Question Easy:
A 45-year-old man presents with a sudden onset of crushing chest pain radiating to his left arm. He is pale and sweating profusely. What is the most appropriate initial diagnostic investigation?
A) ECG
B) Chest X-ray
C) Blood cultures
D) Echocardiogram
E) Exercise stress test
Explanations & Answers:
Question Easy Answer:
A) ECG
Question Easy Explanation:
In a patient presenting with symptoms suggestive of acute myocardial infarction (AMI) such as crushing chest pain radiating to the left arm, the first-line investigation should be an ECG. This is to swiftly diagnose any abnormalities indicating possible AMI. NICE guidelines recommend performing an ECG within 10 minutes of presentation.
Question Medium:
A 68-year-old woman with a 30-pack-year smoking history presents with a persistent cough and weight loss over the past 3 months. A chest X-ray shows a suspicious mass in the right lung. What is the next best step in her management?
A) Repeat chest X-ray in 6 weeks
B) CT scan of the chest
C) Sputum culture
D) Bronchodilator therapy trial
E) Antibiotics for possible pneumonia
Explanations & Answers:
Question Medium Answer:
B) CT scan of the chest
Question Medium Explanation:
The next step in the evaluation of a suspicious mass found on chest X-ray, particularly in a patient with significant smoking history and symptoms like weight loss, would be to obtain a CT scan of the chest. This provides more detailed information about the mass, guiding further diagnostic and therapeutic interventions. This approach aligns with NICE cancer referral guidelines.
Question Hard:
A 50-year-old man with a history of hypertension presents with shortness of breath on exertion, orthopnea, and paroxysmal nocturnal dyspnoea. On examination, he has bilateral basal crackles and an S3 heart sound. Which of the following is the most likely diagnosis?
A) Chronic obstructive pulmonary disease (COPD)
B) Pulmonary embolism
C) Congestive heart failure
D) Acute respiratory distress syndrome (ARDS)
E) Pulmonary hypertension
Explanations & Answers:
Question Hard Answer:
C) Congestive heart failure
Question Hard Explanation:
The patient’s symptoms of dyspnoea on exertion, orthopnea, and paroxysmal nocturnal dyspnoea along with clinical findings of bilateral basal crackles and an S3 heart sound are highly suggestive of congestive heart failure (CHF). Both NICE and NHS guidelines recommend considering CHF in patients with these clinical features and history.
Medical fact of the day:
The most common valvular heart disease in the UK is aortic stenosis, often identified in the elderly due to age-related degeneration.
Quote of the day:
“Every heartbeat and breath you help sustain is a testament to the positive impact you have on the world. Keep pushing forward, healthcare warriors!”