Question Easy:
A 55-year-old woman presents with a sudden onset of chest pain radiating to her left arm and jaw, associated with shortness of breath and sweating. What is the most likely diagnosis?
A) Stable angina
B) Myocardial infarction
C) Pneumothorax
D) Gastroesophageal reflux disease
E) Pulmonary embolism
Question Medium:
A 65-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents with increased dyspnoea, a productive cough, and a fever. Which of the following is the most appropriate initial management?
A) Increase inhaled corticosteroids
B) Prescribe oral antibiotics
C) Order a chest X-ray
D) Start nebulised bronchodilators
E) Admit to hospital
Question Hard:
A 38-year-old woman presents with pleuritic chest pain, haemoptysis, and tachycardia after a long-haul flight. Her pulse is 110 beats per minute and her respiratory rate is 24 breaths per minute. What is the most appropriate next step in management?
A) D-dimer test
B) Ventilation-perfusion (VQ) scan
C) Electrocardiogram (ECG)
D) Administer low molecular weight heparin (LMWH)
E) Chest CT pulmonary angiography (CTPA)
Explanations & Answers:
Question Easy Answer:
B
Question Easy Explanation:
The symptoms described are classic for a myocardial infarction, which typically includes sudden onset chest pain radiating to the left arm and jaw, along with dyspnoea and diaphoresis. Immediate intervention is crucial to reduce mortality and morbidity according to NICE guidelines.
Question Medium Answer:
B
Question Medium Explanation:
According to NICE guidelines, the appropriate initial management for a COPD exacerbation likely due to bacterial infection (evident by the increased dyspnoea, productive cough, and fever) is to prescribe oral antibiotics. Other measures such as a chest X-ray and nebulised bronchodilators can be considered based on the clinical response and severity.
Question Hard Answer:
E
Question Hard Explanation:
The patient’s symptoms and risk factors (pleuritic chest pain, haemoptysis, and tachycardia after a long-haul flight) are highly suggestive of a pulmonary embolism. Chest CT pulmonary angiography (CTPA) is the gold standard for diagnosis in such cases, as per current NICE guidelines.
Medical fact of the day:
Did you know that the United Kingdom’s prevalence of COPD is approximately 2% of the adult population? Early diagnosis and appropriate management can significantly reduce hospital admissions and improve quality of life.
Quote of the day:
“In the midst of chaos, there is an opportunity for kindness. Remember, every small act of care makes a world of difference to your patients.”