Question Easy: A 65-year-old man presents to your GP surgery with a 3-week history of a persistent cough and shortness of breath. He has a 40-pack-year smoking history and used to work in construction. Physical examination reveals decreased breath sounds and dullness to percussion on the right lower zone. What is the most likely diagnosis? 🚬
A) Bronchitis
B) Lung cancer
C) Pneumonia
D) Pulmonary embolism
E) Pleural effusion
Question Medium: A 70-year-old woman is admitted to the hospital with new-onset atrial fibrillation. Her past medical history includes hypertension and congestive heart failure. What medication should be initiated for stroke prevention in this patient according to NICE guidelines? 💊
A) Aspirin
B) Digoxin
C) Warfarin
D) Apixaban
E) Amiodarone
Question Hard: A 58-year-old man presents with exertional dyspnea, orthopnea, and peripheral edema. On examination, he has raised JVP, displaced apex beat, and a pan-systolic murmur at the apex radiating to the axilla. What is the most likely underlying valve pathology? 🔍
A) Aortic stenosis
B) Mitral regurgitation
C) Aortic regurgitation
D) Mitral stenosis
E) Tricuspid regurgitation
Explanations & Answers:
Question Easy Answer: E) Pleural effusion
Question Easy Explanation: This patient’s persistent cough and breathlessness, combined with dullness to percussion and decreased breath sounds, are consistent with a pleural effusion. His smoking history and occupational exposure may contribute to potential lung conditions, but the examination findings point towards fluid accumulation in the pleural space.
Question Medium Answer: D) Apixaban
Question Medium Explanation: According to NICE guidelines, in patients with atrial fibrillation and a high risk of stroke (CHA2DS2-VASc score ≥2 for women and ≥1 for men), a direct oral anticoagulant like apixaban is recommended for stroke prevention over warfarin (unless there is a specific contraindication or preference for monitoring through INR with warfarin).
Question Hard Answer: B) Mitral regurgitation
Question Hard Explanation: The symptoms and examination findings of raised JVP, displaced apex beat, and a pan-systolic murmur radiating to the axilla suggest mitral regurgitation. The murmur’s characteristic nature and location differentiate it from other valve pathologies.
Medical fact of the day: In the UK, cardiovascular disease is one of the leading causes of death, with ischemic heart disease being the most common type. However, since the early 2000s, mortality rates have been steadily decreasing thanks to improvements in healthcare and lifestyle changes.
Quote of the day: “In the quiet moments between heartbeats, remember the compassion that brought you here and let it guide your hands and heart.”