Question Easy:
A 55-year-old man presents to the GP with intermittent chest pain on exertion. The pain is relieved by rest and occurs predictably when he climbs stairs. Which of the following is the most likely diagnosis?
A) Myocardial infarction
B) Unstable angina
C) Stable angina
D) Aortic dissection
E) Pulmonary embolism
Question Medium:
A 70-year-old woman with a history of COPD presents to the emergency department with worsening breathlessness, cough, and increased sputum production. She is tachypneic and her oxygen saturation on air is 86%. What is the most appropriate immediate management?
A) Antibiotics
B) Nebulised salbutamol
C) Oxygen therapy
D) Oral corticosteroids
E) Magnesium sulfate
Question Hard:
A 60-year-old man with a history of hypertension and type 2 diabetes presents to the A&E with sudden onset of severe tearing chest pain radiating to the back. He is diaphoretic and anxious. His blood pressure is 180/110 mmHg. What is the most likely diagnosis?
A) Pulmonary embolism
B) Tension pneumothorax
C) Myocardial infarction
D) Aortic dissection
E) Pericarditis
Explanations & Answers:
Question Easy Answer: C) Stable angina
Question Easy Explanation: Stable angina is characterised by chest pain that occurs predictably with exertion and is relieved by rest. This matches the scenario given, making it the most likely diagnosis. According to NICE guidelines, stable angina management involves lifestyle modifications and medication like nitrates for symptomatic relief.
Question Medium Answer: C) Oxygen therapy
Question Medium Explanation: In this case, the patient has COPD with hypoxia (oxygen saturation 86%). Immediate management involves oxygen therapy, aiming to increase saturation to target levels (88-92% for COPD patients) while monitoring for CO2 retention. NICE guidelines recommend controlled oxygen delivery in acute exacerbations of COPD.
Question Hard Answer: D) Aortic dissection
Question Hard Explanation: The presentation of severe, tearing chest pain radiating to the back with hypertension is suggestive of an aortic dissection, particularly in patients with risk factors like hypertension. Immediate management involves reducing blood pressure and heart rate to prevent further aortic damage. This diagnosis aligns with both clinical presentation and typical risk profiles described by the NHS.
Medical fact of the day: The “stethoscope” was invented in 1816 by René Laennec, and it remains an essential tool for diagnosing conditions like pneumonia and heart valve abnormalities.
Quote of the day: “In the heart of healthcare lies a profound dedication that turns compassion into healing and hope into reality.”