis court! This extensive surface area helps in efficient gas exchange necessary for respiration—a key aspect of respiratory health. 🎾
Quote of the day: “In every heartbeat and every breath taken, lies the courage and commitment of healthcare workers who strive for better tomorrows.” 🌟