23/09/2024 – Cardio and Respiratory

Question Easy:
🚑 A 50-year-old man presents to the GP with sudden onset of chest pain radiating to his left arm, associated with shortness of breath and sweating. His history includes hypertension and smoking. What is the most likely diagnosis?

A) Gastroesophageal reflux disease
B) Costochondritis
C) Angina pectoris
D) Acute myocardial infarction
E) Panic attack

Question Easy Answer:
D) Acute myocardial infarction

Question Easy Explanation:
The patient’s symptoms of sudden chest pain radiating to the left arm, shortness of breath, and sweating are classic signs of acute myocardial infarction (AMI). NICE guidelines emphasize the importance of immediate recognition and treatment of AMI to reduce morbidity and mortality.

Question Medium:
🩺 A 67-year-old woman presents with progressive shortness of breath over the past six months. She has a 40-pack-year smoking history and a chronic cough producing white sputum. On examination, her breath sounds are reduced, and there are bilateral wheezes. What is the most likely diagnosis?

A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Congestive heart failure
D) Pulmonary embolism
E) Bronchitis

Question Medium Answer:
B) Chronic obstructive pulmonary disease (COPD)

Question Medium Explanation:
The patient’s long smoking history, chronic cough with sputum, and progressive dyspnoea are indicative of COPD. NICE guidelines highlight the importance of smoking cessation and bronchodilator treatment in managing COPD. These symptoms and clinical findings are less consistent with asthma, heart failure, pulmonary embolism, or bronchitis.

Question Hard:
🚨 A 55-year-old male presents with acute shortness of breath, pleuritic chest pain, and hemoptysis. He has a history of deep vein thrombosis (DVT) and is currently on anticoagulation therapy. Which of the following diagnostic tests is the gold standard for confirming the suspected diagnosis?

A) Chest X-ray
B) Electrocardiogram (ECG)
C) D-dimer test
D) CT pulmonary angiography (CTPA)
E) Ventilation-perfusion (V/Q) scan

Question Hard Answer:
D) CT pulmonary angiography (CTPA)

Question Hard Explanation:
The patient’s symptoms suggest pulmonary embolism (PE), a potential complication of DVT. The gold standard for diagnosing PE, according to NICE guidelines, is CT pulmonary angiography (CTPA). While other tests like chest X-ray, ECG, D-dimer, and V/Q scan can be helpful, CTPA provides a definitive diagnosis.

Medical fact of the day:
Did you know? The prevalence of COPD is underestimated because many patients remain undiagnosed until the disease is advanced. Early spirometry testing in at-risk populations, such as smokers over 40, can help detect COPD earlier and improve outcomes.

Quote of the day:
“Every life you touch through medicine makes a ripple of hope.” 🌊