Question Easy:
A 68-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with increased sputum production, worsening shortness of breath, and a cough lasting for three days. What is the first-line antibiotic treatment for a COPD exacerbation according to NICE guidelines?
A) Amoxicillin
B) Azithromycin
C) Ciprofloxacin
D) Doxycycline
E) Trimethoprim
Question Medium:
A 55-year-old woman presents with sudden onset chest pain radiating to her jaw and left arm, associated with nausea and sweating. An ECG shows ST-segment elevation in leads II, III, and aVF. What is the most likely coronary artery occlusion?
A) Left main coronary artery
B) Left anterior descending artery
C) Right coronary artery
D) Left circumflex artery
E) Posterior descending artery
Question Hard:
A 40-year-old man with a history of hypertension presents with shortness of breath and palpitations. His blood pressure is 170/100 mmHg, and a chest X-ray shows marked cardiomegaly and pulmonary congestion. Echocardiogram reveals left ventricular hypertrophy with an ejection fraction of 55%. What is the most appropriate antihypertensive therapy to target both his hypertension and potential cardiac issues as per NICE guidelines?
A) Amlodipine
B) Lisinopril
C) Bisoprolol
D) Losartan
E) Spironolactone
Explanations & Answers:
Question Easy Answer: A) Amoxicillin
Question Easy Explanation: For a COPD exacerbation, NICE guidelines recommend using amoxicillin as a first-line antibiotic, considering its effectiveness against common bacterial pathogens and appropriate spectrum of action for respiratory infections. Doxycycline or clarithromycin may also be considered in cases of penicillin allergy.
Question Medium Answer: C) Right coronary artery
Question Medium Explanation: ST-segment elevation in leads II, III, and aVF indicates an inferior myocardial infarction, most commonly due to occlusion of the right coronary artery. This pattern matches the inferior leads supplied by the right coronary artery.
Question Hard Answer: B) Lisinopril
Question Hard Explanation: Lisinopril, an ACE inhibitor, is suitable for treating hypertension and has benefits in managing potential hypertensive heart disease and preventing progression of cardiac hypertrophy. According to NICE guidelines, ACE inhibitors are beneficial in patients with evidence of cardiovascular hypertrophy and hypertension.
Medical fact of the day: The “blue bloater” and “pink puffer” phenotypes historically used to describe types of COPD are based on symptom presentation. These terms are less used now, as management focuses more on the individual’s overall health and symptomatology rather than categorised phenotypes.
Quote of the day: “In caring for others, we find the strength and inspiration to transform lives. Remember, every little act of kindness in healthcare makes a world of difference.”