Question Easy:
A 55-year-old man presents with chest pain radiating to his left arm and jaw. He is sweaty and feels nauseous. What is the most likely diagnosis?
A) Pulmonary embolism
B) Stable angina
C) Myocardial infarction
D) Gastroesophageal reflux disease
E) Costochondritis
Question Medium:
👩⚕️ A 68-year-old woman with a history of COPD presents with increasing breathlessness and productive cough with green sputum. Her oxygen saturation on room air is 88%. What is the next best step in management?
A) Oral prednisolone
B) Oral doxycycline
C) Oral amoxicillin
D) Nebulised salbutamol
E) Admission to hospital
Question Hard:
🩺 A 72-year-old man with a history of hypertension and AF presents with sudden onset of pleuritic chest pain and shortness of breath. His D-dimer is elevated, and his Wells score is 5. What is the most appropriate next step in management?
A) Start warfarin
B) Perform a CT pulmonary angiogram
C) Administer thrombolysis
D) Start a heparin infusion
E) Perform a V/Q scan
Explanations & Answers:
Question Easy Answer:
C) Myocardial infarction
Question Easy Explanation:
This patient’s presentation is classic for myocardial infarction (MI), characterized by chest pain radiating to the left arm and jaw, nausea, and sweating. According to NICE guidelines, these symptoms should prompt urgent assessment and intervention to confirm and treat MI.
Question Medium Answer:
E) Admission to hospital
Question Medium Explanation:
This patient presents with an exacerbation of COPD with signs of severe hypoxia (oxygen saturation of 88% on room air). According to NICE and NHS guidelines, the preferred management includes hospital admission for further assessment and treatment, including possible oxygen therapy, antibiotics, and steroids.
Question Hard Answer:
B) Perform a CT pulmonary angiogram
Question Hard Explanation:
Given the patient’s elevated D-dimer, high Wells score, and clinical presentation, a CT pulmonary angiogram (CTPA) is the most appropriate next step. CTPA is the gold standard for diagnosing pulmonary embolism according to NICE guidelines. Starting treatment without confirmation could be inappropriate and carry unnecessary risks.
Medical fact of the day: Chronic obstructive pulmonary disease (COPD) is the second most common cause of emergency hospital admissions in the UK, underscoring the importance of early intervention and appropriate management in patients at risk.
Quote of the day: “The greatest healing therapy is friendship and love – and that’s what you bring into your practice every day. Keep being awesome.”