Question Easy:
A 56-year-old man presents to your clinic with complaints of breathlessness on exertion and swollen ankles. 🦶 On examination, you notice jugular venous distension and bilateral basal crackles on auscultation. What is the most likely diagnosis?
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Acute coronary syndrome
D) Heart failure
E) Pneumonia
Explanations & Answers:
Question Easy Answer:
D) Heart failure
Question Easy Explanation:
The patient’s symptoms of breathlessness on exertion, swollen ankles (peripheral edema), jugular venous distension, and bilateral basal crackles are indicative of congestive heart failure. NICE guidelines recommend considering these symptoms in the context of heart failure, and further investigations, including an echocardiogram, should be performed.
Question Medium:
A 35-year-old woman presents with sudden onset pleuritic chest pain and shortness of breath. She has a history of taking oral contraceptive pills. On examination, her respiratory rate is 24 breaths per minute, and she has a heart rate of 110 beats per minute. What is the most appropriate initial investigation to confirm the diagnosis?
A) Chest X-ray (CXR)
B) Electrocardiogram (ECG)
C) D-dimer test
D) CT pulmonary angiography (CTPA)
E) Ventilation-perfusion (V/Q) scan
Explanations & Answers:
Question Medium Answer:
D) CT pulmonary angiography (CTPA)
Question Medium Explanation:
Given the patient’s acute presentation of pleuritic chest pain, shortness of breath, and tachycardia, coupled with the risk factor of oral contraceptive use, a pulmonary embolism (PE) is highly suspected. According to NICE guidelines, the most appropriate initial investigation for suspected acute PE is CT pulmonary angiography (CTPA), which provides detailed imaging of the pulmonary arteries.
Question Hard:
A 68-year-old man presents with a chronic cough and progressive shortness of breath over the past six months. He has a 40-pack-year smoking history. Spirometry shows an FEV1/FVC ratio of 0.65. Which medication should be initiated first according to NICE guidelines?
A) Inhaled corticosteroid (ICS)
B) Short-acting beta agonist (SABA)
C) Long-acting muscarinic antagonist (LAMA)
D) Long-acting beta agonist (LABA)
E) Oral corticosteroids
Explanations & Answers:
Question Hard Answer:
B) Short-acting beta agonist (SABA)
Question Hard Explanation:
The patient’s symptoms and spirometry results are indicative of chronic obstructive pulmonary disease (COPD). According to NICE guidelines, the initial management of COPD includes a short-acting beta agonist (SABA) or a short-acting muscarinic antagonist (SAMA) to relieve symptoms. This patient’s 40-pack-year smoking history also supports the diagnosis.
Medical fact of the day:
Did you know? In the UK, cardiovascular diseases remain the leading cause of death, but initiatives like the NHS Health Check aim to identify and manage risk factors early, potentially preventing 650 premature deaths annually.
Quote of the day:
“In the face of adversity, a healthcare worker sees the opportunity to inspire, uplift, and heal. Your dedication makes the world a healthier place one patient at a time.” 🌟