Question Easy:
A 65-year-old man presents to the GP with complaints of breathlessness and a persistent dry cough. He is a heavy smoker with a 40-pack-year history. On examination, you notice decreased breath sounds and wheezing. 🚬 What is the most likely diagnosis?
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Lung Cancer
D) Heart Failure
E) Pulmonary Embolism
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The patient’s age, smoking history, and symptoms of breathlessness and wheezing align with Chronic Obstructive Pulmonary Disease (COPD). According to NICE guidelines, COPD is commonly associated with a significant smoking history and presents with similar respiratory symptoms.
Question Medium:
A 54-year-old woman with a history of hypertension presents with a sudden onset of severe chest pain radiating to her back, described as “tearing” in nature. On examination, she is hypertensive with a blood pressure of 190/100 mmHg in the right arm and 155/90 mmHg in the left arm. 🌡️ What is the most likely diagnosis?
A) Myocardial Infarction
B) Pulmonary Embolism
C) Aortic Dissection
D) Pericarditis
E) Pneumothorax
Question Medium Answer: C
Question Medium Explanation: The presentation of sudden, severe, tearing chest pain radiating to the back, alongside the differential blood pressures in the arms, strongly suggests an aortic dissection. NICE guidelines emphasize such classic features in aortic dissection diagnosis. Immediate management is crucial due to the life-threatening nature of the condition.
Question Hard:
A 17-year-old male, who is otherwise well, presents to the Emergency Department with sudden onset shortness of breath and right-sided pleuritic chest pain. He is tall and thin with no significant medical history. The examination reveals reduced breath sounds on the right side. 🤔 What is the most likely diagnosis?
A) Tension Pneumothorax
B) Pulmonary Embolism
C) Spontaneous Pneumothorax
D) Pneumonia
E) Acute Asthma Exacerbation
Question Hard Answer: C
Question Hard Explanation: This scenario is classic for a primary spontaneous pneumothorax, which typically occurs in tall, thin, young males with sudden onset of unilateral pleuritic chest pain and dyspnoea. NICE recommends a high index of suspicion for diagnosing spontaneous pneumothorax in such demographics. Treatment may vary based on the size and symptoms, often involving observation or aspiration.
Medical fact of the day: Did you know? According to NHS research, the prevalence of COPD is highest in the North West of England, correlating with higher smoking rates in that region. It’s a reminder of the impact environmental and lifestyle factors have on respiratory health.
Quote of the day: “In the rhythm of heartbeats and the breath of hope, healthcare workers find the strength to heal and the courage to care.”