Question Easy:
A 55-year-old man presents with acute, central chest pain radiating to his left arm. He is diaphoretic and has nausea. What is the initial investigation of choice for this patient in the emergency setting?
A) Chest X-ray
B) CT scan of the chest
C) Echocardiography
D) ECG
E) Blood tests
Question Medium:
A 68-year-old woman with a history of hypertension and COPD is brought into the emergency department with shortness of breath, pedal edema, and orthopnea. Which of the following is the most likely diagnosis?
A) Acute asthma exacerbation
B) Pulmonary embolism
C) Acute heart failure
D) Pneumothorax
E) Chronic bronchitis
Question Hard:
A 45-year-old man presents with palpitations. An ECG reveals narrow complex tachycardia at a rate of 180 bpm without visible P waves. Carotid sinus massage temporarily slows the heart rate but the tachycardia promptly resumes. What is the next appropriate step in the management of this patient?
A) Adenosine
B) Amiodarone
C) Beta-blocker
D) Immediate cardioversion
E) Digoxin
Explanations & Answers:
Question Easy Answer:
D)
Question Easy Explanation:
The initial investigation of choice for suspected acute coronary syndrome is an ECG. It is crucial as it helps in the immediate identification of ST-segment elevation myocardial infarction (STEMI), which requires urgent intervention. According to NICE guidelines, a 12-lead ECG should be performed within 10 minutes of presentation for patients with acute chest pain.
Question Medium Answer:
C)
Question Medium Explanation:
The clinical picture of shortness of breath, pedal edema, and orthopnea suggests acute heart failure. This is supported by the patient’s history of hypertension and COPD, which are significant risk factors. NICE guidelines recommend considering heart failure in patients presenting with these symptoms, and early management includes diuretics and other heart failure treatments.
Question Hard Answer:
A)
Question Hard Explanation:
The patient is likely suffering from paroxysmal supraventricular tachycardia (PSVT), as indicated by the narrow complex tachycardia and temporary response to carotid sinus massage. The next appropriate step in management is the administration of adenosine, which can help terminate the PSVT as recommended by NICE and BNF guidelines. Adenosine is preferred for its rapid action and short half-life.
Medical fact of the day:
Did you know that the use of beta-blockers within 24 hours of an acute myocardial infarction can significantly reduce mortality? This is especially true for patients without contraindications such as heart block or reactive airway disease. (NICE guidelines on acute coronary syndromes)
Quote of the day:
“Every patient is a story worth reading; treat each one with the compassion and care you’d want for your own.”