There’s a tickle in your throat? I’m reading these words in medical school? Oh then you MUST be on ACEi mate … every good medical student knows that the number one differential of cough on med school stems is ramipril … or IS it????
Approach to the Patient with Cough - Part One
Stem 1 of 4
A 72YOM presents with chronic cough. He has a 45 year pack history for cigarettes (high tar) and keeps “getting an annoying tickle in the throat”. His cough is productive.
What colour is classical of the chronic cough, given the most likely diagnosis?
Stem 2 of 4Due to this diagnosis, which vaccinations must be prioritised in this demography?
Hepatitis B virus
Hepatitis C virus
Stem 3 of 4Of the listed risk factors, which have the strongest published link to COPD?
Stem 4 of 4The grouping is classified as GOLD group A. What is the first line therapy for his classification?
Stem 1 of 4
A 60YOF presents with dyspnoea. She has a known diagnosis of heart failure. On examination, she is hypertensive, tachycardic with added heart sounds and 7cm JVP elevation. Bilateral ankle oedema is noted.
What should be the height of the pulsations seen in the internal jugular vein?
>2cm above the sternal angle
>3cm above the sternal angle
>4cm above the sternal angle
>12cm above the xiphisternum
> 15cm above the xiphisternum
Stem 2 of 4Select all of the following that would be a first line investigation in this patient.
Stem 3 of 4An ECG is performed and compared to a years previous. New Q waves are discovered. What could, therefore, have been the trigger for this exacerbation?
First degree heart block
Mobitz I heart block
Mobitz II heart block
Stem 4 of 4What is the first line management of this patient?
Stem 1 of 4
A 40YOM presents with a longstanding history of chronic, non-productive cough and irritable sensation at the back of the throat. General examination is otherwise normal.
How does NICE define a “chronic cough”?
Stem 2 of 4What else would form key differentials to a chronic cough presentation?
Foreign body inhalation
Gastro-oesophageal reflux disease
Stem 3 of 4According to the NICE criteria, which of the following vignettes would suggest a patient requiring emergent admission to hospital due to cough?
Respiratory rate of 27 with a cough
Tachycardia of 100 with a cough
Systolic blood pressure of 100 with a cough
Oxygenation of 91% with a cough
PEFR 60% expected
Stem 4 of 4Which medication listed below would be both diagnostic, and therapeutic, in this patient?
Decongestant therapy (eg nasal)
First generation antihistamine
Second generation antihistamine
Stem 1 of 6
A 61 year old patient, with hyperlipidaemia and controlled primary hypertension, is brought to ED by his wife (July 2020). He has a dry cough, high subjective fever and anosmia. His vitals are as follows:
T39ºC ; HR122 ; RR21 ; PaO2 89% ; GCS15 ; SBP120 ;
What are the four cardinal diagnostic factors for COVID19?
Shortness of breath
Stem 2 of 6A chest X-ray is undertaken, and blood is drawn. What are the most likely imaging findings?
Bilateral lung infiltrate
Clear lung fields
Stem 3 of 6RT-PCR of the nasopharynx is undertaken and negative. What is the next best step?
Adopt watch and wait approach
Culture and sensitivity for other cause
Order a high resolution CT thorax
Repeat RT-PCR due to clinical picture
Undertake rapid antigen testing
Stem 4 of 6The patient continues to deteriorate and, amongst other tests, a coagulation study is performed. Which of the following might you suspect of serious disease?
Elevated fibrin-degradation products
Stem 5 of 6The patient is aggressively treated in hospital. Amongst a cocktail of medications, enoxaparin is given. What is the mechanism of this medication?
Antithrombin three activator
Direct factor ten inhibitor
Direct factor two inhibitor
Cofactor (V, VIII) inhibitor
Tissue plasminogen activator
Stem 6 of 6The patient recovers and is discharged home 10 days after the initial diagnosis. How many more days must he self-isolate for?
- BMJ Best Practice – http://bestpractice.bmj.com
- Churchill Pocketbook of Differential Diagnoses, 4th Ed 2014
- Geeky Medics – https://geekymedics.com/jugular-venous-pressure-jvp/
- NICE CKS Cough – https://cks.nice.org.uk/topics/cough/
- Oxford Handbook of Clinical Medicine – 10th Ed 2017