Question Easy: A 55-year-old woman presents to the GP with complaints of persistent cough and shortness of breath. She has been smoking 20 cigarettes per day for the last 30 years. Which of the following is the most likely initial investigation to perform for this patient?
A) Chest X-ray
B) Spirometry
C) CT scan of the thorax
D) MRI of the thorax
E) Arterial blood gas analysis
Question Medium: A 68-year-old man with a history of hypertension and type 2 diabetes presents with sudden onset central chest pain radiating to the left arm, sweating, and nausea. ❗️ ECG shows ST elevation in leads II, III, and aVF. Which coronary artery is most likely involved?
A) Left anterior descending artery
B) Right coronary artery
C) Left circumflex artery
D) Left main coronary artery
E) Posterior descending artery
Question Hard: A 72-year-old woman with a history of COPD presents with increased dyspnea, cough, and purulent sputum. She has been admitted to the hospital with acute exacerbation. Her blood gases reveal PaO2 of 7 kPa and PaCO2 of 9 kPa. Which of the following is the most appropriate next step in management according to UK guidelines?
A) High flow oxygen therapy
B) Non-invasive ventilation
C) Intravenous antibiotics
D) Oral corticosteroids
E) Mechanical ventilation
Explanations & Answers:
Question Easy Answer: B) Spirometry
Question Easy Explanation: According to NICE guidelines, spirometry is the most appropriate initial test for the diagnosis of COPD as it measures airflow obstruction, which is crucial in confirming the diagnosis and assessing severity.
Question Medium Answer: B) Right coronary artery
Question Medium Explanation: The ECG findings indicate an inferior myocardial infarction, which is most commonly due to occlusion of the right coronary artery. NICE guidelines emphasize that ECG interpretation allows identification of the area of ischemia and guides treatment decisions.
Question Hard Answer: B) Non-invasive ventilation
Question Hard Explanation: In patients with COPD exacerbation and respiratory acidosis (high PaCO2 and low pH), non-invasive ventilation is recommended according to NICE and BTS guidelines as it can effectively improve ventilation and reduce the need for intubation.
Medical fact of the day: Did you know that approximately one in five adults in the UK has undiagnosed COPD? Early diagnosis through spirometry can significantly improve outcomes and reduce hospitalization risks.
Quote of the day: “In the intricate landscape of healthcare, every positive action is a building block for a healthier tomorrow.”