Question Easy: A 55-year-old man presents with chest pain, radiating to his left arm after climbing stairs. The pain is relieved by rest and sublingual glyceryl trinitrate (GTN). What is the most likely diagnosis? 🚶♂️
A) Stable angina
B) Unstable angina
C) Myocardial infarction
D) Pericarditis
E) Aortic dissection
Question Medium: A 60-year-old woman presents with worsening dyspnoea, persistent cough, and night sweats. A chest X-ray reveals bilateral hilar lymphadenopathy. Which condition is the most likely cause? 🩺
A) Tuberculosis
B) Sarcoidosis
C) Pulmonary embolism
D) Lung cancer
E) Heart failure
Question Hard: A 72-year-old man with a history of atrial fibrillation is commenced on a new medication. He later complains of nausea, visual disturbances, and confusion. Which medication is most likely responsible for these symptoms? 😵💫
A) Digoxin
B) Amiodarone
C) Warfarin
D) Bisoprolol
E) Diltiazem
Explanations & Answers:
Question Easy Answer:
A) Stable angina
Question Easy Explanation:
Stable angina is characterised by chest pain or discomfort that typically occurs with exertion and is relieved by rest or nitrates. The classic presentation includes pain radiating to the left arm, triggered by activities like climbing stairs, and relieved by GTN. NICE guidelines suggest management of stable angina with lifestyle advice, GTN for symptom relief, and possible further investigation with a functional imaging test.
Question Medium Answer:
B) Sarcoidosis
Question Medium Explanation:
Bilateral hilar lymphadenopathy on a chest X-ray is a classic finding in sarcoidosis, a multi-system granulomatous disease. While tuberculosis can also cause similar symptoms, sarcoidosis is more often associated with the specific radiological pattern described. NICE guidelines recommend considering sarcoidosis when there is bilateral hilar lymphadenopathy and systemic features without any clear infectious symptoms.
Question Hard Answer:
A) Digoxin
Question Hard Explanation:
Digoxin toxicity can present with symptoms such as gastrointestinal disturbance (nausea), visual changes (blurred or yellow vision), and confusion. Elderly patients or those with renal impairment are at higher risk. Correct use and monitoring of digoxin blood levels, as recommended by BNF guidelines, are essential to avoiding toxicity.
Medical fact of the day: In the UK, chronic obstructive pulmonary disease (COPD) is one of the most common respiratory conditions seen in clinical practice, with smoking being the biggest risk factor. Annually, the NHS spends over £1 billion addressing COPD and related issues.
Quote of the day: “Healing may require actions that cannot always be captured in a prescription. Let empathy be your greatest tool.”