21/10/2024 – Cardio and Respiratory

Question Easy:
A 55-year-old man presents to the GP with complaint of chest discomfort that occurs when he walks up the stairs. He states that the pain is relieved with rest. Which of the following is the most likely diagnosis? 🏃‍♂️💔
A) Myocardial infarction
B) Stable angina
C) Unstable angina
D) Gastroesophageal reflux disease
E) Panic attack

Question Medium:
A 62-year-old woman with a 40 pack-year smoking history presents with a chronic cough and shortness of breath. Her FEV1/FVC ratio is 65%. Which of the following conditions is most consistent with her spirometry results? 🚬🌬️
A) Asthma
B) Bronchiectasis
C) Chronic obstructive pulmonary disease
D) Interstitial lung disease
E) Pulmonary embolism

Question Hard:
A 28-year-old man presents to the emergency department with sudden-onset pleuritic chest pain and dyspnoea. His past medical history is unremarkable. The chest x-ray shows a unilateral hyperlucent hemithorax with no vascular markings. What is the most likely diagnosis? 📸😮
A) Pneumonia
B) Pulmonary embolism
C) Tension pneumothorax
D) Spontaneous pneumothorax
E) Pleural effusion

Explanations & Answers:

Question Easy Answer:
B) Stable angina

Question Easy Explanation:
The symptoms described are characteristic of stable angina, which typically presents as chest discomfort triggered by exertion and relieved by rest. According to NICE guidelines, stable angina results from myocardial ischaemia due to coronary artery disease that is predictable with physical exertion or emotional stress. Management includes lifestyle changes and medications such as nitrates and beta-blockers.

Question Medium Answer:
C) Chronic obstructive pulmonary disease

Question Medium Explanation:
The patient’s significant smoking history and spirometry findings indicate chronic obstructive pulmonary disease (COPD), as evidenced by a reduced FEV1/FVC ratio less than 70%. COPD is a common respiratory condition characterized by persistent respiratory symptoms and airflow limitation. The BNF and NICE recommend management strategies including smoking cessation, bronchodilators, and corticosteroids.

Question Hard Answer:
D) Spontaneous pneumothorax

Question Hard Explanation:
A spontaneous pneumothorax occurs when air collects in the pleural space, often causing sudden chest pain and breathlessness. The unilateral hyperlucent hemithorax on chest x-ray with the absence of vascular markings supports this diagnosis. While a tension pneumothorax (C) is a more life-threatening variant, its presentation typically includes signs of hemodynamic instability and mediastinal shift, which are not mentioned here. Management typically involves observation for small pneumothoraxes or needle decompression and intercostal drain insertion for larger ones, following NHS pathways.

Medical fact of the day:
Did you know that the UK was the first country to implement a nationwide screening program for abdominal aortic aneurysms (AAA) in men over 65? This program has significantly reduced the mortality associated with ruptured AAAs by enabling early detection and management.

Quote of the day:
“Compassion is at the heart of our care, transforming each challenge into an opportunity to heal. Let’s keep lighting the way for our patients, one act of kindness at a time.”