InnovAiT 2008 1(1):48; doi:10.1093/innovait/inm017
© The Author 2008. Published by Oxford University Press on behalf of the RCGP. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.
Applied Knowledge Test (AKT) on cardiovascular disease
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Option List
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 TOP
 Option List
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- A. Reassure and do nothing
- B. Dial 999 for emergency ambulance
- C. Check the D Dimer
- D. Check Troponin T
- E. Prescribe aspirin 75mg daily
- F. Send for a chest x-ray
- G. Prescribe an antacid
- H. Arrange an abdominal ultrasound scan
- I. Refer to the rapid access chest pain clinic
Instruction
For each patient select the single most appropriate management plan from the above list of options. Select ONE answer only. Each option may be used once, more than once, or not at all
- A 43 year old woman presents with an episode of severe pain in her upper abdomen of one hour 's duration and one vomit. She has had three previous episodes, one of which woke her at night and lasted for two hour ’s. She is now asymptomatic. She has tenderness on inspiration in her right upper quadrant.
- A 48 year old sales manager with no medical history presents following a medical by a private insurer. The examining doctor was concerned about his left-sided chest pain which came on at variable times, was sharp in quality and which the patient associated with stress. A full biochemical screen and ECG at the medical were normal.
- A 70 year old patient telephones to tell you that he has had severe retrosternal pain for 30 minutes and has vomited once. His wife has told him that he looks dreadful.
- A 25 year old woman presents with right-sided chest pain which has occurred in conjunction with an URTI. Clinically she is normotensive with a pulse rate of 90 regular, some chest wall tenderness and reproduction of pain on thoracic spine rotation. She takes the contraceptive pill.
- A 40 year old police cadet was thumped in the ribs during unarmed combat training three days before. He has left-sided chest pain worse on breathing and moving but has been able to work. Apart from rib tenderness clinical examination is unremarkable, he is normotensive and his oxygen saturations are 98% on air.
- A 43 year old labourer presents with a short episode of severe thoracic spine pain earlier in the day which settled after 40 minutes or so. He had a previous episode the week before. On examination he looks well, BP 90/60, pulse 100 regularly and he has a soft early diastolic murmur.
- A 58 year old French teacher has a persistent cough and a niggling right-sided chest pain. She smoked 20 cigarettes a day until 3 years ago.
- Arthur – an 80 year old Type 11 diabetic has tightness in his chest which occurs on walking 100 yards on the flat or on emotion – especially after eating. He has not experienced the pain at rest and when he stops it settles after 5–6 minutes.
For more AKT questions on this subject please visit www.rcgp-innovait@oxfordjournals.org
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