Question Easy:
A 67-year-old male presents to the GP with a persistent cough lasting more than three weeks, weight loss, and night sweats. He has a history of smoking and recently returned from a trip abroad. What is the most likely diagnosis?
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Pneumonia
D) Lung Cancer
E) Tuberculosis (TB) 🦠
Explanations & Answers:
Question Easy Answer:
E) Tuberculosis (TB)
Question Easy Explanation:
The symptoms described, including a persistent cough, weight loss, night sweats, history of smoking, and travel history, are classic indicators of tuberculosis. NICE guidelines emphasize considering TB in patients presenting with these symptoms, especially for those with relevant travel histories or social circumstances.
Question Medium:
A 58-year-old woman comes to A&E with sudden onset chest pain and shortness of breath. She describes the pain as sharp and worse when she breathes in. She recently underwent hip surgery. What is the most likely diagnosis?
A) Myocardial Infarction
B) Pulmonary Embolism 🏥
C) Pneumothorax
D) Aortic Dissection
E) Angina
Question Medium Answer:
B) Pulmonary Embolism
Question Medium Explanation:
The clinical context of sudden onset chest pain, shortness of breath, and recent hip surgery (a risk factor for venous thromboembolism) suggests a pulmonary embolism. NICE guidelines highlight recent surgery as a significant risk factor for PE, and the presence of pleuritic chest pain (pain worsening on breathing) aligns with this diagnosis.
Question Hard:
A 45-year-old woman with a longstanding history of hypertension and chronic kidney disease has been managed with an ACE inhibitor. She recently developed a persistent dry cough. Which change in her medication regime is most appropriate?
A) Discontinue ACE inhibitor and start Beta-blocker
B) Discontinue ACE inhibitor and start Angiotensin II Receptor Blocker (ARB)
C) Add a Cough Suppressant
D) Increase ACE inhibitor dose
E) Start an inhaled corticosteroid
Question Hard Answer:
B) Discontinue ACE inhibitor and start Angiotensin II Receptor Blocker (ARB)
Question Hard Explanation:
A persistent dry cough is a well-known side effect of ACE inhibitors, as per the BNF and NICE guidelines. Switching to an ARB, which has a similar therapeutic effect without causing cough, is the appropriate management strategy.
Medical fact of the day: The “silent” nature of high blood pressure often means it’s only diagnosed during screening or when it leads to another health issue. Routine blood pressure checks are important for early detection and management.
Quote of the day: “In the tapestry of healthcare, every thread counts. Let compassion be the strongest fiber.” 🌟