A 55-year-old man presents to the clinic with complaints of chest pain and difficulty breathing. He had been hospitalized four weeks ago for acute coronary syndrome and was discharged on bisoprolol, simvastatin, aspirin, and ramipril. During the examination, a narrow complex tachycardia is observed. What is the absolute contraindication in this scenario?
A 16-year-old boy is discovered following a street brawl where he was stabbed. He has a stab wound on the left side of his chest, specifically the fifth intercostal space, mid-clavicular line. His blood pressure (BP) is 70 mmHg systolic, his heart sounds are muffled, and his jugular veins are distended, with a prominent x descent and an absent y descent.
What is the most appropriate way to characterize the boy’s condition?
A newborn baby is found to have a heart murmur that is later identified as Ebstein’s anomaly. Is it possible that a medication taken by the mother during pregnancy could have played a role in causing this congenital heart defect?
A woman with known angina currently managed on glyceryl trinitrate (GTN) spray presents to Accident and Emergency with crushing central chest pain. A 12-lead electrocardiogram (ECG) reveals ST depression and flat T waves. She is managed as acute coronary syndrome without ST elevation.
Which one of the following options is most likely to be used in her immediate management?
A school caretaker receives a letter inviting him to attend for an ultrasound scan, as part of the NHS Abdominal Aortic Aneurysm (AAA) Screening Programme. He has never attended AAA screening before.
What is the age range of patients who are typically invited to attend AAA screening for the first time?
A 35-year-old man presents to the Emergency Department with sudden-onset, severe chest pain, radiating to the intrascapular area, which he describes as a tearing-type pain.
The patient is usually well, with the only other medical history of note being a diagnosis of Ehlers–Danlos syndrome. He is a non-smoker and rarely drinks.
On examination, the patient appears to be in a significant amount of pain. He is apyrexial, with oxygen saturation of 98% on room air. Of note, the patient has a blood pressure of 175/100 mmHg in the right arm and 150/80 mmHg in the left. An early diastolic murmur is also heard in the aortic area.
What is the most likely diagnosis?
A 20-year-old man was brought to the Emergency Department via ambulance following a knife altercation in the city on a Saturday evening. He sustained a chest wound from the stabbing. Upon resuscitation and stabilization, it was observed that he had left scapular winging. Which nerve was affected to result in this injury?
A 57-year-old woman presents to the Emergency Department with sudden onset of palpitations and shortness of breath. She is speaking in broken sentences and appears distressed, with visible sweating. Her vital signs are as follows: blood pressure 70/30, heart rate 180 bpm, respiratory rate 28, and sats 98% on air. Upon auscultation, there are crepitations at both lung bases. The patient reports experiencing crushing chest pain during the assessment. A 12-lead electrocardiogram (ECG) reveals a regular broad complex tachycardia. What is the most appropriate next step in managing this patient?
A 68-year-old man presents to his general practitioner (GP) with shortness of breath. He describes shortness of breath on exertion and feeling short of breath when he lies flat. He now uses four pillows when sleeping. His past medical history is remarkable for hypertension, hypercholesterolaemia and type II diabetes.
On examination, he has bilateral crepitation, a jugular venous pressure (JVP) of 5 cm and pitting oedema up to his shins. Despite these symptoms, his oxygen saturation is 99% and he is functioning normally at home. He says the symptoms started gradually about 6 months ago and have progressed slowly since.
Which of the following should the GP do first to confirm the provisional diagnosis?
A 65-year-old man visits his doctor complaining of a persistent cough with yellow sputum, mild breathlessness, and fever for the past three days. He had a heart attack nine months ago and received treatment with a bare metal stent during angioplasty. Due to his penicillin allergy, the doctor prescribed oral clarithromycin 500 mg twice daily for a week to treat his chest infection. However, after five days, the patient returns to the doctor with severe muscle pains in his thighs and shoulders, weakness, lethargy, nausea, and dark urine. Which medication has interacted with clarithromycin to cause these symptoms?