Question Easy: A 55-year-old man presents to the GP with a persistent dry cough and shortness of breath. He is a non-smoker and has no significant past medical history. His chest X-ray shows bilateral hilar lymphadenopathy. What is the most likely diagnosis? 🌿
A) Asthma
B) Tuberculosis
C) Sarcoidosis
D) Pneumonia
E) Chronic Obstructive Pulmonary Disease (COPD)
Explanations & Answers:
Question Easy Answer: C) Sarcoidosis
Question Easy Explanation: The combination of a persistent dry cough, shortness of breath, and bilateral hilar lymphadenopathy on a chest X-ray is classic for sarcoidosis. Sarcoidosis is an inflammatory disease that commonly affects the lungs and lymph nodes. NICE guidelines mention the characteristic radiographic features of sarcoidosis, which often include bilateral hilar lymphadenopathy.
Question Medium: A 67-year-old woman with a history of hypertension presents to the clinic with new onset chest pain. Her ECG shows ST-segment depression in the leads V2-V4. Her troponin levels are slightly elevated. What is the most appropriate next step in management? 🚑
A) Thrombolysis
B) Coronary angiography
C) Prescribe aspirin and discharge
D) Administer IV nitrates
E) Arrange for a CT pulmonary angiogram
Question Medium Answer: B) Coronary angiography
Question Medium Explanation: The presentation is suggestive of non-ST elevation myocardial infarction (NSTEMI). According to the NICE guidelines and NHS, the most appropriate next step in management is early invasive management with coronary angiography, especially since there is cardiac biomarker elevation and typical angina signs. This plan will help delineate the coronary anatomy and guide further revascularization strategies.
Question Hard: A 48-year-old male patient is brought to the Emergency Department with severe shortness of breath and pleuritic chest pain. He has a history of recurrent deep vein thrombosis and is currently on warfarin. His INR is reported as 2.3. A CT pulmonary angiogram confirms a large pulmonary embolism. What is the most appropriate immediate treatment? 🩺
A) Increase warfarin dose
B) Administer intravenous heparin
C) Administer oral dabigatran
D) Thrombolysis with alteplase
E) Subcutaneous low molecular weight heparin
Question Hard Answer: D) Thrombolysis with alteplase
Question Hard Explanation: In the case of massive pulmonary embolism, defined by haemodynamic instability or large clot burden, thrombolysis is considered the immediate treatment. NICE and BNF guidelines recommend the use of thrombolytic therapy such as alteplase in life-threatening conditions where rapid clot dissolution is necessary. The patient’s INR indicates warfarin therapy, but in acute settings with severe symptoms, thrombolysis is warranted.
Medical fact of the day: Did you know that the right lung is slightly larger and heavier than the left lung? This difference is due to the space occupied by the heart on the left side of the chest, leading to the left lung having two lobes while the right lung has three.
Quote of the day: “In the rhythm of healing, let compassion be your tune and resilience your melody. Every note saves a life.”