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WorksheetsChest pain and breathlessness roundup
Total questions: 12
Worksheet time: 24mins
A 64 year old woman presents with acute severe chest pain. She has ST elevation in the anterior chest leads on ECG and a significantly raised troponin. BP is 76/38 mmHg.
What is the most likely cause of hypotension in this patient?
Antihypertensives
Cardiogenic shock
Postural hypotension
Pulmonary embolus
Sepsis
A 70 year old man presents with recent onset breathlessness, pleuritic chest pain, and a productive cough. On examination of the chest there are crackles in the left lower zone and he has SpO2 92%.
What is the most likely diagnosis?
Community acquired pneumonia
Exacerbation of COPD
Pneumothorax
Pulmonary embolus
Upper respiratory tract infection
The F1 on your base ward asks you to interpret the following arterial blood gas, the patient is not on supplementary oxygen.
pH 7.32 (7.35 - 7.45)
PaO2 7.9 (>11)
PaCO2 6.9 (4.5 - 6.0)
HCO3 34 (21 - 29)
Base excess +4 (-3 - +3)
Metabolic acidosis with partial compensation and type 1 respiratory failure
Metabolic acidosis with partial compensation and type 2 respiratory failure
Respiratory acidosis with partial compensation and type 1 respiratory failure
Respiratory acidosis with partial compensation and type 2 respiratory failure
When examining a patient who presented with chest pain and breathlessness on exertion you detect a slow rising pulse. BP is 108/88 mmHg.
What are you most likely to hear on auscultation of their precordium?
Early diastolic decrescendo murmur
Ejection systolic murmur
Normal heart sounds
Pansystolic murmur
Pericardial friction rub
What is the rhythm?
Asystole
Atrial fibrillation
Supraventricular tachycardia
Ventricular fibrillation
Ventricular tachycardia
When examining a patient you find they have reduced chest expansion on the left with hyper-resonant percussion notes and quiet breath sounds.
What is the most likely cause of the clinical findings?
Consolidation
Lobar collapse
Pleural effusion
Pneumothorax
Pulmonary oedema
Which of the following is most associated with higher mortality in community acquired pneumonia?
Age 62 years
CRP 180 (normal <5)
Lobar consolidation on CXR
Pulse 94 bpm
Urea 9.6 (normal 2.5 - 7.8)
A 74 year old man presents with acute breathlessness. On examination he looks unwell, pale, is cool to touch, and has crackles throughout the lung fields. Pulse 104, BP 112/74, SpO2 91% (air), RR 28, temperature 36.8.
FBC is within normal range, other blood tests are pending.
What is the most likely reason for the clinical findings?
Acute heart failure
Anaemia
Community acquired pneumonia
Pneumothorax
Pulmonary embolus
A 54 year old woman presents with a few months' history of breathless and persistent cough which is usually non-productive. She has not had haemoptysis. She is a smoker. Examination of the respiratory system is normal except for clubbing.
What step should the GP take first?
2 week wait cancer referral
Start on bronchodilator and inhaled steroid
Routine chest X-Ray
Urgent chest X-Ray within 2 weeks
7 day course of doxycycline
A 68 year old man with hypertension presents following a third episode of losing consciousness shortly after standing. He feels 'lightheaded' and has tunnelled vision before he blacks out, is out for 10-30 seconds, and makes a quick recovery. DH: Ramipril, atorvastatin and aspirin.
What is the most likely cause of his symptoms?
Aortic stenosis
Arrhythmia
Medication
Micturition syncope
Seizure
On standard ECG paper, how long is represented by one large square?
0.04 ms
0.04 s
0.2 ms
0.2 s
How long is a normal QRS complex?
<0.12 ms
<0.12 s
<0.15 ms
<0.15 s
