Question Easy:
A 45-year-old man comes to the GP with complaints of a persistent dry cough lasting 3 weeks, shortness of breath, and wheezing. He doesn’t smoke and has no history of asthma, but mentions his symptoms get worse with physical activity and at night. What is the most likely diagnosis?
A) Chronic bronchitis
B) Asthma
C) COPD
D) Hay fever
E) Lung cancer
Question Medium:
A 62-year-old man with a history of hypertension and hyperlipidaemia attends the clinic for review. He is asymptomatic and his only medication is amlodipine 10mg daily. His recent blood pressure reading is 145/95 mmHg. According to NICE guidelines, what is the next best step in managing his hypertension?
A) Increase amlodipine to 20mg daily
B) Add an ACE inhibitor
C) Start a thiazide diuretic
D) Advise on lifestyle modifications only
E) Add a beta-blocker
Question Hard:
A 72-year-old woman presents with severe central chest pain radiating to her jaw and left arm. She is diaphoretic and pale. Her ECG shows new ST-segment elevations in leads II, III, and aVF. Troponin levels are elevated. She undergoes coronary angiography and a stent is placed in the right coronary artery. Which complication is she at highest risk for in the first 24 hours post-procedure?
A) Renal failure
B) Stroke
C) Bleeding from the access site
D) Coronary artery re-occlusion
E) Arrhythmia
Explanations & Answers:
Question Easy Answer: B) Asthma
Question Easy Explanation: The presentation of symptoms like a dry cough, wheezing, and shortness of breath that worsen at night and with exercise aligns closely with asthma. NICE guidelines highlight asthma as a condition characterized by these episodic symptoms, often triggered by environmental factors, allergens, and physical activities.
Question Medium Answer: C) Start a thiazide diuretic
Question Medium Explanation: According to NICE guidelines for managing hypertension, if blood pressure is not controlled with calcium channel blockers like amlodipine alone in patients over 55 or of Afro-Caribbean descent, adding a thiazide-like diuretic is recommended, ensuring a stepwise approach to manage hypertension effectively.
Question Hard Answer: E) Arrhythmia
Question Hard Explanation: Post-percutaneous coronary intervention (PCI), patients are at increased risk for arrhythmias, especially within the first 24 hours due to reperfusion injury and cardiac tissue ischemia. Ensuring continuous monitoring and readiness to address arrhythmias promptly according to NHS and BNF guidelines can mitigate risks.
Medical fact of the day: Did you know that the UK has one of the fastest heart attack treatment times in the world, with ambulance services and hospitals working hard to keep the average time from call to treatment under 90 minutes? This remarkable achievement has significantly improved survival rates. 🏥🚑
Quote of the day: “Healing is a journey, not a destination. Let your passion for caring light the path for those in need.” 🌟✨