Question Easy:
A 65-year-old woman presents to the GP with breathlessness, orthopnoea, and paroxysmal nocturnal dyspnoea. On examination, you hear bilateral basal crackles and her jugular venous pressure (JVP) is elevated. What’s the most likely diagnosis? 😊
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Heart failure
D) Pulmonary embolism
E) Pneumonia
Question Medium:
A 72-year-old man with a history of ischemic heart disease presents with worsening breathlessness. On auscultation, a third heart sound is heard. Which of the following is the most appropriate pharmacological management initiated in primary care?
A) Aspirin
B) Bisoprolol
C) Digoxin
D) Furosemide
E) Amlodipine
Question Hard:
A 56-year-old man with a history of hypertension and smoking comes to the emergency department with severe, sudden-onset chest pain and dyspnoea. His ECG shows significant S1Q3T3 changes, and D-dimer levels are elevated. What is the definitive diagnostic test to confirm your suspicion? 😰
A) Chest X-ray
B) Echocardiogram
C) CT pulmonary angiography
D) V/Q scan
E) Coronary angiography
Explanations & Answers:
Question Easy Answer: C
Question Easy Explanation: The symptoms and signs described are classic for heart failure, particularly left-sided heart failure. Breathlessness on exertion, orthopnoea, and paroxysmal nocturnal dyspnoea are indicative. Bilateral basal crackles suggest fluid overload, a hallmark feature of heart failure, according to NICE guidelines.
Question Medium Answer: D
Question Medium Explanation: Furosemide, a loop diuretic, is often the first-line treatment for managing symptoms of heart failure, especially in the presence of fluid overload, as per NICE guidelines. It helps in quickly reducing the fluid load, alleviating the symptoms of breathlessness.
Question Hard Answer: C
Question Hard Explanation: The presentation strongly suggests a pulmonary embolism (PE), especially with an ECG showing S1Q3T3 pattern. CT pulmonary angiography is the gold standard and definitive diagnostic test for PE, as per NICE recommendations.
Medical fact of the day: Did you know that in the UK, COPD is the second most common cause of emergency hospital admissions? Smoking cessation remains the most important intervention to slow the progression of COPD and improve survival.
Quote of the day: “In the rhythm of life, it’s health workers who help us find our heartbeat. Keep inspiring and healing with compassion.”