Question Easy:
A 55-year-old female presents to the GP with palpitations and a sensation of chest fluttering. She has no significant medical history. On physical examination, her pulse is irregularly irregular. What is the most likely diagnosis?
A) Ventricular tachycardia
B) Atrial flutter
C) Atrial fibrillation
D) Sinus tachycardia
E) Supraventricular tachycardia
Question Medium:
A 68-year-old male with a 40-pack-year smoking history presents with a chronic cough and increasing dyspnea over the last year. Pulmonary function tests show an FEV1/FVC ratio of 60%. Which of the following is the most appropriate management step to improve his symptoms?
A) Oral corticosteroids
B) Long-acting muscarinic antagonist (LAMA)
C) Short-acting beta-agonist (SABA)
D) Oral theophylline
E) Lung resection
Question Hard:
A 45-year-old patient with known aortic stenosis presents with exertional dizziness and syncope. On examination, you note a systolic ejection murmur radiating to the carotids. Echocardiogram confirms severe aortic stenosis. What is the definitive treatment to improve this patient’s prognosis?
A) Balloon valvuloplasty
B) Loop diuretics
C) Beta-blockers
D) Aortic valve replacement
E) Angiotensin-converting enzyme inhibitors (ACEi)
Explanations & Answers:
Question Easy Answer:
C) Atrial fibrillation
Question Easy Explanation:
Atrial fibrillation is characterized by an irregularly irregular pulse, often accompanied by palpitations or a feeling of a fluttering heart. This is a common arrhythmia, especially in older adults, and requires appropriate management to reduce the risk of thromboembolic events according to NICE guidelines.
Question Medium Answer:
B) Long-acting muscarinic antagonist (LAMA)
Question Medium Explanation:
In patients with COPD, particularly those with significant symptoms and moderate airflow obstruction (FEV1/FVC < 70%), a LAMA is recommended as a first-line treatment to help relieve symptoms and improve quality of life, per NICE guidelines.
Question Hard Answer:
D) Aortic valve replacement
Question Hard Explanation:
Severe aortic stenosis with symptoms such as syncope and exertional dizziness warrants aortic valve replacement as the definitive treatment, as per the NHS and NICE guidelines. This intervention significantly improves survival and symptomatic relief in affected patients.
Medical fact of the day:
Did you know that the UK has one of the highest rates of COPD hospital admissions in Europe? This highlights the importance of early diagnosis, smoking cessation, and effective management to improve outcomes.
Quote of the day:
“In the rhythms of the heart and the breath of life, every challenge faced is a pulse of progress for those who heal. Keep beating strong.”