Question Easy: A 60-year-old man is brought to the A&E with chest pain and shortness of breath. He describes the pain as crushing and radiating to his left arm. An ECG shows ST elevation in the anterior leads. What is the most likely diagnosis? 🚑
A) Aortic dissection
B) Pulmonary embolism
C) Myocardial infarction
D) Pericarditis
E) Pneumonia
Explanations & Answers:
Question Easy Answer: C) Myocardial infarction
Question Easy Explanation: The clinical presentation of crushing chest pain radiating to the left arm, along with ST elevation in the anterior ECG leads, is classic for an ST-elevation myocardial infarction (STEMI). According to NICE guidelines, this presentation requires immediate intervention, often with percutaneous coronary intervention (PCI).
Question Medium: A 75-year-old woman with a history of COPD presents with increased sputum production, worsening dyspnoea, and a new fever. What is the initial empirical antibiotic therapy recommended according to UK guidelines? 🌬️
A) Amoxicillin
B) Clarithromycin
C) Co-amoxiclav
D) Doxycycline
E) Ciprofloxacin
Explanations & Answers:
Question Medium Answer: A) Amoxicillin
Question Medium Explanation: For acute exacerbations of COPD with evidence of bacterial infection, such as increased sputum purulence, NICE guidelines recommend starting with amoxicillin. Alternatives like doxycycline can be used if there is a penicillin allergy.
Question Hard: A 45-year-old female with a history of asthma presents to the clinic with worsening symptoms, including night-time awakenings and increased use of her rescue inhaler. Her treatment regimen currently includes low-dose inhaled corticosteroids. According to NICE guidelines, what is the next step in her asthma management? 💨
A) Increase the dose of inhaled corticosteroids
B) Add a leukotriene receptor antagonist
C) Add a long-acting beta agonist
D) Start oral corticosteroids
E) Add theophylline
Explanations & Answers:
Question Hard Answer: C) Add a long-acting beta agonist
Question Hard Explanation: According to NICE guidelines, if a patient with asthma is not controlled on low-dose inhaled corticosteroids, the next step is to add a long-acting beta agonist. This combination helps to improve symptom control and reduce exacerbations.
Medical fact of the day: Did you know? The vagus nerve, which is crucial for heart and lung function, is the longest cranial nerve in the body. It “wanders” from the brainstem through the neck into the thorax and abdomen—hence its name from Latin “vagus,” meaning wandering.
Quote of the day: “Healing isn’t just about the medicine; it’s about the moments shared, the connections made, and the hope given.” 🌟