Question Easy:
A 55-year-old man presents to the Accident & Emergency department with sudden onset of chest pain radiating to his left arm. He is diaphoretic and feels nauseous. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial management for this patient? 😷
A) Administer aspirin and arrange immediate PCI
B) Administer GTN spray and discharge
C) Refer to cardiology outpatient clinic
D) Prescribe ibuprofen for pain relief
E) Order a chest X-ray and wait for results
Question Easy Answer:
A) Administer aspirin and arrange immediate PCI
Question Easy Explanation:
This presentation is classic for an acute ST-elevation myocardial infarction (STEMI). The initial management, according to NHS and NICE guidelines, should be the administration of aspirin and arranging for an immediate percutaneous coronary intervention (PCI).
Question Medium:
A 78-year-old woman comes to the GP with a persistent cough and shortness of breath. On examination, her chest has wheeze bilaterally, and she has a high-pitched inspiratory stridor. Spirometry shows a reduced FEV1/FVC ratio. What is the most likely diagnosis?
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Pulmonary fibrosis
D) Pulmonary embolism
E) Bronchiectasis
Question Medium Answer:
B) Chronic Obstructive Pulmonary Disease (COPD)
Question Medium Explanation:
The combination of symptoms, physical examination findings, and spirometry results indicating a reduced FEV1/FVC ratio suggest a diagnosis of COPD. NHS and NICE guidelines highlight that COPD is characterized by persistent respiratory symptoms and airflow limitation.
Question Hard:
A 45-year-old woman with a history of systemic lupus erythematosus presents with fatigue and dyspnoea. On examination, she has a raised jugular venous pressure, peripheral oedema, and her cardiac apex is displaced laterally. Echocardiogram shows a dilated right ventricle with reduced function. What is the most likely underlying condition?
A) Primary pulmonary hypertension
B) Left ventricular failure
C) Right ventricular failure secondary to pulmonary hypertension
D) Cor pulmonale
E) Acute coronary syndrome
Question Hard Answer:
C) Right ventricular failure secondary to pulmonary hypertension
Question Hard Explanation:
In patients with systemic lupus erythematosus, pulmonary hypertension can develop and lead to right ventricular failure. The clinical presentation and echocardiographic findings are consistent with right ventricular failure due to elevated pulmonary pressures. NICE guidelines advise considering underlying connective tissue diseases in cases of unexplained pulmonary hypertension.
Medical fact of the day:
Did you know? Approximately one-third of the UK population will experience a severe asthma attack at some point in their lives, and asthma accounts for about 1000 deaths each year in the UK.
Quote of the day:
“Every small act of kindness and care in the medical field begins a ripple that can create a wave of healing.” 🌊