Question Easy: 🚑 A 62-year-old man with a history of hypertension presents with chest pain radiating to his left arm. His ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A) Left anterior descending artery
B) Right coronary artery
C) Circumflex artery
D) Left main coronary artery
E) Posterior descending artery
Question Medium: 🌬️ A 48-year-old woman with a 20-pack-year smoking history presents with chronic cough and sputum production. Spirometry shows an FEV1/FVC ratio of 65%. What is the most likely diagnosis?
A) Asthma
B) Chronic bronchitis
C) Bronchiectasis
D) Restrictive lung disease
E) Pulmonary embolism
Question Hard: 💡 A 78-year-old man with atrial fibrillation is started on warfarin. After two weeks, his INR is 8.0, and he has no signs of bleeding. What is the most appropriate management?
A) Withhold warfarin and give vitamin K IV
B) Withhold warfarin and give vitamin K orally
C) Continue warfarin and monitor INR closely
D) Reduce the dose of warfarin
E) Withhold warfarin and monitor INR
Explanations & Answers:
Question Easy Answer: B) Right coronary artery
Question Easy Explanation: The ECG showing ST elevation in leads II, III, and aVF indicates an inferior myocardial infarction, which is commonly associated with occlusion of the right coronary artery. According to the NICE guidelines, prompt identification and treatment of the occluded vessel can improve outcomes.
Question Medium Answer: B) Chronic bronchitis
Question Medium Explanation: The chronic cough and sputum production with a reduced FEV1/FVC ratio is indicative of chronic obstructive pulmonary disease (COPD), specifically chronic bronchitis in this scenario. The NICE guidelines emphasize the importance of smoking cessation and appropriate pharmacological therapy as key management strategies.
Question Hard Answer: B) Withhold warfarin and give vitamin K orally
Question Hard Explanation: An INR of 8.0 presents a significant risk of bleeding. For patients without bleeding, NICE guidelines recommend withholding warfarin and administering oral vitamin K to safely reduce the INR. Continuous monitoring is also necessary to readjust the warfarin dosing.
Medical fact of the day: Did you know that in the UK, COPD is one of the most common respiratory conditions, affecting approximately 1.2 million people? Early diagnosis and intervention can greatly enhance quality of life.
Quote of the day: “In every heartbeat and every breath, lies the art of healing. Keep the rhythm of care and compassion alive.” 🌟