Question Easy:
A 67-year-old man presents to the clinic with a swollen and tender left calf. He has recently returned from a long-haul flight. He reports mild shortness of breath, but otherwise seems well. Which of the following is the most appropriate FIRST step in the management of this patient?
A) Administer aspirin
B) Arrange for a D-dimer test
C) Start low-molecular-weight heparin
D) Perform a chest X-ray
E) Prescribe compression stockings
Explanations & Answers:
Question Easy Answer: B) Arrange for a D-dimer test
Question Easy Explanation: According to NICE guidelines, the initial step in managing suspected deep vein thrombosis (DVT) involves assessing the probability using a clinical prediction rule (like the Wells score) and, if DVT is likely or the score is intermediate, arranging for a D-dimer test. This helps guide further management and the necessity for ultrasound.
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Question Medium:
A 55-year-old woman with a history of hypertension and type 2 diabetes presents with chest pain radiating to her jaw and left arm. She is sweaty and looks unwell. Her ECG shows ST-segment elevation in the anterior leads. What is the most appropriate immediate management?
A) Commence high-flow oxygen
B) Administer a nitrate
C) Urgent coronary angiography with PCI
D) Administer a beta-blocker
E) Provide calcium channel blocker therapy
Explanations & Answers:
Question Medium Answer: C) Urgent coronary angiography with PCI
Question Medium Explanation: In line with NHS guidelines for a suspected ST-elevation myocardial infarction (STEMI), immediate reperfusion therapy is critical. PCI is the preferred immediate treatment to quickly restore coronary blood flow, reducing the risk of further cardiac damage. The priority is minimizing time to treatment, enhancing patient outcomes.
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Question Hard:
A 34-year-old woman presents with a persistent dry cough and gradual onset of dyspnea over the past month. She has noticed weight loss and night sweats but denies any hemoptysis. She works as a veterinarian. Chest X-ray reveals bilateral hilar lymphadenopathy. Which of the following conditions is most likely?
A) Asthma
B) Tuberculosis
C) Sarcoidosis
D) Pneumonia
E) Pulmonary embolism
Explanations & Answers:
Question Hard Answer: C) Sarcoidosis
Question Hard Explanation: The presentation of bilateral hilar lymphadenopathy on a chest X-ray, in combination with systemic symptoms such as weight loss and night sweats, aligns with sarcoidosis. The patient’s occupational exposure might initially raise suspicion for infections, but the X-ray findings strongly suggest sarcoidosis, consistent with NICE guidelines.
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Medical fact of the day: The coronary arteries supply blood to the heart muscle itself, which is why they are crucial in keeping the heart healthy. The left coronary artery divides into two branches, making it a critical vessel for supplying the left side of the heart.
Quote of the day: “In the tapestry of healthcare, each thread we weave today strengthens the future fabric of countless lives. Keep weaving with care and compassion.” 🌟