Welcome to MedGuide takes on chest pain. This is a very important differential to gain good understanding of in medical school – timely, critical and common its an exam, and ED, favourite. As such, this will be split into a few parts so that you can have as much practice into the clinical reasoning as possible. Good luck!
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Chest Pain 1
Stem 1 of 5
A 72YOM patient presents with heaviness in the chest, at rest, for 2 hours. He feels sick, short of break and weak in all extremities. His history is notable for smoking 30 cigarettes daily for 12 years and controlled hyperlipidaemia and secondary hypertension. For his hypertension, he was told to lose weight and given a CPAP machine from the NHS.
Calculate the patient’s pack years
Stem 2 of 5Which is the most likely cause of his ORDINARILY elevated systolic blood pressure?
Coarctation of the aorta
Obstructive sleep apnoea
Renal artery stenosis
Stem 3 of 5Which would be the least-expected examination finding in this patient?
A normal examination
Bilateral basal rales
Stem 4 of 5The patient shows contiguous lead ST elevation in V3, V4. Which coronary artery is most likely implicated?
Left anterior descending
Left circumflex artery
Left marginal artery
Posterior interventricular artery
Right marginal artery
Stem 5 of 5Based on the most likely diagnosis, which of the following investigations would be appropriate to order first line? Select all that may be appropriate options.
B-type natriuretic peptide
Stem 1 of 4
A 59 year old patient presents to his GP lucidly, with acute shortness of breath, productive cough and pain accentuated in inhalation. His resp rate is raised and he is pyrexic, but other vitals are within normal limits.
A CXR shows pulmonary infiltrates and pleural effusion unilaterally. What is the best matched differential?
Acute coronary syndrome
Community acquired pneumonia
Hospital acquired pneumonia
Small-cell lung cancer
Stem 2 of 4The patient has no known medical history or concerning exposures. Which is the most likely causative organism?
Stem 3 of 4Using a NICE-approved calculation, how would you arrange care for this patient?
Call ambulance for <1 hour transfer to hospital
Call ambulance for 3 hour transfer to hospital
Reassure with no treatment needed
Treat in the community with PO antibiotics
Urgent referral for outpatient chest X-ray
Stem 4 of 4What is the first line medication for this patient?
Coamoxiclav + clarithromycin
Stem 1 of 2
A 22YOF presents to the ED short of breath acutely with pleuritic, focal chest pain. She has no notable history, medical or drug history and has never been to a Doctor before.
Given her demography, and history, a CXR is performed and is clear. What is the best-matched differential?
Stem 2 of 2What would be the next best step?
Naproxen with omeprazole