Question Easy:
A 65-year-old man comes to your clinic with complaints of chest pain on exertion, which relieves with rest. He has a history of smoking and hypertension. What is the most likely diagnosis? 😊
A) Acute myocardial infarction
B) Chronic stable angina
C) Unstable angina
D) Pulmonary embolism
E) Pericarditis
Question Medium:
A 40-year-old female with a history of asthma 🫁 presents with shortness of breath, wheezing, and a cough that worsens at night. Despite using her regular salbutamol inhaler, she finds little relief. According to NICE guidelines, what is the next step in managing her asthma?
A) Increase the dose of salbutamol
B) Add a leukotriene receptor antagonist
C) Start an oral corticosteroid
D) Use a long-acting beta-agonist
E) Refer to a respiratory specialist
Question Hard:
A 28-year-old woman presents with progressive shortness of breath over the past three months. She experiences significant fatigue, especially after climbing stairs. On examination, there are signs of right ventricular hypertrophy, and an echocardiogram shows elevated pressures in the pulmonary arteries. Which condition is most likely causing her symptoms?
A) Idiopathic pulmonary fibrosis
B) Chronic thromboembolic pulmonary hypertension
C) Primary pulmonary hypertension
D) Eisenmenger syndrome
E) Congenital heart disease
Explanations & Answers:
Question Easy Answer: B) Chronic stable angina
Question Easy Explanation: Chronic stable angina presents with predictable chest pain during exertion that typically resolves with rest. The patient’s history of smoking and hypertension are significant risk factors. According to NICE, the management includes addressing risk factors and considering anti-anginal therapy.
Question Medium Answer: B) Add a leukotriene receptor antagonist
Question Medium Explanation: For asthma that is not well-controlled by a salbutamol (short-acting beta-agonist) inhaler alone, NICE recommends adding a leukotriene receptor antagonist as the next step for patients, especially if the symptoms include nocturnal waking and wheezing which are not controlled by inhaled corticosteroids.
Question Hard Answer: C) Primary pulmonary hypertension
Question Hard Explanation: This young woman’s presentation is suggestive of primary pulmonary hypertension (now called pulmonary arterial hypertension). The symptoms of progressive exertional dyspnea and right ventricular hypertrophy are typical for this diagnosis. This condition is differentiated from secondary causes by a lack of identifiable source for the pulmonary hypertension.
Medical fact of the day: Chronic obstructive pulmonary disease (COPD) is one of the most common respiratory disorders in the UK, with smoking being a major cause. However, 10% to 20% of cases in the UK are caused by occupational factors, emphasizing the importance of detailed occupational history in diagnosis and management.
Quote of the day: “In the world of healthcare, the greatest breakthroughs often begin with a compassionate inquiry and a listening ear.” 🌟