Question Easy:
A 45-year-old man presents with crushing central chest pain radiating to his left arm. He is also feeling nauseous and sweaty. What is the most likely diagnosis?
A) Gastroesophageal reflux disease
B) Myocardial infarction
C) Costochondritis
D) Anxiety
E) Pneumonia
Question Easy Answer:
B) Myocardial infarction
Question Easy Explanation:
The patient’s symptoms are characteristic of a myocardial infarction (heart attack), which often presents with central chest pain radiating to the left arm, accompanied by nausea and sweating. According to NICE guidelines, such presentation warrants immediate emergency response and evaluation, including an ECG and cardiac enzymes.
Question Medium:
A 25-year-old woman with a history of asthma presents with worsening shortness of breath, wheezing, and a peak flow of 150 L/min. What is the next best step in management?
A) Initiate oral antibiotics
B) Increase the dose of her inhaled corticosteroid
C) Administer nebulised salbutamol
D) Initiate oral antifungals
E) Perform a chest X-ray
Question Medium Answer:
C) Administer nebulised salbutamol
Question Medium Explanation:
The patient is experiencing an acute exacerbation of asthma. NICE guidelines recommend the administration of nebulised salbutamol as the next best step to provide rapid relief of bronchospasm. Increasing the dose of inhaled corticosteroids or initiating antibiotics would not be immediately effective in this acute setting.
Question Hard:
A 62-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with increased sputum production, dyspnoea, and fever. His arterial blood gas shows pH 7.32, PaCO2 55 mmHg, and PaO2 60 mmHg. What is the most appropriate next step in management?
A) Immediate intubation and mechanical ventilation
B) Administer high-flow oxygen at 15 L/min
C) Start non-invasive ventilation (NIV)
D) Administer intravenous diuretics
E) Schedule an urgent bronchoscopy
Question Hard Answer:
C) Start non-invasive ventilation (NIV)
Question Hard Explanation:
This patient is experiencing an acute exacerbation of COPD with type 2 respiratory failure, as evidenced by the elevated PaCO2 and reduced pH. According to NICE guidelines, non-invasive ventilation (NIV) is recommended to support breathing and correct gas exchange abnormalities. High-flow oxygen should be avoided in COPD patients to prevent suppressing their hypoxic drive.
Medical fact of the day:
Did you know that in the UK, coronary heart disease remains the leading cause of mortality, accounting for approximately 64,000 deaths annually? Regular exercise, a balanced diet, and smoking cessation are key lifestyle changes recommended by NICE to reduce the risk.
Quote of the day:
“Every heartbeat and every breath are reminders of our duty to care, to heal, and to inspire hope in every patient we meet.”