Question Easy: A 45-year-old man presents to the GP with exertional dyspnoea and a persistent dry cough. He has a 30 pack-year smoking history. On examination, his fingernails show clubbing. What is the most likely diagnosis? 🚬🤔
A) Asthma
B) Chronic Obstructive Pulmonary Disease (COPD)
C) Lung Cancer
D) Asthma-COPD Overlap Syndrome
E) Interstitial Lung Disease
Question Medium: A 68-year-old woman with a history of hypertension presents with sudden-onset chest pain radiating to her back. Her blood pressure is 190/110 mmHg in both arms. What is the most likely diagnosis? 🚑
A) Acute Coronary Syndrome
B) Pulmonary Embolism
C) Aortic Dissection
D) Pericarditis
E) Costochondritis
Question Hard: A 72-year-old man presents with syncope. He has a previous history of valvular heart disease. On examination, you hear a loud mid-systolic ejection murmur at the right second intercostal space that radiates to the carotids. What is the most likely underlying problem causing his symptoms? 🎶🩺
A) Mitral Stenosis
B) Mitral Regurgitation
C) Aortic Stenosis
D) Aortic Regurgitation
E) Tricuspid Stenosis
Explanations & Answers:
Question Easy Answer: C) Lung Cancer
Question Easy Explanation: Finger clubbing combined with a smoking history and respiratory symptoms is highly suggestive of lung cancer. COPD and asthma do not typically present with clubbing. NICE guidelines indicate clubbing is a common clinical sign in various lung diseases, including lung cancer.
Question Medium Answer: C) Aortic Dissection
Question Medium Explanation: The sudden-onset chest pain radiating to the back, coupled with hypertension, suggests an aortic dissection, particularly when the blood pressure is significantly elevated. This corresponds with NHS guidelines for the presentation of this cardiovascular emergency.
Question Hard Answer: C) Aortic Stenosis
Question Hard Explanation: The characteristics of the murmur—a mid-systolic ejection sound at the right second intercostal space that radiates to the neck—along with syncope and the patient’s history, are classic signs of aortic stenosis, as per BNF and NICE guidelines.
Medical fact of the day: Did you know that the left lung is slightly smaller than the right to accommodate the heart? This anatomical feature is something to consider when interpreting chest X-rays!
Quote of the day: “In the silent corridors of healthcare, every heartbeat tells a story. Listen closely, and let compassion be your guide.”