A 55-year-old man comes in with a sudden onset of severe central chest pain that has been going on for an hour. He has no significant medical history. His vital signs are stable with a heart rate of 90 bpm and blood pressure of 120/70 mmHg. An electrocardiogram reveals 5 mm of ST-segment elevation in the anterior leads (V2–V4). He was given aspirin (300 mg) and diamorphine (5 mg) in the ambulance. What is the definitive treatment for this patient?
A 33-year-old known intravenous drug user presents to your GP clinic with complaints of fatigue, night sweats and joint pain. During the examination, you observe a new early-diastolic murmur. What is the probable causative organism for this patient’s condition?
A 42-year-old man presents to the Emergency Department with severe central chest pain. The pain is exacerbated by lying down, relieved by sitting forward, and radiates to the left shoulder. He has recently undergone two cycles of radiotherapy for prostate cancer. Upon examination, his blood pressure is 96/52 mmHg (normal <120/80 mmHg), his jugular venous pressure (JVP) is elevated, and his pulse is 98 bpm, which appears to fade on inspiration. Heart sounds are faint. The electrocardiogram (ECG) reveals low-voltage QRS complexes.
What is the most appropriate initial management for this condition?
A 40-year-old man presents with pyrexia, night sweats and has recently noticed changes to his fingernails. He has no past medical history except he remembers that as a child he was in hospital with inflamed, painful joints, and a very fast heartbeat following a very sore throat.
What is the most likely diagnosis?
A man in his early 40s comes to you with a rash. Upon examination, you notice that he has eruptive xanthoma. What is the most probable diagnosis?
A 72-year-old woman visits her GP for a routine check-up. During the examination, she seems generally healthy but slightly fatigued and experiences some breathlessness at rest. Her pulse is irregularly irregular and measures 72 bpm, while her blood pressure is 126/78 mmHg. Upon further examination, no concerning issues are found. The patient has no significant medical history and is not taking any regular medications.
What is the probable reason for this woman’s development of atrial fibrillation (AF)?
A 60-year-old man presents with shortness of breath and dizziness. On examination, he has an irregularly irregular pulse.
Which of the following conditions in his past medical history might be the cause of his presentation?
A 25-year-old woman attends a new patient health check at the General Practice surgery she has recently joined. She mentions she occasionally gets episodes of palpitations and light-headedness and has done so for several years. Her pulse is currently regular, with a rate of 70 bpm, and her blood pressure is 110/76 mmHg. A full blood count is sent, which comes back as normal. The general practitioner requests an electrocardiogram (ECG), which shows a widened QRS complex with a slurred upstroke and a shortened PR interval.
Which of the following is the most likely diagnosis?
A 40-year-old male patient complains of shortness of breath, weight loss, and night sweats for the past six weeks. Despite being generally healthy, he is experiencing these symptoms. During the examination, the patient’s fingers show clubbing, and his temperature is 37.8°C. His pulse is 88 beats per minute, and his blood pressure is 128/80 mmHg. Upon listening to his heart, a pansystolic murmur is audible. What signs are likely to be found in this patient?
A 59-year-old man is admitted to the Intensive Care Unit from the Coronary Care Ward. He has suffered from an acute myocardial infarction two days earlier. On examination, he is profoundly unwell with a blood pressure of 85/60 mmHg and a pulse rate of 110 bpm. He has crackles throughout his lung fields, with markedly decreased oxygen saturations; he has no audible cardiac murmurs. He is intubated and ventilated, and catheterised.
Investigations:
Investigation Result Normal value
Haemoglobin 121 g/l 135–175 g/l
White cell count (WCC) 5.8 × 109/l 4–11 × 109/l
Platelets 285 × 109/l 150–400 × 109/l
Sodium (Na+) 128 mmol/l 135–145 mmol/l
Potassium (K+) 6.2 mmol/l 3.5–5.0 mmol/l
Creatinine 195 μmol/l 50–120 µmol/l
Troponin T 5.8 ng/ml <0.1 ng/ml
Urine output 30 ml in the past 3 h
ECG – consistent with a myocardial infarction 48 h earlier
Chest X-ray – gross pulmonary oedema
Which of the following fits best with the clinical picture?