Question Easy:
A 55-year-old man presents to the GP with a persistent cough and shortness of breath. He is a smoker with a 40-pack-year history. On examination, he has wheezing and prolonged expiration. What is the most likely diagnosis?
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Lung cancer
D) Pneumonia
E) Heart Failure
Explanations & Answers:
Question Easy Answer: B) Chronic Obstructive Pulmonary Disease (COPD)
Question Easy Explanation: The patient’s history of smoking, chronic cough, and wheezing, along with prolonged expiration, are most consistent with COPD. According to NICE guidelines, COPD is characterized by fixed airway obstruction due to exposure to harmful particles or gases, most commonly from smoking. 🚬
Question Medium:
A 68-year-old woman with a history of hypertension and hyperlipidaemia presents with chest discomfort while climbing stairs. The pain is relieved by rest. What is the most appropriate initial test to investigate her condition?
A) Coronary angiography
B) Echocardiogram
C) Exercise tolerance test (ETT)
D) CT coronary angiography
E) Chest X-ray
Question Medium Answer: C) Exercise tolerance test (ETT)
Question Medium Explanation: The woman’s symptoms suggest stable angina, which aligns with NICE guidelines indicating the use of ETT as a non-invasive test to evaluate the heart’s response to stress and detect myocardial ischemia. It helps assess the severity of angina, guiding further management. ❤️
Question Hard:
A 62-year-old man is admitted with shortness of breath and severe orthopnoea. He has a history of ischemic heart disease. His vitals reveal a blood pressure of 160/95 mmHg, pulse 110 bpm, and respiratory rate of 28 breaths per minute. He has jugular venous distension and bilateral pulmonary crackles. What is the most suitable initial treatment?
A) Digoxin
B) Carvedilol
C) Furosemide
D) Atorvastatin
E) Ramipril
Question Hard Answer: C) Furosemide
Question Hard Explanation: The patient’s presentation is consistent with acute decompensated heart failure, possibly caused by fluid overload secondary to ischemic heart disease, as evidenced by orthopnoea and pulmonary crackles. NICE guidelines recommend using a loop diuretic, like furosemide, as an initial measure to relieve congestion and improve symptoms. 💧
Medical fact of the day: The UK has one of the highest rates of asthma in the world. Asthma prevalence is on the rise, and it’s important for healthcare practitioners to stay updated on management guidelines to offer the best patient care. 🌬️
Quote of the day: “In the hearts of healthcare workers lie the beats of hope and the breath of compassion, bringing life to every patient, one act at a time.”