Question Easy:
A 65-year-old man presents with central crushing chest pain radiating to his left arm and jaw, persisting for over 30 minutes. He looks pale and sweaty. What is the most appropriate immediate management?
A) Refer for urgent exercise ECG
B) Administer glyceryl trinitrate spray
C) Offer chewable aspirin 300 mg
D) Arrange for a routine cardiology follow-up
E) Reassure and discharge
Explanations & Answers:
Question Easy Answer: C) Offer chewable aspirin 300 mg
Question Easy Explanation: According to NICE guidelines, aspirin 300 mg is recommended immediately for suspected myocardial infarction (MI) as it reduces mortality by inhibiting platelet aggregation. 🚑
Question Medium:
A 22-year-old female presents to the emergency department with acute shortness of breath, pleuritic chest pain, and hemoptysis. Her pulse rate is 110 bpm and SpO2 is 91% on room air. What is the most likely diagnosis?
A) Asthma exacerbation
B) Pulmonary embolism
C) Chronic obstructive pulmonary disease (COPD) exacerbation
D) Pneumonia
E) Pneumothorax
Explanations & Answers:
Question Medium Answer: B) Pulmonary embolism
Question Medium Explanation: The combination of acute onset pleuritic chest pain, shortness of breath, hemoptysis, and tachycardia is highly suggestive of a pulmonary embolism. NICE and NHS guidelines recommend considering immediate diagnostic testing for PE in such scenarios. 🚨
Question Hard:
A 50-year-old woman with a 25-year history of rheumatoid arthritis (RA) presents with progressive dyspnea and dry cough over several months. On examination, there are bibasilar inspiratory crackles. What is the most likely diagnosis?
A) Pulmonary arterial hypertension
B) Rheumatoid lung disease
C) Interstitial lung disease
D) Bronchiectasis
E) Chronic obstructive pulmonary disease (COPD)
Explanations & Answers:
Question Hard Answer: C) Interstitial lung disease
Question Hard Explanation: Interstitial lung disease (ILD) is a known complication of rheumatoid arthritis and often presents with progressive dyspnea, dry cough, and bibasilar crackles. Early recognition and referral to a respiratory specialist are crucial. 🎯
Medical fact of the day: The UK has introduced lung cancer screening with low-dose CT for individuals aged 55-74 who have a history of smoking, aiming to catch the disease early when it is more treatable.
Quote of the day: “Caring for others is the embodiment of hope and compassion – you may be the beacon in someone’s darkest hour.” 💖