Question Easy: A 55-year-old male presents with chest pain that radiates to his left arm and jaw, occurring after climbing stairs and relieved by rest. He has a history of hypertension. What is the most likely diagnosis?
A) Gastroesophageal reflux disease
B) Stable angina
C) Acute myocardial infarction
D) Pericarditis
E) Pulmonary embolism
Question Medium: A 60-year-old woman with a history of smoking and COPD is admitted with increased shortness of breath, wheezing, and productive cough. Her respiratory rate is 24/minute, and oxygen saturation is 88% on room air. What is the most appropriate initial management?
A) High-flow oxygen therapy
B) Intravenous antibiotics
C) Short-acting beta-agonist via nebuliser
D) Oral steroids
E) Non-invasive ventilation
Question Hard: A 46-year-old man presents with acute chest pain, hypotension, and muffled heart sounds. He was admitted with a fever and dyspnoea three days prior. What is the most likely diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Cardiac tamponade
E) Pneumothorax
Explanations & Answers:
Question Easy Answer: B) Stable angina
Question Easy Explanation: Stable angina is characterized by chest pain or discomfort that typically occurs with physical exertion or stress and is relieved by rest or nitroglycerin. The pain often radiates to the arm and jaw, as seen in this patient. According to NICE guidelines, management includes lifestyle modifications, risk factor management, and medications like beta-blockers or calcium channel blockers.
Question Medium Answer: C) Short-acting beta-agonist via nebuliser
Question Medium Explanation: For a COPD exacerbation, initial management involves bronchodilation. NICE recommends using a short-acting beta-agonist, such as salbutamol, typically administered via nebuliser for rapid relief of symptoms. High-flow oxygen is used cautiously as COPD patients can have a blunted hypoxic drive.
Question Hard Answer: D) Cardiac tamponade
Question Hard Explanation: The combination of chest pain, hypotension, and muffled heart sounds is known as Beck’s triad and suggests cardiac tamponade, a condition where fluid accumulation in the pericardial space impairs cardiac filling. His recent fever and dyspnoea raise suspicion for an underlying pericardial effusion, progressing to tamponade. Immediate pericardiocentesis is the standard emergency management according to NHS guidelines.
Medical fact of the day: 💡 Did you know that chronic obstructive pulmonary disease (COPD) is one of the leading causes of hospital admissions in the UK? Smoking cessation remains the most effective intervention for slowing disease progression.
Quote of the day: “In the heart of healthcare lies a never-ending mission of compassion and hope, where each compassionate act is a bridge to healing.” – Anonymous