Question Easy:
A 50-year-old man presents to the GP with chest pain that occurs when he climbs stairs and is relieved by rest. He is a smoker and has a family history of coronary artery disease. What is the most likely diagnosis?
A) Gastroesophageal reflux disease
B) Stable angina
C) Pulmonary embolism
D) Aortic stenosis
E) Pneumonia
Question Medium:
A 65-year-old woman with a history of hypertension and type 2 diabetes presents with shortness of breath, orthopnea, and paroxysmal nocturnal dyspnoea. Which one of the following medications is most appropriate as first-line management for her heart failure with reduced ejection fraction according to NICE guidelines?
A) Digoxin
B) Furosemide
C) Lisinopril
D) Ivabradine
E) Spironolactone
Question Hard:
A 72-year-old man with a history of COPD is admitted to the hospital with exacerbation. His arterial blood gas (ABG) on air shows: pH 7.28, PaCO2 8.0 kPa, PaO2 6.0 kPa, and HCO3- 31 mmol/L. What is the most likely acid-base disturbance?
A) Metabolic acidosis with respiratory compensation
B) Respiratory acidosis with metabolic compensation
C) Mixed respiratory and metabolic acidosis
D) Metabolic alkalosis with respiratory compensation
E) Respiratory alkalosis
Explanations & Answers:
Question Easy Answer:
B) Stable angina
Question Easy Explanation:
Stable angina is characterized by chest pain or discomfort that typically occurs with exertion and is relieved by rest. The pain is often described as squeezing or pressure-like in nature. In this patient, his chest pain pattern fits perfectly with angina, especially considering his risk factors like smoking and family history of coronary artery disease.
Question Medium Answer:
C) Lisinopril
Question Medium Explanation:
According to NICE guidelines, an ACE inhibitor like Lisinopril is recommended as a first-line treatment for heart failure with reduced ejection fraction. It works by reducing the workload on the heart and improving symptoms and survival rates. Diuretics like Furosemide are often used for symptom relief of fluid overload but do not address the underlying condition as a first-line therapy.
Question Hard Answer:
B) Respiratory acidosis with metabolic compensation
Question Hard Explanation:
The ABG results show a high PaCO2 and acidic pH, indicating respiratory acidosis. The elevated HCO3- suggests that metabolic compensation is occurring. This scenario is typical in patients with chronic respiratory conditions such as COPD who retain CO2 and over time develop compensatory metabolic alkalosis.
Medical fact of the day:
Did you know that chronic obstructive pulmonary disease (COPD) affects approximately 1.2 million people in the UK? It’s critical to encourage smoking cessation and provide pulmonary rehabilitation to manage symptoms and improve quality of life.
Quote of the day:
“In every heartbeat that echoes through silence, lies the dedication of those who choose to heal. Thank you for your unwavering commitment to care beyond the call.” 🌟