Ten-minute consult

1. A 58-year-old woman with diabetes attends after 40 minutes of severe central chest pain. A 12-lead ECG is described as follows: sinus rhythm 88 bpm; ST-segment elevation of 3 mm in V2, V3 and V4; reciprocal ST depression in leads II, III and aVF; no Q waves yet. What is the most appropriate interpretation and next step?

2. A 52-year-old man has clinic blood pressure 158/96 mmHg on two occasions, no target-organ damage, QRISK3 8%. He is not diabetic. What is the most appropriate next step? Select TWO correct statements.

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3. A 71-year-old man with HFrEF (ejection fraction 32%) is on bisoprolol 10 mg, ramipril 10 mg and spironolactone 25 mg. eGFR 58 mL/min/1.73 m², potassium 4.4 mmol/L, no type 2 diabetes. He remains NYHA class II. What additional disease-modifying therapy should be offered if no contraindication?

4. A 72-year-old man with COPD (FEV1 45% predicted) presents in January with 3 days of increased dyspnoea, wheeze and a small increase in sputum volume. Sputum remains mucoid (not purulent). Oxygen saturations 93% on air, respiratory rate 22/min, no confusion, no chest-film consolidation last winter with similar episodes. What is the most appropriate first-line oral treatment for this exacerbation? Select TWO correct statements.

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5. A 19-year-old student has twice-weekly wheeze and uses a salbutamol inhaler bought overseas. She has had no inhaled corticosteroid. She is not acutely unwell today. What is the most appropriate prescribing decision? Select TWO correct statements.

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6. A 76-year-old woman with COPD and previous hypercapnic respiratory failure is breathless during a viral winter illness. Oxygen saturations are 86% on air. You have oxygen available in the treatment room while awaiting the ambulance. What target saturation range is most appropriate while giving controlled oxygen? Select TWO correct statements.

Select all that apply.

7. A 22-year-old tall slim man has sudden unilateral chest pain and mild dyspnoea after stretching. Oxygen saturations 97% on air, heart rate 88 bpm. You suspect primary spontaneous pneumothorax. What is the most appropriate next step? The most appropriate action is: Same-day chest X-ray (or emergency assessment) rather than treating as musculoskeletal pain

8. A 69-year-old man with COPD has an exacerbation with frankly purulent green sputum, increased volume and dyspnoea. He is not systemically septic. No penicillin allergy. Local guidance follows NICE. What is the most appropriate antibiotic decision?

9. A 54-year-old man has low-severity community-acquired pneumonia (CRB65 0), no comorbidity, no penicillin allergy. He will be treated at home with safety-netting. What is the most appropriate first-line antibiotic if local resistance patterns allow? The most appropriate action is: Amoxicillin 500 mg three times daily for 5 days

10. A 46-year-old man describes the worst headache of his life, peaking within seconds while lifting a crate. He is now photophobic with a stiff neck. Neurological examination is otherwise normal. What is the most appropriate action?