Question Easy:
A 60-year-old man presents with sudden onset chest pain that radiates to his left arm and neck. He looks pale and is sweating profusely. Given the classic presentation, which condition is most likely? ⚠️
A) Gastroesophageal reflux disease (GERD)
B) Chronic obstructive pulmonary disease (COPD)
C) Acute coronary syndrome (ACS)
D) Asthma
E) Pulmonary embolism (PE)
Explanations & Answers:
Question Easy Answer: C) Acute coronary syndrome (ACS)
Question Easy Explanation: The patient’s symptoms of chest pain radiating to the left arm and neck, along with pallor and sweating, are classical signs of acute coronary syndrome (ACS). ACS includes conditions such as myocardial infarction (MI) and unstable angina, requiring urgent medical care.
Question Medium:
A 45-year-old woman with a history of asthma comes to the clinic with worsening shortness of breath and wheezing. She is currently on a regular inhaled corticosteroid and short-acting beta-agonist as needed. What is the next step in her management according to the NICE guidelines? 🫁
A) Add a long-acting beta-2 agonist (LABA)
B) Increase the dose of inhaled corticosteroid
C) Switch to an oral corticosteroid
D) Add a leukotriene receptor antagonist (LTRA)
E) Add an anticholinergic inhaler
Explanations & Answers:
Question Medium Answer: A) Add a long-acting beta-2 agonist (LABA)
Question Medium Explanation: According to NICE guidelines, if asthma control is inadequate on a low-dose inhaled corticosteroid, the next step is to add a long-acting beta-2 agonist (LABA). This can help in better managing symptoms and decreasing the frequency of exacerbations.
Question Hard:
A 70-year-old female with a history of hypertension and diabetes presents with shortness of breath, orthopnoea, and paroxysmal nocturnal dyspnoea. On examination, she has bilateral basal crackles, raised jugular venous pressure, and peripheral oedema. An echocardiogram reveals a left ventricular ejection fraction of 35%. What is the most appropriate initial management step for her condition? 🏥
A) Oral nitrates
B) ACE inhibitor and beta-blocker
C) Calcium channel blocker
D) Loop diuretic
E) Aspirin and statin
Explanations & Answers:
Question Hard Answer: B) ACE inhibitor and beta-blocker
Question Hard Explanation: The patient’s symptoms and examination findings are indicative of heart failure with reduced ejection fraction (HFrEF). NICE guidelines recommend starting an ACE inhibitor (or ARB) and a beta-blocker initially, as these medications improve symptoms, reduce hospital admissions, and prolong life in patients with heart failure.
Medical fact of the day: Did you know that the UK has one of the highest rates of bronchiectasis worldwide? This chronic lung condition, characterized by frequent infections and sputum production, requires vigilant long-term management.
Quote of the day: Healing is a matter of time, but it is sometimes also a matter of opportunity. Let’s create opportunities for our patients to heal.