Question Easy:
A 60-year-old man presents to the GP with a persistent dry cough and breathlessness on exertion. He is a non-smoker with no significant past medical history. On examination, fine basal inspiratory crackles are heard, and a chest X-ray reveals reticular opacities at the lung bases. What is the most likely diagnosis? 🌬️
A) Asthma
B) Chronic obstructive pulmonary disease (COPD)
C) Bronchiectasis
D) Idiopathic pulmonary fibrosis
E) Congestive heart failure
Question Medium:
A 55-year-old woman with a history of hypertension and hypercholesterolemia presents with central, crushing chest pain radiating to the left arm and jaw which started 30 minutes ago. She is anxious, pale, and sweaty. The most appropriate initial management to be given by a paramedic is: 🚑
A) Atenolol
B) Sublingual nitroglycerin
C) Morphine sulfate
D) Aspirin
E) Metformin
Question Hard:
A 40-year-old female with a history of asthma presents with worsening respiratory symptoms. She is using her inhalers regularly, but reports shortness of breath and nocturnal symptoms once a week. On examination, she has a respiratory rate of 18/min and oxygen saturation of 95% on room air. According to NICE guidelines, which medication change is most appropriate? 🌬️💊
A) Increase dose of inhaled corticosteroid
B) Add leukotriene receptor antagonist
C) Change to long-acting beta agonist
D) Regular oral corticosteroids
E) Combine inhaled corticosteroid with long-acting beta agonist
Explanations & Answers:
Question Easy Answer: D
Question Easy Explanation: The presentation of a persistent dry cough, breathlessness, and crackles on auscultation with reticular opacities on chest X-ray suggests idiopathic pulmonary fibrosis. NICE guidelines indicate this pattern of interstitial lung disease. Smoking history is less relevant here as the patient is a non-smoker.
Question Medium Answer: D
Question Medium Explanation: For an acute myocardial infarction suspected in a pre-hospital setting, NICE guidelines state that 300 mg of aspirin should be given immediately, provided there are no contraindications, to inhibit platelet aggregation and improve patient outcomes. While other treatments such as nitrates, morphine, and beta-blockers are important, aspirin is the first-line intervention.
Question Hard Answer: B
Question Hard Explanation: According to NICE asthma management guidelines, if a patient with asthma experiences symptoms more than twice a month or any nocturnal awakening, the next step after inhaled corticosteroids is to add a leukotriene receptor antagonist. Increasing inhaled corticosteroids is another option but not the immediate next step according to the NICE pathway.
Medical fact of the day: The UK has one of the highest asthma prevalence rates in Europe, with approximately one in 12 adults affected by asthma, highlighting the importance of effective respiratory management and education.
Quote of the day: “In the face of adversity, healthcare workers are the pillars holding up the world, one compassionate act at a time.”