Question Easy:
A 55-year-old smoker presents with chest pain, which radiates to the left arm and jaw, and is associated with sweating and shortness of breath. What is the most appropriate initial management for this patient in the emergency department?
A) Prescribe antibiotics
B) Administer GTN spray and aspirin
C) Refer for a chest X-ray
D) Initiate physiotherapy
E) Encourage the patient to quit smoking
Explanations & Answers:
Question Easy Answer:
B) Administer GTN spray and aspirin
Question Easy Explanation:
For patients presenting with symptoms suggestive of an acute coronary syndrome (ACS), NICE guidelines recommend the immediate administration of glyceryl trinitrate (GTN) spray and aspirin to manage pain and reduce clot formation. 🚑 These are the first-line interventions before further diagnostic evaluations and treatments.
Question Medium:
A 34-year-old woman presents with shortness of breath, wheezing, and a cough that worsens at night and early in the morning. A peak flow meter reading is 60% of her predicted value. What is the most appropriate initial step in management?
A) Prescribe a short-acting beta-agonist inhaler
B) Refer for spirometry
C) Start oral corticosteroids
D) Recommend increased physical activity
E) Order a chest CT scan
Explanations & Answers:
Question Medium Answer:
A) Prescribe a short-acting beta-agonist inhaler
Question Medium Explanation:
Asthma is characterised by reversible airway obstruction, leading to symptoms like wheezing, shortness of breath, and cough, often worse at night. According to the BNF and NICE guidelines, initial management should include a short-acting beta-agonist (SABA) inhaler to relieve acute symptoms. 🫁
Question Hard:
A 72-year-old man with a history of hypertension and chronic obstructive pulmonary disease (COPD) presents with increasing breathlessness, swollen legs, and a recent weight gain of 3 kg in one week. Bibasal crackles and an elevated jugular venous pressure (JVP) are noted. What is the most appropriate initial diagnostic investigation?
A) Electrocardiogram (ECG)
B) Echocardiogram
C) Pulmonary function test
D) Blood gas analysis
E) Brain natriuretic peptide (BNP) test
Explanations & Answers:
Question Hard Answer:
E) Brain natriuretic peptide (BNP) test
Question Hard Explanation:
The presentation of symptoms—including breathlessness, leg swelling, and bibasal crackles—along with an elevated JVP, suggest congestive heart failure (CHF). NICE guidelines recommend measuring BNP levels as the initial investigation for suspected heart failure. Elevated BNP levels are strongly indicative of heart failure, especially in patients with a history of cardiovascular diseases like hypertension. 🫀
Medical fact of the day:
Continuous positive airway pressure (CPAP) therapy is highly effective for treating obstructive sleep apnoea, which is prevalent in the UK. It significantly reduces daytime drowsiness and cardiovascular risks, enhancing overall quality of life.
Quote of the day:
“Every heartbeat counts, and every breath matters. As healthcare workers, you make these moments possible.” 🌟